Evidence map›Paper›PMID 32327425›Full record

GuidelineAnnals of the rheumatic diseases2021

EULAR points to consider for the diagnosis and management of rheumatic immune-related adverse events due to cancer immunotherapy with checkpoint inhibitors.

Marie Kostine, Axel Finckh, Clifton O Bingham, Karen Visser, Jan Leipe, Hendrik Schulze-Koops, Ernest H Choy, Karolina Benesova, Timothy R D J Radstake, Andrew P Cope and 13 more

Open access · bronzeAbstract readConsensus StatementPractice Guideline
PubMed Full text at PMC Publisher
In one paragraph

Guideline in Annals of the rheumatic diseases, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 138 papers, 5 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
138citing papers in PubMed, 5 pooled it
12.7field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

138 citing papers in PubMed, 5 syntheses or guidelines pooled it, 263 citations in OpenAlex.

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  13. Treatment-related pain in refractory cancer pain: prevalence, mechanisms, and clinical implications in a tertiary referral cohort.Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2026
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  17. Pain spectrum in immune checkpoint inhibitor-related adverse events: evolution, characteristics and management challenges based on bibliometrics.Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2026
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78 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

23 authors at 19 institutions in 8 countries.

Marie KostineRheumatology, University Hospital of Bordeaux, Bordeaux, France marie.kostine@chu-bordeaux.fr.ORCID 0000-0002-6729-6200
Axel FinckhDivision of Rheumatology, University Hospital of Geneva, Geneva, Switzerland.ORCID 0000-0002-1210-4347
Clifton O BinghamRheumatology, Johns Hopkins University, Baltimore, Maryland, USA.
Karen VisserRheumatology, Haga Hospital, Den Haag, The Netherlands.
Jan LeipeDepartment of Medicine V, Division of Rheumatology, University Hospital Centre, Mannheim, Germany.
Hendrik Schulze-KoopsDepartment of Internal Medicine IV, Division of Rheumatology and Clinical Immunology, University of Munich, Munich, Germany.
Ernest H ChoyInstitute of Infection and Immunity, Cardiff University School of Medicine, Cardiff, UK.
Karolina BenesovaRheumatology, University Hospital Heidelberg, Heidelberg, Germany.
Timothy R D J RadstakeRheumatology and Clinical Immunology, Utrecht Medical Center, Utrecht, The Netherlands.
Andrew P CopeAcademic Department of Rheumatology, King's College London, London, UK.
Olivier LambotteInternal Medicine and Clinical Immunology, Hopital Bicetre, Le Kremlin-Bicetre, France.
Jacques-Eric GottenbergRheumatology, University Hospital of Strasbourg, Strasbourg, France.ORCID 0000-0002-9469-946X
Yves AllenbachInternal Medicine and Clinical Immunology, Sorbonne Université, Pitié-Salpêtrière University Hospital, Paris, France.ORCID 0000-0002-3185-7993
Marianne VisserEULAR PARE Patient Research Partners, Amsterdam, The Netherlands.
Cindy RusthovenEULAR PARE Patient Research Partners, Amsterdam, The Netherlands.
Lone ThomasenAarhus University Hospital, Aarhus, Denmark.
Shahin JamalRheumatology, The University of British Columbia, Vancouver, British Columbia, Canada.
Aurélien MarabelleDrug Development, Gustave Roussy Cancer Center, Villejuif, France.
James LarkinRoyal Marsden Hospital NHS Foundation Trust, London, UK.
John B A G HaanenThe Netherlands Cancer Institute, Amsterdam, Noord-Holland, The Netherlands.
Leonard H CalabreseImmunology and Rheumatology, Cleveland Clinic, Cleveland, Ohio, USA.ORCID 0000-0002-1789-4923
Xavier MarietteRheumatology, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux universitaires Paris-Sud - Hôpital Bicêtre, Le Kremlin Bicêtre, France.
Thierry SchaeverbekeRheumatology, University Hospital of Bordeaux, Bordeaux, France.
Heidelberg University · DEUniversité de Bordeaux · FRAarhus University Hospital · DKBicêtre Hospital · FRCardiff University · GBCleveland Clinic · USHaga Hospital · NLInstitut Gustave Roussy · FRJohns Hopkins University · USKing's College London · GBLudwig-Maximilians-Universität München · DERoyal Marsden NHS Foundation Trust · GBSorbonne Université · FRThe Netherlands Cancer Institute · NLUniversité de Strasbourg · FRUniversité Paris-Sud · FRUniversity Hospital of Geneva · CHUniversity Medical Center Utrecht · NLUniversity of British Columbia · CA

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundRheumatic and musculoskeletal immune-related adverse events (irAEs) are observed in about 10% of patients with cancer receiving checkpoint inhibitors (CPIs). Given the recent emergence of these events and the lack of guidance for rheumatologists addressing them, a European League Against Rheumatism task force was convened to harmonise expert opinion regarding their identification and management.

methodsFirst, the group formulated research questions for a systematic literature review. Then, based on literature and using a consensus procedure, 4 overarching principles and 10 points to consider were developed.

resultsThe overarching principles defined the role of rheumatologists in the management of irAEs, highlighting the shared decision-making process between patients, oncologists and rheumatologists. The points to consider inform rheumatologists on the wide spectrum of musculoskeletal irAEs, not fulfilling usual classification criteria of rheumatic diseases, and their differential diagnoses. Early referral and facilitated access to rheumatologist are recommended, to document the target organ inflammation. Regarding therapeutic, three treatment escalations were defined: (1) local/systemic glucocorticoids if symptoms are not controlled by symptomatic treatment, then tapered to the lowest efficient dose, (2) conventional synthetic disease-modifying antirheumatic drugs, in case of inadequate response to glucocorticoids or for steroid sparing and (3) biological disease-modifying antirheumatic drugs, for severe or refractory irAEs. A warning has been made on severe myositis, a life-threatening situation, requiring high dose of glucocorticoids and close monitoring. For patients with pre-existing rheumatic disease, baseline immunosuppressive regimen should be kept at the lowest efficient dose before starting immunotherapies.

conclusionThese statements provide guidance on diagnosis and management of rheumatic irAEs and aim to support future international collaborations.

Indexed as

Advisory CommitteesAnalgesicsAnti-Inflammatory Agents, Non-SteroidalAntirheumatic AgentsArthralgiaArthritis, PsoriaticArthritis, ReactiveAutoantibodiesDecision Making, SharedDeprescriptionsEuropeGlucocorticoidsHumansImmune Checkpoint InhibitorsImmunoglobulins, IntravenousImmunologic FactorsAnalgesicsAnti-Inflammatory Agents, Non-SteroidalAntirheumatic AgentsAutoantibodiesGlucocorticoidsImmune Checkpoint InhibitorsImmunoglobulins, IntravenousImmunologic FactorsMethotrexateTumor Necrosis Factor Inhibitorsarthritisautoimmunityinflammationmultidisciplinary team caretreatment

Identifiers

PMID32327425
PMCPMC7788064
OpenAlexW3018517995

What Socratic holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.