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Case Report Open Access

Optimizing management of immune checkpoint inhibitor‑induced inflammatory arthritis: A case series and literature review

  • Authors:
    • Yuanyuan Wang
    • Yingmei Wen
    • Jinxiong Xia
    • Hongyan Feng
    • Fei Wu
    • Dafu Ye
    • Yanjun Gao
    • Qingqing Li
    • Yi Yao
  • View Affiliations / Copyright

    Affiliations: Cancer Center, Renmin Hospital of Wuhan University, Wuhan, Hubei 430065, P.R. China, Positron Emission Tomography‑Computed Tomography/Magnetic Resonance Imaging Center, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China, Department of Orthopedic Surgery, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
    Copyright: © Wang et al. This is an open access article distributed under the terms of Creative Commons Attribution License.
  • Article Number: 201
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    Published online on: May 29, 2026
       https://doi.org/10.3892/etm.2026.13196
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Abstract

Immune checkpoint inhibitors (ICIs) are widely applied in the treatment of various malignant tumors, leading to notable improvements in patient prognosis. However, with their increased use, various immune‑related adverse events (irAEs), including ICI‑induced inflammatory arthritis (ICI‑IA), may develop, affecting clinical evaluation and treatment decisions. The present report presents 3 cases of ICI‑IA and reviews the literature on its clinical features, diagnosis and therapeutic approaches. The first patient, who had been diagnosed with metastatic bladder cancer, developed limb joint pain after undergoing combination therapy involving ICIs and chemotherapy. Laboratory tests showed elevated levels of C‑reactive protein and interleukin (IL)‑6. Bone scintigraphy excluded bone metastasis, and the symptoms of the patient improved following corticosteroid therapy. The second patient had advanced cervical cancer and a history of rheumatoid arthritis. Following multiple cycles of ICI combined with anti‑angiogenic treatment, the patient experienced recurrent joint swelling and pain, accompanied by elevated IL‑6 and IL‑10 levels. Bone scintigraphy excluded bone metastasis, and the symptoms were controlled with corticosteroid therapy. The third patient had advanced lung cancer and developed persistent pain in the shoulders, knees and ankles during immunotherapy. Corticosteroid therapy effectively controlled the symptoms after bone metastases and autoimmune diseases were excluded. These cases illustrate that ICI‑IA is a clinically relevant irAE. Early recognition and management are crucial for improving patient prognosis. A thorough understanding of the pathogenesis of ICI‑IA is essential for optimizing treatment strategies and improving quality of life.
View Figures

Figure 1

Whole-body bone scintigraphy of case
1. The anterior and posterior images show symmetrically increased
radiotracer uptake in multiple bilateral joints, including the
shoulders, wrists, knees and ankles (red arrows), consistent with
immune checkpoint inhibitor-induced inflammatory arthritis. No
focal areas of markedly intense uptake suggestive of bone
metastases are identified. R, right; L, left.

Figure 2

Two whole-body bone scintigraphy
scans with anterior imaging of case 2. (A) First onset of ICI-IA:
Mildly increased tracer uptake is observed in the right anterior
fourth rib, the left pubic region (possibly due to contamination
from a vesicovaginal fistula), right knee and dorsal aspect of
bilateral feet (red arrows). (B) Recurrent ICI-IA: Recurrent
episode demonstrating more extensive polyarticular uptake,
involving the bilateral elbows, wrists, left interphalangeal
joints, right knee and bilateral ankles, with perilesional uptake
and central photopenia in the right hip, consistent with recurrent
ICI-IA (red arrows). To highlight the abnormal joint metabolic
activity, areas of physiological tracer accumulation in the bladder
and tracer leakage at the left elbow have been digitally removed,
resulting in white areas in the images. ICI-IA, immune checkpoint
inhibitor-induced inflammatory arthritis; R, right; L, left.

Figure 3

Magnetic resonance imaging of the
left ankle in case 3. (A) Coronal T2-weighted fat-suppressed image
shows tarsal sinus effusion (red arrow), subcutaneous soft tissue
edema (purple arrow) and tibiotalar joint and bursal effusions
(blue arrow), reflecting widespread intra-articular and
periarticular inflammation. (B) Sagittal post-contrast T1-weighted
fat-suppressed image demonstrates marked enhancement of the
retrocalcaneal bursa (red arrow), indicating active inflammatory
bursitis. (C) Coronal post-contrast T1-weighted fat-suppressed
image reveals enhancement of the flexor tendon sheaths along the
medial ankle (red arrow), consistent with active tenosynovitis. (D)
Axial post-contrast T1-weighted fat-suppressed image shows diffuse
synovial enhancement within the tarsal sinus (red arrow), an early
indicator of inflammatory arthropathy in this region between the
talus and calcaneus.

Figure 4

FDG PET/CT scan of case 3 and
representative fused PET/CT images showing polyarticular and
periarticular FDG uptake, consistent with immune checkpoint
inhibitor-induced inflammatory arthritis. (A) Whole-body
musculoskeletal FDG uptake imaging. (B) Bilateral shoulder joints
and periarticular soft tissues. (C) Bilateral elbow joints. (D)
Bilateral hip joints. (E) Bilateral knees and surrounding soft
tissues, depicting a small amount of joint effusion within the knee
cavities. (F) Bilateral ankle joints and periarticular soft
tissues, showing swelling. In panel A, the red arrows indicate
representative sites of abnormal periarticular FDG uptake. In
panels B-F, the crosses indicate the representative joints/regions
shown on the corresponding fused PET/CT images. FDG,
2-deoxy-2-[18F]fluoro-D-glucose; PET/CT, positron
emission tomography-computed tomography.
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Copy and paste a formatted citation
Spandidos Publications style
Wang Y, Wen Y, Xia J, Feng H, Wu F, Ye D, Gao Y, Li Q and Yao Y: Optimizing management of immune checkpoint inhibitor‑induced inflammatory arthritis: A case series and literature review. Exp Ther Med 32: 201, 2026.
APA
Wang, Y., Wen, Y., Xia, J., Feng, H., Wu, F., Ye, D. ... Yao, Y. (2026). Optimizing management of immune checkpoint inhibitor‑induced inflammatory arthritis: A case series and literature review. Experimental and Therapeutic Medicine, 32, 201. https://doi.org/10.3892/etm.2026.13196
MLA
Wang, Y., Wen, Y., Xia, J., Feng, H., Wu, F., Ye, D., Gao, Y., Li, Q., Yao, Y."Optimizing management of immune checkpoint inhibitor‑induced inflammatory arthritis: A case series and literature review". Experimental and Therapeutic Medicine 32.2 (2026): 201.
Chicago
Wang, Y., Wen, Y., Xia, J., Feng, H., Wu, F., Ye, D., Gao, Y., Li, Q., Yao, Y."Optimizing management of immune checkpoint inhibitor‑induced inflammatory arthritis: A case series and literature review". Experimental and Therapeutic Medicine 32, no. 2 (2026): 201. https://doi.org/10.3892/etm.2026.13196
Copy and paste a formatted citation
x
Spandidos Publications style
Wang Y, Wen Y, Xia J, Feng H, Wu F, Ye D, Gao Y, Li Q and Yao Y: Optimizing management of immune checkpoint inhibitor‑induced inflammatory arthritis: A case series and literature review. Exp Ther Med 32: 201, 2026.
APA
Wang, Y., Wen, Y., Xia, J., Feng, H., Wu, F., Ye, D. ... Yao, Y. (2026). Optimizing management of immune checkpoint inhibitor‑induced inflammatory arthritis: A case series and literature review. Experimental and Therapeutic Medicine, 32, 201. https://doi.org/10.3892/etm.2026.13196
MLA
Wang, Y., Wen, Y., Xia, J., Feng, H., Wu, F., Ye, D., Gao, Y., Li, Q., Yao, Y."Optimizing management of immune checkpoint inhibitor‑induced inflammatory arthritis: A case series and literature review". Experimental and Therapeutic Medicine 32.2 (2026): 201.
Chicago
Wang, Y., Wen, Y., Xia, J., Feng, H., Wu, F., Ye, D., Gao, Y., Li, Q., Yao, Y."Optimizing management of immune checkpoint inhibitor‑induced inflammatory arthritis: A case series and literature review". Experimental and Therapeutic Medicine 32, no. 2 (2026): 201. https://doi.org/10.3892/etm.2026.13196
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