Symptom Grade

Moderate or severe pain, limiting instrumental activities of daily living and may disable self care
Signs of inflammation such as joint swelling
Awaking of pain at night Early morning stiffness (>30min)
Multiple joints may be affected
Evaluate pain with visual analogue scale

Severity of pain is not a criterium for escalating treatment, treatment will rather be defined by the type and amount of joints affected

Show locations on body

Management escalation pathway

Escalate analgesics and use NSAID (If not contraindicated)
Prednisone (10-20mg) to be started ideally after consultation with rheumatologist
Withhold ICPI until resolution of symptoms
Intra-articular injections only if infection was ruled out (usually done by treating rheumatologist)
Consider methotrexate or salazopyrine if steroid refractory or for steroid sparing purposes (experience and not evidence based)

Assessment and Investigations

Always do X-ray (consider arthropathy, pre-existing arthropathy, metastasis or baseline evaluation)
If possible, try to objectify arthritis (eg by ultrasound or arthrocentesis)
Complete rheumatological history regarding differential diagnosis
Examination of all joints
Always consider joint aspiration especially when fever or severe inflammation to rule out septic arthritis and crystalarthropathies

Autoimmune panel:
ANA (by indirect immunofluorescence) followed by more specific analysis if posiitive result (according to local practice)
ANCA (to be discussed with rheumatologist)

Joint biopsy can be done in collaboration with certain centres for scientific purposes

Rheumatology department
  • Ghent University Hospital
  • Hopital St-Pierre
  • Hopital St-Luc, UCL
  • Hopital Universitaire de Liège. ULG
  • University Hospital Leuven


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