Inflammation Workup and Management

Diagnostic Workup

The initial approach to an inflammation workup should include a complete rheumatologic history, physical examination of all joints and skin, and laboratory testing including inflammatory markers, autoimmune tests, and muscle enzymes to determine the underlying cause and guide appropriate management, as recommended by the American College of Rheumatology 1, 2
Inflammatory markers, such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), should be assessed to evaluate the degree of inflammation, according to the American College of Rheumatology 1, 2
Autoimmune tests, including antinuclear antibodies (ANA), rheumatoid factor (RF), and anti-citrullinated protein antibodies (anti-CCP), should be evaluated to assess for specific autoimmune conditions, as recommended by the American College of Rheumatology 1, 2
Muscle enzymes, such as creatine kinase (CK), should be evaluated to assess for muscle inflammation, according to the American College of Rheumatology 3, 4

For Grade 1 (Mild) inflammation, the American College of Rheumatology recommends continuing regular activities and monitoring, and initiating symptomatic treatment with acetaminophen and/or NSAIDs if no contraindications 1, 8
For Grade 2 (Moderate) inflammation, the American College of Rheumatology recommends considering referral to rheumatology for specialized evaluation and management, and initiating prednisone 10-20 mg/day or equivalent for 4-6 weeks 1, 8
For Grade 3-4 (Severe) inflammation, the American College of Rheumatology recommends urgent referral to rheumatology, and initiating prednisone 0.5-1 mg/kg or equivalent 1, 8

The American College of Rheumatology recommends monitoring inflammatory markers (ESR, CRP) and clinical symptoms regularly, and tapering corticosteroid dose gradually once symptoms improve 1, 2, 5, 8
For patients on corticosteroids, the American College of Rheumatology recommends considering PCP prophylaxis for patients on high-dose corticosteroids for >12 weeks, and serial rheumatologic examinations every 4-6 weeks after treatment initiation 8

The American College of Rheumatology emphasizes the importance of early recognition of inflammatory conditions to prevent irreversible tissue damage, and considering that inflammation may be a manifestation of immune-related adverse events in patients receiving immune checkpoint inhibitor therapy 6, 8, 9
The goal of treatment should be to control clinical signs and symptoms and normalize laboratory biomarkers of systemic inflammation using a treat-to-target approach, as recommended by the European League Against Rheumatism 7