The Canadian Research Group of Rheumatology in Immuno-Oncology
Connecting patients to specialist care. Advancing clinical education and research.
For Patients & Caregivers
Get a referral to a CanRIO clinic
Understand Your Condition
For Healthcare Providers
Earn certificates - Free registration
Education
Research
Investigator Resources (Members Only)
Find a Specialist
CanRIO investigators across Canada have expertise in managing rheumatic immune-related adverse events from cancer immunotherapy.
For Patients: Bring this information to your oncologist or family doctor to request a referral.
For Physicians: Contact clinics directly for consultations on challenging cases.
News from CanRIO
General Updates
View all →
Website Refresh!
Things are looking fresh around here...
New Article Alert! Acrocyanosis after Immunotherapy: A CanRIO Case Series
A new article published by CanRIO members in the Journal of Rheumatology (April 2025) describes 8 new cases of acral digital ischemia associated with ICI. See link for details: https://www.jrheum.org/
Learning Rounds
View all →
Research from CanRIO
View all →Validation of International Classification of Diseases Code–Based Case Definitions of Immune Checkpoint Inhibitor–Associated Inflammatory Arthritis From Administrative Health Data
Objective Immune checkpoint inhibitors (ICIs) for cancer can lead to immune-related adverse events, including ICI-associated inflammatory arthritis (ICI-IA). There are no validated International Classification of Diseases (ICD) code–based case definitions for ICI-IA. Methods We conducted a validation study using the Canadian Research Group of Rheumatology in Immuno-Oncology (CanRIO) database. Rheumatologist-confirmed ICI-IA was the reference standard, defined as new onset of at least one swollen joint on examination or synovitis on imaging following ICI exposure, without another cause or pre-existing IA. We compared ICD-9 (714.x and 696.0) and ICD-10 (M05.x, M06.x, and M07.x) IA diagnostic codes against the reference standard. Seven core case definitions of different combinations of ICD codes from the Physician Claims Database (PCD) and the Discharge Abstract Database were tested. Results were stratified by sex. Sensitivity testing with additional criteria was also evaluated. Results We included 228 patients in the final analysis: 100 with ICI-IA and 128 without ICI-IA. Sensitivity of the tested case definitions ranged from 1.0% to 88.0%, whereas specificity ranged from 86.7% to 100.0%. The case definition with at least one PCD IA code achieved the best balance of sensitivity (88.0%, 95% confidence interval [CI] 81.6%–94.4%) and specificity (86.7%, 95% CI 80.8%–92.6%). Case definition performances were similar between sexes. Additional criteria minimally improved specificity but sacrificed sensitivity. Conclusion ICD code–based case definitions of ICI-IA can accurately detect ICI-IA and can be used to support ICI-IA surveillance and research with administrative health data.
CRA/CanRIO Living Guidelines for Baseline Immunosuppression in Individuals with Preexisting Rheumatic Diseases Initiating Immune Checkpoint Inhibitors. Part 2: Preexisting Systemic Autoimmune Rheumatic Diseases.
Objective: Although immune checkpoint inhibitors (ICIs) are increasingly used in patients with preexisting systemic autoimmune rheumatic diseases (SARDs), a key concern is whether baseline immunosuppression at the start of ICI treatment might negatively affect cancer outcomes. This risk must be carefully weighed against the potential for a SARD flare. The objective of this study was to develop a living guideline that will provide up-to-date guidance on the management of baseline immunosuppression for preexisting SARDs when initiating cancer immunotherapy with ICIs. Methods: The Canadian Research Group of Rheumatology in Immuno-Oncology (CanRIO) formed a multidisciplinary panel composed of rheumatologists, oncologists, researchers, and a patient representative, with methodological support from the Canadian Rheumatology Association (CRA). We completed a systematic literature review to inform this first installment of our living guideline. Using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach, the panel developed recommendations for the management of baseline immunosuppression in individuals with preexisting SARDs. Results: We identified 67 publications that reported on immunosuppression and cancer outcomes by specific preexisting rheumatic diseases, including 36 on preexisting SARD. Eight best practice statements were developed, highlighting the importance of shared decision making between patients and their care team and careful consideration of risk of SARD flare, risk of organ- or life-threatening manifestations, and potential effect of immunosuppression on cancer outcomes. Seven specific recommendations were made, 1 each for preexisting systemic lupus erythematosus, systemic sclerosis, Sjögren disease, myositis, sarcoidosis, vasculitis, and Behçet disease, considering both the available evidence and expert consensus. The general recommendation for preexisting SARDs was to continue baseline immunosuppression, particularly if there are organ- or life-threatening manifestations. Conclusion: This living guideline will provide contemporary baseline immunosuppression recommendations for individuals with cancer and preexisting SARDs when initiating ICI therapy. New recommendations will be added over time and updated, with the latest recommendations, evidence summaries, and Evidence to Decision summaries available through the CRA and CanRIO websites (www.rheum.ca, www.canrio.ca). (PROSPERO registration: CRD42023461024).
Support Our Research
Your donation to the Arthritis Research Committee (ARC) funds CanRIO's research and education programs, advancing care for patients with rheumatic irAEs.
Donate to Support CanRIO
Educational and/or research support from industry partners including:
