First use of tofacitinib to treat an immune checkpoint inhibitor-induced arthritis

BMJ Case Rep. 2021 Feb 4;14(2):e238851. doi: 10.1136/bcr-2020-238851.


Immune checkpoint inhibitors have revolutionised cancer treatment; however, immune-related adverse events do occur, with up to 7% developing inflammatory arthritis. Common rheumatoid arthritis therapies such as methotrexate, prednisolone and biologics have been used to treat this arthritis in small, uncontrolled case series with varying success. In this case of personalised medicine, we report the first use of tofacitinib, a small molecular inhibitor of the Janus kinase-signal transducer and activator of transcription pathway, to treat checkpoint inhibitor-related inflammatory arthritis. This resulted in a rapid clinical response and complete, sustained remission of the arthritis with associated marked reduction in synovial molecular and cellular immune response.

Keywords: drugs: musculoskeletal and joint diseases; malignant disease and immunosuppression.

Publication types

  • Case Reports

MeSH terms

  • Arthritis, Rheumatoid / drug therapy*
  • Arthritis, Rheumatoid / pathology
  • Humans
  • Immune Checkpoint Inhibitors*
  • Lung Neoplasms
  • Male
  • Middle Aged
  • Piperidines / therapeutic use*
  • Precision Medicine
  • Protein Kinase Inhibitors / therapeutic use*
  • Pyrimidines / therapeutic use*


  • Immune Checkpoint Inhibitors
  • Piperidines
  • Protein Kinase Inhibitors
  • Pyrimidines
  • tofacitinib