What drives you to initiate a csDMARD early rather than relying on prolonged corticosteroids alone in a patient with ICI-induced inflammatory arthritis who has moderate disease activity with polyarticular involvement and tenosynovitis at the time of rheumatology referral?

My approach differs somewhat from the traditional paradigm of early csDMARD initiation. In patients with immune checkpoint inhibitor-induced inflammatory arthritis (ICI-IA), particularly those with moderate disease activity, polyarticular involvement, and tenosynovitis, my primary goal is to avoid prolonged corticosteroid exposure while maintaining cancer control and preserving patient function. However, rather than routinely escalating to a csDMARD, I often favor earlier use of targeted biologic therapy when corticosteroid tapering is unsuccessful.

Although csDMARDs are generally considered cost-effective and familiar to rheumatologists, they provide relatively broad immunosuppression. In contrast, targeted therapies such as IL-6 inhibition...