Arthralgia – Grade 2


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)


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