PF 1.1.1 Arthralgia – Grade 1
April 20, 2025PF 1.3 Arthritis
April 26, 2025Inflammatory arthralgia
Symptom Grade 1
- Mild pain
- No signs of inflammation
- Pain depends on exercise
Management escalation pathway
- Initiate analgesia with paracetamol and/or NSAID (If not contraindicated)
- Continue ICPI
Assessment and Investigations
- Complete rheumatological history
- Examination of all joints and skin
- Consider imaging to exclude metastases
- Consider ultrasound to exclude artritis
Abbrevations
ACPA: Anti Citrullinated Antibody
ANCA: Anti Neutrophil Cytoplasmic Antibody
ANF: Anti Nuclear Factor
ICPi: Immune Checkpoint Blockade Inhibition
NSAID: Non Steroidal Anti-Inflammatory Drugs
RF: Rheuma Factor
Symptom Grade 2
- Moderate or severe pain limiting daily activities
- Signs of inflammatory arthralgia (pain at rest, pain worsening with exercise)
Management escalation pathway
- Escalate analgesia and use NSAID (if not contraindicated) or low dose corticoids (≤10mg prednisone)
- Benefits of corticoids may be reevaluated by a rheumatologist after 2 weeks; in case of doubt contact rheumatologist before
- Discuss witholding ICPi until resolution of pain (if corticoids are required, restart of ICPi should be discussed in a multidisciplinary team)
Assessment and Investigations
- Perform X-rays to assess inflammatory pathology, always consider other imaging to exclude possible metastasis
- Complete rheumatological history
- Examination of all joints and skin
- Consider ultrasound to exclude arthritis
- Autoimmune panel:
- ACPA
- RF
- ANA (by indirect immunofluorescence) followed by more specific analysis if positive result (according to local practice)
Abbreviations
-ACPA: Anti Citrullinated Antibody
-ANCA: Anti Neutrophil Cytoplasmic Antibody
-ANF: Anti Nuclear Factor
-ICPi: Immune Checkpoint Blockade Inhibition
-NSAID: Non Steroidal Anti-Inflammatory Drugs
-RF: Rheuma Factor