75 year old female patient with melanoma was treated with pembrolizumab, after 7 months after pembrolizumab stopped the patient has inflamatory arthralgia of the shoulders, hands, knees, ankles, feet. she has swelling of the feet and ankles, and claw like hands, she has no pain when metacarpofalangeal and interfalangial joints are squeezed. she has high esr and high pcr, anemia Hb 10.5g/dl, and thrombocitosis 477000/mm3, normal asat and alat, low hematuria.