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

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

Examinationof all joints and skin

Consider ultrasound to exclude arthritis

Autoimmune panel:
– RF
– ANA (by indirect immunofluorescence) followed by more specific analysis if positive result (according to local practice)



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