Gout presenting as a chronic inflammatory arthritis from immune checkpoint inhibitors: case series
Kevin Lee, Shokrollah Elahi, Siavash Mashhouri, Carrie Ye
Abstract
Dear Editor, as a consequence of immune checkpoint blockade, there is the risk of eliciting undue hyperimmune activation or autoimmune responses. The safety of immune checkpoint inhibitors (ICIs) has been of concern and several toxic episodes termed immune-related adverse events (irAEs) have been described. Inflammatory arthritis (ir-IA) is one of the described irAEs following ICI therapy [1]. Although there is a case report of pseudogout [2], no cases of increased gout activity following ICI have been described. Using descriptive statistics and CARE reporting guidelines [3], we present the first eight cases of atypical gout flares after ICI. Symptoms were similar to chronic ir-IA with prolonged mono- or oligo-arthritic pain and swelling but confirmed to be gout by synovial fluid analysis, imaging or presence of podagra with response to allopurinol or colchicine; addition of DMARD was sometimes necessary. Eight male adults, aged 48–77 years,...