From the Guidelines
For progressively worsening muscle stiffness and joint pain, the most essential laboratory tests to order include creatine kinase (CK) levels, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), troponin, and inflammatory markers, as recommended by the American Society of Clinical Oncology clinical practice guideline 1. These tests are crucial in assessing muscle damage, inflammation levels, and myocardial involvement, which can help differentiate between various causes of progressive muscle and joint symptoms.
- The diagnostic work-up should also include a complete rheumatologic and neurologic history, as well as a physical examination to evaluate muscle strength and skin findings suggestive of dermatomyositis.
- Additional tests such as electromyography (EMG), imaging (MRI), and/or biopsy may be considered on an individual basis when the diagnosis is uncertain or when overlap with neurologic syndromes is suspected 1.
- Inflammatory markers, including ESR and CRP, are useful in monitoring the patient's condition and response to treatment, as recommended by the American Society of Clinical Oncology clinical practice guideline update 1.
- The most recent guideline update from the European Society for Medical Oncology (ESMO) also emphasizes the importance of assessing joint count, ESR, CRP, rheumatoid factor, and anti-cyclic citrullinated peptide antibodies in patients with immune-related inflammatory arthritis and polymyalgia rheumatica 1.
- It is essential to note that the choice of laboratory tests may vary depending on the individual patient's presentation and medical history, and a comprehensive evaluation should be guided by the most recent and highest-quality evidence available 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Labs to Check for Progressively Worsening Muscle Stiffness and Joint Pain
To diagnose and monitor the progression of rheumatoid arthritis, several laboratory tests can be used, including:
- Erythrocyte sedimentation rate (ESR) 2
- C-reactive protein (CRP) 2
- Interleukin 6 (IL-6) 2
- Tumor necrosis factor-alpha (TNF-α) 2
- Visual analogue scale (VAS) 2
- Disease activity score in 28 joints (DAS) 2
Treatment Options
Several treatment options are available for rheumatoid arthritis, including:
- Methotrexate monotherapy 3, 4, 5, 2
- Combination therapy with methotrexate and other disease-modifying antirheumatic drugs (DMARDs) such as sulfasalazine, hydroxychloroquine, and biologic DMARDs 3, 4, 5, 2
- Addition of prednisone to methotrexate treatment to alleviate side effects 6
Efficacy and Safety of Treatment Options
Studies have shown that:
- Combination therapy with methotrexate and other DMARDs can be more effective than methotrexate monotherapy in reducing disease activity and improving quality of life 4, 5, 2
- Methotrexate plus hydroxychloroquine combination therapy can achieve better outcomes than methotrexate monotherapy 2
- Addition of prednisone to methotrexate treatment can alleviate common methotrexate side effects such as nausea and elevated liver enzymes 6