Complete Atrioventricular Block Smartwatch Enhanced Diagnosis in Lyme’s Carditis: A Case Report and an M-Health Utilization

Function-limiting arthropathy is an uncommon toxicity of immune checkpoint inhibitor therapy. We analyzed the clinical features and outcome of this toxicity in a series of cancer patients. Patients treated with methotrexate, infliximab, or adalimumab were identified in our patient care database. Individual patient records were reviewed for concomitant checkpoint inhibitor treatment to analyse patient characteristics and clinical outcome. Sixteen patients were identified that met study requirements. Ten patients developed seronegative arthropathy consisting of severe arthralgia's and morning stiffness as a de novo immunologic adverse event. Five patients eventually achieved symptom resolution and five required ongoing treatment. Arthritis-related toxicity caused a treatment delay in 5/10 of these patients, but only one required treatment discontinuation. Six additional patients had pre-existing symptomatic inflammatory arthritis. Four reported flares during treatment, two achieved complete symptom resolution with treatment and two require ongoing therapy. Only one of these six patients had a treatment delay. Median time to onset of arthropathy was 1.3 1.5 months in patients with pre-existing arthritis versus 5.2 10.7 months in patients who developed arthropathy as an adverse event (p=.037). There is relatively little information about function-limiting arthropathy associated with checkpoint inhibitor treatment. Median time to symptoms was significantly shorter in patients with pre-existing arthritis versus those who developed arthropathy due to treatment. Patients with flares of pre-existing arthritis during treatment were more likely to achieve resolution of their symptoms and less likely to have treatment delays than patients who develop de novo arthropathy.