{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:30:33Z","timestamp":1760059833413,"version":"build-2065373602"},"reference-count":31,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2025,7,15]],"date-time":"2025-07-15T00:00:00Z","timestamp":1752537600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000069","name":"NIAMS","doi-asserted-by":"publisher","award":["K23AR079588","R03AG082857"],"award-info":[{"award-number":["K23AR079588","R03AG082857"]}],"id":[{"id":"10.13039\/100000069","id-type":"DOI","asserted-by":"publisher"}]},{"name":"NIA","award":["K23AR079588","R03AG082857"],"award-info":[{"award-number":["K23AR079588","R03AG082857"]}]},{"name":"Spondyloarthritis Research &amp; Treatment Network\u2019s Early Career Investigator Award","award":["K23AR079588","R03AG082857"],"award-info":[{"award-number":["K23AR079588","R03AG082857"]}]},{"name":"Spondylitis Association of America Jane Bruckel Early Career Investigator Award","award":["K23AR079588","R03AG082857"],"award-info":[{"award-number":["K23AR079588","R03AG082857"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background: Immune checkpoint inhibitors (ICIs) transformed cancer treatment, producing significant survival benefits. However, ICIs can trigger toxicities called immune-related adverse events (irAEs), including inflammatory arthritis (IA) and polymyalgia rheumatica (PMR)-like syndromes. Our study aimed to systematically further characterize musculoskeletal ultrasound (MSKUS) findings in patients with ICI-IA and ICI-PMR, collectively referred to as \u201cMSK-irAEs\u201d, and explore the role of US in guiding treatment. Methods: The authors conducted a comprehensive chart review for patients receiving ICIs undergoing MSKUS at our center\u2019s rheumatology clinics. US examinations were performed and reviewed by two MSKUS-certified rheumatologists. Descriptive statistics were performed to summarize demographic, clinical, and treatment-related variables. US findings were categorized with a novel scoring system: 0\u2014no signs of inflammatory arthropathy or tendinopathy, 1\u2014potential signs of inflammation (grayscale \u2265 2, effusion without power Doppler, synovial hypertrophy in the joint), and 2\u2014active inflammation in joints and\/or tendons (characterized by power Doppler) and signs of inflammation. Results: Twenty-three patients were included. The median age was 63 years, 52% were male, and 87% were White. Melanoma was the most common cancer (48%). MSK-irAEs were diagnosed in nineteen (83%), with MSKUS showing inflammation in seventeen (74%). Sixteen (70%) received escalation in MSK-irAE treatment after MSKUS. Four (17%) had erosive disease due to MSK-irAEs, while one had erosive osteoarthritis. Individuals with inflammatory erosive changes experienced prolonged intervals between symptom onset and MSKUS, ranging from 17 to 82 months, suggesting that erosions may reflect chronic, under-recognized inflammation. On MSK-irAE therapy, nine (47%) experienced symptomatic improvement, five (26%) achieved resolution, and in four (21%) cases, it was too early to assess the response. MSKUS detected other causes of MSK symptoms besides MSK-irAEs in several patients, allowing ICI resumption in one. Conclusions: Our study highlights the clinical utility of MSKUS not only as a diagnostic tool but also to guide therapeutic decision-making.<\/jats:p>","DOI":"10.3390\/cancers17142344","type":"journal-article","created":{"date-parts":[[2025,7,15]],"date-time":"2025-07-15T11:52:58Z","timestamp":1752580378000},"page":"2344","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Sonographic Signatures of Immune Checkpoint Inhibitor-Associated Musculoskeletal Adverse Events"],"prefix":"10.3390","volume":"17","author":[{"given":"Hans Vitzthum","family":"von Eckstaedt","sequence":"first","affiliation":[{"name":"Division of Rheumatology, University of Washington, Seattle, WA 98195, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kevin","family":"Weng","sequence":"additional","affiliation":[{"name":"School of Public Health, University of Washington, Seattle, WA 98195, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ingeborg","family":"Sacksen","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, University of Washington, Seattle, WA 98195, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0355-4020","authenticated-orcid":false,"given":"Rachael","family":"Stovall","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, University of Washington, Seattle, WA 98195, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3965-3394","authenticated-orcid":false,"given":"Petros","family":"Grivas","sequence":"additional","affiliation":[{"name":"Division of Hematology-Oncology, University of Washington, Seattle, WA 98109, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shailender","family":"Bhatia","sequence":"additional","affiliation":[{"name":"Division of Hematology-Oncology, University of Washington, Seattle, WA 98109, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0305-7745","authenticated-orcid":false,"given":"Evan","family":"Hall","sequence":"additional","affiliation":[{"name":"Division of Hematology-Oncology, University of Washington, Seattle, WA 98109, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Scott","family":"Pollock","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, University of Washington, Seattle, WA 98195, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7149-363X","authenticated-orcid":false,"given":"Namrata","family":"Singh","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, University of Washington, Seattle, WA 98195, USA"},{"name":"Department of Epidemiology, University of Washington, Seattle, WA 98195, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,7,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1093\/annonc\/mdx686","article-title":"Mechanistic Overview of Immune Checkpoints to Support the Rational Design of Their Combinations in Cancer Immunotherapy","volume":"29","author":"Rotte","year":"2018","journal-title":"Ann. 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