Inflammatory arthritis happens when inflammation damages your joints. There are different kinds of inflammatory arthritis, and treatment may look different depending on what type you have.
HealthyWomen spoke with Tiffany Lin, M.D., rheumatologist and associate professor in the Department of Medicine, Division of Rheumatology at the University of Wisconsin School of Medicine and Public Health, about how medicine and lifestyle tweaks can help you live well with inflammatory arthritis.
What are the goals for treatment of inflammatory arthritis?
I take care of patients with different forms of arthritis, and we’re often trying to first identify the cause of the arthritis so that we target the treatment appropriately.
The ultimate goal of treatment is to manage pain and prevent disability-related damage from the condition.
Is treatment different depending on the type of inflammatory arthritis you have?
With inflammatory arthritis, the treatment depends on whether we’re dealing with a type of inflammatory arthritis caused by an autoimmune disease (such as psoriatic arthritis and rheumatoid arthritis), gout/pseudogout (forms of arthritis caused by crystals) or infection.
For example, for patients with psoriatic arthritis, we treat with long-term anti-inflammatory medications. The choice of medication depends on the severity of symptoms and the person’s risk of developing irreversible joint damage. We tend to lean toward oral medications for milder disease, while we consider biologics and JAK inhibitors for more severe disease.
Read: Biologics, Biosimilars and Generics: What’s the Difference? >>
What types of treatment can help reduce pain?
We treat with anti-inflammatories, and we start with the mildest treatments. So we might, for example, suggest using topical anti-inflammatory medications such as diclofenac gel.
We also recommend common over-the-counter medicines like ibuprofen and naproxen but remind our patients that they have side effects just like any other medication so they should be used under the guidance of a medical professional.
What medicines are used most to slow or stop progression of disease?
The treatments that have been studied have been targeted to directly work on the immune system to calm inflammation down in the body, so there’s less inflammation in the joint. And as a result of less inflammation in the joints, we do prevent or slow damage over time.
Some of these medicines, like hydroxychloroquine and methotrexate, have been around for a long time and are a great starting point for controlling inflammation. They may involve monitoring to make sure they’re not causing any safety concerns in the liver, kidneys or blood.
There’s also a group of drugs called biologics that are administered typically by injection at home by the patient or through an IV infusion.
Biologics have really changed the landscape of how aggressive these diseases are in people who are at higher risk or tend to be in a category of more severe disease. They’ve transformed how patients do if they were otherwise going to develop really bad joint disease.
These medicines are also pretty compatible with normal life for patients. They do have a higher risk for serious infections, and we also have to watch for complications like higher risk of non-melanoma skin cancers. But when a patient needs them, and when they haven’t done well on oral medications, they’re a really great option.
Can treatment reverse joint damage that has already occurred?
Most of our treatments are directed at controlling inflammation, and there isn’t a pill or an injection or an infusion that would reverse damage. However, in certain circumstances, we might think about surgical procedures to help clear away damage or potentially replace the joint.
Surgery is an option we consider later on in the course of arthritis, if the damage has gotten to the point that we don’t have a lot of other interventions.
How do physical therapy and exercise fit into a treatment plan?
Even if we see joint damage on X-ray or other kinds of imaging, a lot of the pain, mobility and function issues can be addressed with treatments like physical therapy and exercise.
Although these treatments don’t actually do anything to alter the joint damage, they can do a whole lot in terms of addressing symptoms — so we don’t need to go to more aggressive treatments like surgery.
What are additional lifestyle changes or modifications that can help manage arthritis pain, stiffness and weakness?
Although we don’t have specific guidelines for this, many rheumatologists feel that patients benefit from a diet that’s rich in whole foods like whole grains, vegetables, fruit and legumes.
Minimizing inflammatory elements of the diet, like red meat, could also help limit inflammatory joint pain.
Inflammatory arthritis can feel like an invisible diagnosis. This can lead to depression and difficulty coping, because not everyone sees the challenges patients deal with on a daily basis. Organizations like the Arthritis Foundation provide opportunities for connection with others who understand what you’re going through.
Online groups can be helpful for people who aren’t able to meet in person. They’re not a substitute for your own clinician when it comes to medical advice, but they can provide a much needed sense of community.
Resources
Arthritis Foundation – Connect Groups
This educational resource was created with support from Merck and Takeda.
