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JAMA Oncology Clinical Challenge
September 26, 2019

Erosive Deforming Inflammatory Arthritis in a Patient With Cervical Adenocarcinoma

Author Affiliations
  • 1Office of the Clinical Director, Intramural Research Program, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland
  • 2Laboratory of Tumor Immunology and Biology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
JAMA Oncol. 2019;5(11):1628-1629. doi:10.1001/jamaoncol.2019.3140

A 58-year-old white woman with history of metastatic human papillomavirus–positive cervical adenocarcinoma presented with multiple joint deformities. Her initial symptoms started 1 month after the initiation of nivolumab, which was 1 year prior to the index visit. Treatment with nonsteroidal anti-inflammatory drugs failed, and the patient had a partial response to intra-articular steroids. She refused systemic therapies owing to concern about diminishing the effectiveness of nivolumab. Despite the joint symptoms, nivolumab treatment was continued for a year. Evaluation showed fixed swan neck deformities in multiple fingers (Figure, A). There was evidence of chronic synovial hypertrophy with no active synovitis on examination. The results of a comprehensive autoantibody blood panel, including antinuclear antibody, rheumatoid factor, and anti-citrullinated peptide antibody, were unremarkable. Plain radiographs of the hands demonstrated diffuse osteopenia, joint space narrowing, and multiple deformities. Magnetic resonance imaging of both hands revealed multifocal osseous erosions (Figure, B), synovitis, and tenosynovitis.

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