Inflammatory arthritis occurs when inflammation damages your joints. There are different types of inflammatory arthritis and treatment may vary depending on the type.
HealthyWomen spoke with Tiffany Lin, MD, rheumatologist and associate professor in the Department of Rheumatology at the University of Wisconsin School of Medicine and Public Health, about how medications and lifestyle changes can help you live well with inflammatory arthritis.
What are the goals of treating inflammatory arthritis?
I care for patients with various forms of arthritis and we often first try to identify the cause of the arthritis so we can target treatment.
The ultimate goal of treatment is to relieve pain and prevent disabling damage from the condition.
Does treatment differ depending on the type of inflammatory arthritis you have?
For inflammatory arthritis, treatment depends on whether it is a form of inflammatory arthritis caused by an autoimmune disease (such as psoriatic arthritis and rheumatoid arthritis), gout/pseudogout (arthritis caused by crystals), or an infection.
For example, we treat patients with psoriatic arthritis long-term with anti-inflammatory medications. The choice of medication depends on the severity of symptoms and a person’s risk of developing irreversible joint damage. For milder illnesses we tend to lean toward oral medications, while for more severe illnesses we consider biologics and JAK inhibitors.
Read: Biologics, Biosimilars and Generics: What’s the Difference? >>
What types of treatments can help relieve pain?
We treat with anti-inflammatory agents and start with the mildest treatments. For example, we might suggest the use of topical anti-inflammatory medications such as diclofenac gel.
We also recommend common over-the-counter medications such as ibuprofen and naproxen, but remind our patients that like any other medication, they have side effects and should therefore be used under the guidance of a doctor.
What medications are most commonly used to slow or stop disease progression?
The treatments studied aim to act directly on the immune system to calm inflammation in the body, leading to less inflammation in the joint. And because there is less inflammation in the joints, we prevent or slow damage over time.
Some of these drugs, like hydroxychloroquine and methotrexate, have been around for a long time and are a good starting point for controlling inflammation. They may require monitoring to ensure they are not causing liver, kidney, or blood safety concerns.
There is also a group of medications called biologics, which are typically given to the patient by injection at home or through an intravenous infusion.
Biologics have really changed the landscape in terms of the aggressiveness of these diseases in people who are at higher risk or tend to be in a category of more severe disease. They have changed the way patients act when they would otherwise develop really bad joint disease.
These medications are also well compatible with patients’ normal lives. They are at higher risk of serious infections, and we also need to watch out for complications such as a higher risk of non-melanoma skin cancer. But if a patient needs them and isn’t doing well with oral medications, they’re a really good option.
Can treatment reverse joint damage that has already occurred?
Most of our treatments are aimed at controlling inflammation and there is no pill, injection or infusion that can reverse damage. However, in certain circumstances we may consider surgical procedures to repair damage or possibly replace the joint.
Surgery is an option we consider later in the course of arthritis when the damage has progressed to the point where we are unable to perform many other procedures.
How do physical therapy and exercise fit into a treatment plan?
Even if we detect joint damage on x-rays or other types of imaging, many pain, mobility and function problems can be managed through treatments such as physical therapy and exercise.
Although these treatments don’t actually change the joint damage, they can do a lot in terms of relieving symptoms – so we don’t have to resort to more aggressive treatments like surgery.
What additional lifestyle changes or modifications can help relieve arthritis pain, stiffness, and weakness?
Although we do not have specific guidelines for this, many rheumatologists believe that patients benefit from a diet rich in whole foods such as whole grains, vegetables, fruits, and legumes.
Minimizing inflammatory components of the diet, such as red meat, could also help relieve inflammatory joint pain.
Inflammatory arthritis can feel like an invisible diagnosis. This can lead to depression and difficulty coping because not everyone recognizes the challenges patients face on a daily basis. Organizations like the Arthritis Foundation provide an opportunity to connect with others who understand what you’re going through.
Online groups can be helpful for people who cannot meet in person. They are not a replacement for your own doctor when it comes to medical advice, but they can provide a much-needed sense of community.
Resources
Arthritis Foundation – Connecting Groups
This educational resource was created with support from Merck and Takeda.
