{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T21:58:53Z","timestamp":1790805533758,"version":"4.1.0"},"reference-count":35,"publisher":"BMJ","issue":"4","license":[{"start":{"date-parts":[[2025,10,5]],"date-time":"2025-10-05T00:00:00Z","timestamp":1759622400000},"content-version":"unspecified","delay-in-days":4,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["RMD Open"],"accepted":{"date-parts":[[2025,9,2]]},"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To explore the prevalence and distribution of ultrasound-detected inflammation and structural damage in the joints, tendons and entheses of patients who developed new-onset arthritis or arthralgia following exposure to immune checkpoint inhibitor (ICI) therapy, including a comparison between those with ICI-induced arthritis and those with ICI-induced arthralgia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Patients with cancer who developed clinical arthritis or arthralgia (ie, joint pain without clinical synovitis) after receiving ICIs were consecutively recruited from six international centres. Patients underwent a full clinical assessment and ultrasound evaluation of 18 joints, 15 tendons and 5 entheses bilaterally, using the Outcome Measures in Rheumatology definitions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 101 patients were included: 53 (52.5%) had ICI-arthralgia (absent clinical synovitis). Among them, 25 (47.2%) had ultrasound-detected subclinical synovitis, 10 (18.9%) tenosynovitis, 1 (1.9%) digital extensor peritendinitis and 13 (24.5%) enthesitis. In the 48 patients with ICI-arthritis, ultrasound-detected synovitis was more prevalent than in ICI-arthralgia (93.8% vs 47.2%, p&lt;0.001), particularly in the wrists (56.3% vs 20.8%, p&lt;0.001) and the knees (54.2% vs 13.2%, p&lt;0.001), which were the most frequently affected joints. Tenosynovitis (52.1% vs 18.9%, p&lt;0.001), peritendinitis (10.4% vs 1.9%, p=0.099) and bone erosions (25% vs 7.5%, p=0.027) were also more frequent in ICI-arthritis. \u2018Active\u2019 enthesitis was similar between groups (31.3% vs 24.5%), with no significant differences.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This multicentre study reveals a higher burden of ultrasound-detected changes in ICI-arthritis compared with ICI-arthralgia, with diverse patterns across joints, tendons and entheses in both subtypes. Significant subclinical inflammation suggests that many cases of non-specific ICI-arthralgia may benefit from targeted interventions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/rmdopen-2025-005879","type":"journal-article","created":{"date-parts":[[2025,10,6]],"date-time":"2025-10-06T06:35:20Z","timestamp":1759732520000},"page":"e005879","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Ultrasound-detected inflammation and structural changes in the joints, tendons and entheses of patients with cancer who developed arthritis or arthralgia after exposure to immune checkpoint inhibitors"],"prefix":"10.1136","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0867-7051","authenticated-orcid":false,"given":"Andrea","family":"Di Matteo","sequence":"first","affiliation":[{"name":"Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK"},{"name":"Department of Rheumatology, Leeds Teaching Hospital NHS Trust, Leeds, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4699-1498","authenticated-orcid":false,"given":"Kate","family":"Harnden","sequence":"additional","affiliation":[{"name":"Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK"},{"name":"Department of Rheumatology, Leeds Teaching Hospital NHS Trust, Leeds, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sana","family":"Sharrack","sequence":"additional","affiliation":[{"name":"Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK"},{"name":"Department of Rheumatology, Leeds Teaching Hospital NHS Trust, Leeds, UK"},{"name":"NIHR Leeds Musculoskeletal Biomedical Research Unit, LIRMM, Leeds, UK"},{"name":"Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kerem","family":"Abacar","sequence":"additional","affiliation":[{"name":"Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Didem","family":"Sahin","sequence":"additional","affiliation":[{"name":"Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tadashi","family":"Okano","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine School of Medicine, Osaka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rudolf","family":"Horvath","sequence":"additional","affiliation":[{"name":"Department of Paediatric and Adult Rheumatology, Motol University Hospital, Prague, Czech Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1139-539X","authenticated-orcid":false,"given":"Jana","family":"Hurnakova","sequence":"additional","affiliation":[{"name":"Department of Paediatric and Adult Rheumatology, Motol University Hospital, Prague, Czech Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5193-2284","authenticated-orcid":false,"given":"Paraskevi V","family":"Voulgari","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, School of Health Sciences, University of Ioannina Faculty of Medicine, Ioannina, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melina","family":"Yerolatsite","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, University of Ioannina Faculty of Medicine, Ioannina, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan Jos\u00e9","family":"de Agust\u00edn","sequence":"additional","affiliation":[{"name":"Rheumatology Unit, Hospital Universitari Vall d\u2019Hebron, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ernesto","family":"Trallero-Aragu\u00e1s","sequence":"additional","affiliation":[{"name":"Rheumatology Unit, Hospital Universitari Vall d\u2019Hebron, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luca","family":"Di Geso","sequence":"additional","affiliation":[{"name":"Internal Medicine, Ospedale Provinciale Madonna del Soccorso, San Benedetto del Tronto, Marche, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5352-8683","authenticated-orcid":false,"given":"Richard J","family":"Wakefield","sequence":"additional","affiliation":[{"name":"Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK"},{"name":"Department of Rheumatology, Leeds Teaching Hospital NHS Trust, Leeds, UK"},{"name":"NIHR Leeds Musculoskeletal Biomedical Research Unit, LIRMM, Leeds, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7251-7784","authenticated-orcid":false,"given":"Emilio","family":"Filippucci","sequence":"additional","affiliation":[{"name":"Clinica Reumatologica, Universita Politecnica delle Marche, Jesi, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7429-8482","authenticated-orcid":false,"given":"Paul","family":"Emery","sequence":"additional","affiliation":[{"name":"Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK"},{"name":"Department of Rheumatology, Leeds Teaching Hospital NHS Trust, Leeds, UK"},{"name":"NIHR Leeds Musculoskeletal Biomedical Research Unit, LIRMM, Leeds, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kulveer","family":"Mankia","sequence":"additional","affiliation":[{"name":"Leeds 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Whole-body mri reveals distinct imaging phenotypes in patients with arthralgia or inflammatory arthritis after exposure to immune checkpoint inhibitors. 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