Table II.

Recommendations regarding management of inflammatory arthropathy and enthesitis in patients taking dupilumab

1. Prior to initiating dupilumab, counsel all patients about the risk of new-onset joint pain and that if it occurs, it is generally mild and easily managed. If it is more severe, the dupilumab can be discontinued, and it will resolve.

2. If a patient reports new-onset mild joint pain restricted to 1 or few joints, consider conservative management with over-the-counter nonsteroidal anti-inflammatory drugs, such as ibuprofen, on an as-needed basis.

3. If a patient reports new-onset moderate joint pain involving several joints or widespread pain, consider discontinuing the dupilumab, although in many cases it can be continued. Consider management with prescription of nonsteroidal anti-inflammatory drugs, such as celecoxib and a referral to rheumatology for comanagement.

4. If a patient reports new-onset severe joint pain that is widespread, we recommend immediate discontinuation of dupilumab, consideration of a short course of systemic steroids, and referral to rheumatology.