Onco-Rheumatology Program

About the Onco-Rheumatology Program

Advances in cancer treatment have led to powerful new therapies, including immune checkpoint inhibitors and aromatase inhibitors. While these treatments can be lifesaving, they can also cause musculoskeletal symptoms, including joint pain and stiffness, joint swelling, and muscle aches.

Working closely with world-class specialists across Mass General Brigham, our rheumatology experts provide comprehensive and individualized care to patients experiencing musculoskeletal symptoms during cancer treatment. Our goal is to minimize disruptions to your cancer treatment while also effectively managing your symptoms.

A Multidisciplinary Team Approach

At the Mass General Onco-Rheumatology Program, we take a collaborative, team-based approach to treatment. Our specialists work closely with experts across multiple fields, including:

• Oncologists
• Dermatologists
• Nephrologists
• Neurologists
• Cardiologists
• Gastroenterologists
• Pulmonologists

We also partner with the Severe Immunotherapy Complications (SIC) team to manage side effects, or toxicities, specifically from immunotherapy.

In addition, our rheumatologists work side-by-side with scientists at the Center for Immunology and Inflammatory Diseases to advance research on immunotherapy-related side effects. Through this partnership, we aim to develop approaches to manage side effects while ensuring immunotherapy remains as effective as possible.

What to Expect from the Onco-Rheumatology Program

If you are experiencing increased musculoskeletal pain after initiation of immunotherapy or other cancer treatment, your oncologist may refer you to be evaluated by our rheumatologists. Our team is highly experienced in caring for patients with rheumatic complications caused by immune checkpoint inhibitors and other cancer treatments. Because there is no single test to confirm these conditions, our rheumatologists take a comprehensive, personalized approach. They will diagnose and manage your condition based on your medical history, symptoms, physical examination, imaging, and blood tests.

Your treatment plan will be tailored to you, considering the extent and severity of your symptoms and their impact on your overall health. Because symptoms can vary over time, most of our patients receive long-term care at Mass General. For those receiving cancer treatment at Mass General Brigham Cancer Institute, we coordinate care with the timing of your follow-up oncology visits whenever possible. If you live outside the area, we can co-manage your care with your local physician while providing periodic follow-ups at Mass General.

Treatments and Services We Provide

We offer therapies to help you manage your symptoms and maintain an active lifestyle during cancer treatment. Common treatment approaches include:

• Nonsteroidal anti-inflammatory drugs, such as topical diclofenac and oral medications like naproxen and ibuprofen
• Steroids (corticosteroids or glucocorticoids), such as prednisone and methylprednisolone. Patients may take these orally or receive them through targeted injections.
• Conventional immunosuppressive medications, which are tailored to reduce the inflammation from rheumatic complications while preserving the anti-cancer effects of immunotherapy.
• Biologic agents, which target specific immune pathways to offer a more precise approach to treatment.

In addition to routine clinic evaluations, we offer the following:

• Musculoskeletal ultrasound — Our specialists use advanced musculoskeletal ultrasound technology to provide real-time, dynamic assessments of joint health. This tool enables precise, ultrasound-guided procedures to provide quick, targeted pain relief.
• Virtual care — We offer ways for patients to interact with our specialists remotely. This includes telemedicine, consisting of convenient electronic visits that include educational resources and a secure online questionnaire. These visits help determine if you need treatment adjustments between in-person appointments. Additionally, our secure online portal, Patient Gateway, makes it easy for you to communicate with your care team, schedule appointments, and access important health information.

Deep Expertise in Research and Clinical Care

Mass General has a strong history of care and research relating to complications of immunotherapy. Our specialists are part of the SIC Service and Clinical-Translational Research Effort, the first multidisciplinary group of its kind consisting of clinicians and researchers that studied immunotherapy-related complications.

Today, we lead a variety of innovative research studies to discover new approaches to diagnosing and managing toxicities of cancer therapy.

Recent and ongoing studies led by our experts include:

• Minna Kohler, MD, RhMSUS, Greg Challener, MD, and Mark Matza, MD, RhMSUS recently published a study “Musculoskeletal Ultrasound Characteristics of Checkpoint Inhibitor-Associated Inflammatory Arthritis” in Seminars in Arthritis and Rheumatism that described typical ultrasound findings and synovial fluid characteristics of patients with musculoskeletal symptoms following immunotherapy.
• Greg Challener, MD, and Minna Kohler, MD, RhMSUS, conducted a study on mortality in patients with underlying autoimmune disease receiving treatment with immune checkpoint inhibitors, demonstrating no difference in mortality between those with underlying autoimmunity and those without. This research was highlighted at a plenary session at the American College of Rheumatology (ACR) 2024 Annual Meeting.
• Greg Challener, MD, Minna Kohler, MD, RhMSUS, and Janeth Yinh, MD, RhMSUS, performed a study evaluating the use of sulfasalazine in patients with immune checkpoint inhibitor-inflammatory arthritis, demonstrating high rates of adverse events, including hypersensitivity reactions. This was presented at the European League of Associations for Rheumatology (EULAR) 2024 conference.

We are also advancing translational research by partnering with the Center for Immunology and Inflammatory Diseases to better understand the mechanisms of immune dysregulation that contribute to these conditions. These efforts aim to develop safer, more effective treatments.

Graduate Assistant

Greg Challener, MD