Rheumatic diseases are not only musculoskeletal diseases but also systemic autoimmune conditions. Typically, these diseases are known to affect joints, as well as the nervous system and internal organs. Part of a new study by Johns Hopkins testing two new drugs, ipilimumab and nivolumab, produced a higher than normal risk in patients for developing autoimmune joint and tissue diseases.

In the study, cancer patients were taking either one or both of the two new drugs, ipilimumab and nivolumab, in an effort for testing immunotherapy treatments. During the test, thirteen patients with no previous history with rheumatism, developed at least one of the diseases labeled “rheumatic diseases”, which make up approximately 200 diseases. One of the doctors associated with the study was quoted to saying “I don't think anyone is particularly surprised that rheumatologic disorders might be a complication of drugs that boost the immune system”.

What makes this particular study recently conducted so important is that it produced the largest number of patients who felt ill with rheumatism since the beginning of treatment with these drugs. Ipilimumab, one of the drugs from the study, is used for the approved treatment for melanoma, particularly for patients who have had the disease spread to the lymph nodes. Nivolumab is approved for a wider range of cancer diseases, such as melanoma, lung cancer, and cancer in the immune system. Both of these drugs are checkpoint inhibitors, which can turn off checkpoints in the cancer to allow the immune system to detect and attack the cancer. The link between the drugs and rheumatism is from the increased activity from the immune system, triggering increased autoimmune response, leading to rheumatism.

Due to the evidence of the side effects that can come from the drugs, it is unclear what decisions doctors will make in prescribing these drugs. The risk of developing crippling rheumatic diseases may be worth the benefit in curing specific cancers. Currently, the doctors from this study at Johns Hopkins will be tracking and studying any predispositions or characteristics that may indicate higher risks of developing rheumatic diseases from these drugs.



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