How do you approach evaluation and management of arthralgia in a patient after CAR-T cell therapy?

This is a great question - part of cytokine release at syndrome includes joint pain. So my questions are:

1. How far after?
2. What was the reason for the CAR-T?

These are vital questions to understand first. To that be said - the answers will determine if you give a one-and-done treatment or long-term. There is limited data on long-term CART side effects.

Is the joint pain inflammatory or more OA?

• If inflammatory - you could approach it like seronegative RA and treat it with an anti-IL-6 and Plaquenil. You may want to try Plaquenil first.
• If OA - supportive measures, NSAIDs, Cymbalta, Plaquenil.

Steroids could always be used but likely want to minimize.