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<p>In my previous article we discussed potential new and exciting medications and research that was presented at the recent EULAR meeting in London. This highlighted how rheumatology continues to evolve with new therapies potentially changing patients’ lives. &nbsp;</p><p>However, controversy has erupted over a recent therapy that was approved in 2021. You might have seen Avacopan (brand name Tavneos) in the news recently. So what has happened?&nbsp;</p><h2>What is ANCA Vasculitis, and How Is ANCA Vasculitis Usually Treated?&nbsp;</h2><p>ANCA vasculitis (Anti-Neutrophil Cytoplasmic Antibody) is a rheumatological condition where the immune system starts attacking the small blood vessels, leading to problems in multiple organs. Originally characterised in the 1980s, it used to carry a poor prognosis with over 80% of untreated people dying within one year of diagnosis. With the introduction of medications like steroids, cyclophosphamide and rituximab, outcomes have improved significantly, with the risk of death in the first year dropping to below 10%.&nbsp;</p><p>However, while steroids are very good at controlling inflammation, prolonged high-dose steroid use carries significant risk in itself - including infection, diabetes, high blood pressure and thinning of the bones (to name a few). Therefore, there was a big unmet need for long-term treatment without steroids. &nbsp;</p><h2>What is Avacopan (Tavneos) and why is it controversial?&nbsp;</h2><p>Avacopan appeared to be the saviour to meet that unmet need. It blocks an immune system molecule called complement 5a, and is used alongside other treatments to help control ANCA-associated vasculitis whilst reducing the need for long-term steroid treatment.&nbsp;</p><p>In 2021, a trial called ADVOCATE was published in the New England Journal of Medicine, a high-profile and well-respected medical journal. It compared Avacopan to the standard treatment of long-term steroids and showed that people on the medication did better at 52 weeks, with fewer disease flare-ups. This was seen as an important breakthrough because it offered the possibility of reducing patients' exposure to long-term steroid treatment. &nbsp;</p><p>This led to approval for the use of Avacopan across the world, and it appeared in guidelines as a treatment option in Europe, USA and Britain. &nbsp;</p><p>However, a subsequent investigation by the US regulator the FDA revealed that trial data for a small number of patient records had been manipulated, without the knowledge of the doctors conducting the trial. These altered records were the tipping point for the data calculations, resulting in the medication being shown to be superior to steroids. &nbsp;Had this small number of records not been manipulated, the results would not have shown clear evidence that Avacopan performed better than steroids.&nbsp;</p><p>The doctors involved then retracted the study from the journal, citing improper research conduct. &nbsp;</p><p>Unfortunately, the controversy didn’t end there. Liver side effects in real-world patient populations have been reported at a much higher rate than in the original trial. In Japan, there have been cases of a very rare condition where bile ducts in the liver become damaged and disappear, called Vanishing Bile Duct Syndrome (VBDS). This has led to liver failure, which is very serious. &nbsp;</p><p>This has left the future role of Avacopan very tenuous. The FDA has recommended the drug is withdrawn, with similar statements issued by the European Medicines Agency (EMA). In the UK the medication is undergoing a review, but a statement by the Medicines and Healthcare Products Regulatory Agency (MHRA) has suggested extreme caution while this review is taking place. On a personal note, I have stopped this medication on all my patients to be on the safe side. &nbsp;</p><h2>What does this mean for patients taking Avacopan?&nbsp;</h2><p>Occurrences like this are extremely rare. Throughout my whole rheumatology career, I have never seen another medication go through such controversy. While it is an intriguing story and has impacted my clinical practice, new innovations in treatment options continue to change my patients lives for the better. &nbsp;</p><p>If you are currently taking Avacopan, it is important not to stop treatment without discussing it with your rheumatology team. Although the recent concerns have raised important questions about the medication, treatment decisions should always be made on an individual basis. Fortunately, there remain several effective treatment options for ANCA vasculitis, and ongoing reviews by regulators are designed to ensure medicines remain both safe and effective.&nbsp;</p><h2>Frequently Asked Questions&nbsp;</h2><h3>Should I stop taking Avacopan (Tavneos)?&nbsp;</h3><p>No. You should not stop taking Avacopan without first discussing it with your rheumatology team. Stopping treatment suddenly may increase the risk of your vasculitis becoming active again. Decisions about changing treatment should always be made with specialist advice.&nbsp;</p><h3>I am currently taking Avacopan. Should I be worried?&nbsp;</h3><p>The recent concerns relate to questions about the original clinical trial data and reports of rare liver complications. However, not every patient taking Avacopan will experience side effects. If you are concerned, speak to your rheumatology team before making any changes to your medication.&nbsp;</p><h3>What Are the Warning Signs of Liver Problems While Taking Avacopan?&nbsp;</h3><p>Patients taking Avacopan should seek medical advice if they develop symptoms that could suggest liver problems, including:&nbsp;</p><ul><li>Yellowing of the skin or eyes (jaundice)&nbsp;</li><li>Dark urine&nbsp;</li><li>Pale stools&nbsp;</li><li>Persistent nausea&nbsp;</li><li>Abdominal pain&nbsp;</li><li>Severe itching </li><li>Unusual fatigue&nbsp;</li></ul><p>&nbsp;&nbsp;</p><h3>What Treatments Can Be Used Instead of Avacopan?&nbsp;</h3><p>ANCA vasculitis can still be treated effectively using established therapies including corticosteroids, rituximab and, in some cases, cyclophosphamide. The most appropriate treatment depends on the severity of the disease and each patient's individual circumstances.&nbsp;</p><h3>Will Avacopan be withdrawn in the UK?&nbsp;</h3><p>At the time of writing, regulatory reviews are ongoing. Guidance may change as more information becomes available. Patients should discuss any concerns with their rheumatologist rather than making treatment decisions based on media reports.&nbsp;</p><h3>Does this affect all forms of vasculitis?&nbsp;</h3><p>No. The concerns discussed in this article relate specifically to ANCA-associated vasculitis and the use of Avacopan in that condition. There are many different forms of vasculitis which are treated in different ways.&nbsp;</p><h3>Are situations like this common?&nbsp;</h3><p>No. Drug withdrawals following concerns about clinical trial data are extremely uncommon. Although this has become a high-profile story within rheumatology, the vast majority of new treatments undergo extensive safety monitoring and continue to benefit patients.&nbsp;</p>

Avacopan controversy: could this vasculitis treatment be withdrawn?

<p>As a consultant rheumatologist, I always make sure I stay up to date with major international research so I can keep my patients informed about the latest advances in arthritis care.</p><p><br>The EULAR (European Alliance of Associations for Rheumatology) 2026 conference in London brought together leading experts from around the world to share new research on arthritis, autoimmune disease, and emerging treatments.</p><p>There were literally hundreds of studies presented across the 4-day conference, ranging from lifestyle changes to the latest therapies in rheumatology – some so new that they have only been investigated in a handful of patients.</p><p>In this article, I’ve summarised five key updates from EULAR 2026 that are particularly relevant to my patients.</p><h2>What Is EULAR?<br></h2><p>EULAR (European Alliance of Associations for Rheumatology) is one of the most important global rheumatology conferences, where doctors and medical professionals from around the world meet and share research.</p><p>Each year, alongside major meetings such as:</p><p>ACR (American College of Rheumatology)<br>BSR (British Society for Rheumatology)<br>it helps provide new evidence that directly influences how arthritis is treated in everyday clinical practice.</p><p>I have also presented at these conferences myself.</p><p>Read on for the key takeaways.</p><h2>1. Exercise Is Safe and Essential for All Types of Arthritis<br></h2><p>A common misconception is that when you have arthritis, exercise is a bad idea. The truth is quite the opposite.</p><p>The 2026 EULAR guidelines for Physical Activity (PA) and Sedentary Behaviour (SB) position movement as a central and necessary part of standard care. It is considered both safe and essential for patients with inflammatory arthritis and osteoarthritis.</p><p>This should be spread across the week and include a mix of strength training, reduced sitting, and regular movement throughout the day.</p><p>Overall, we are moving away from what we used to call the “weekend warrior” – somebody who is sedentary during the week but then very active at the weekend. There also appears to be additional benefit from breaking up long periods of sitting.</p><h3>Key benefits of exercise for arthritis:</h3><ul><li>Reduces joint pain and stiffness</li><li>Improves mobility and function</li><li>Boosts energy and mental wellbeing</li></ul><h3>Updated recommendations for exercise with arthritis - patients should aim for:</h3><ul><li>At least 150 minutes of moderate-intensity or 75 minutes of vigorous-intensity aerobic activity per week</li><li>Strength training at least twice weekly</li><li>Regular movement throughout the day</li><li>Reduced sitting time<br></li></ul><p>Important principles:</p><ul><li>Exercise is safe for inflammatory arthritis and osteoarthritis</li><li>Activity should be tailored to your symptoms and energy levels</li><li>You do not have to do this all at once. Small, intermittent bursts of movement throughout the day still add up and are highly encouraged</li></ul><h3>Key takeaway for exercise in arthritis:</h3><p><span style="font-family: inherit; font-size: 18px; font-weight: inherit;" data-mce-style="font-family: inherit; font-size: 18px; font-weight: inherit;">Modern rheumatology no longer advises “resting” arthritis. Instead, the focus is on helping patients stay active safely and consistently.</span></p><p>While these guidelines discuss aerobic and resistance training, the key message really boils down to <strong>doing something you enjoy and can stay consistent with.</strong></p><h2>2. New Drug Comparison in Psoriatic Arthritis: BE-BOLD Trial<br></h2><p>Psoriatic arthritis is a form of inflammatory arthritis associated with skin psoriasis. While up to 50% of patients respond to DMARD (disease-modifying anti-rheumatic drugs) therapy, a significant proportion do not.</p><p>When this happens, patients are moved onto what is known as advanced therapy. These drugs target specific molecules in the immune system that drive inflammation.</p><p>Choosing which advanced therapy to use can be tricky, as it is rare for these treatments to be compared directly. This is why this high-quality trial is particularly important.</p><p>The BE-BOLD trial compared two advanced therapies, randomising 553 patients to receive either:</p><ul><li>Bimekizumab</li><li>Risankizumab</li></ul><p><br>These drugs target different immune pathways. Both act on interleukins, which are molecules that regulate the immune system and drive inflammation in psoriatic arthritis.</p><h3>Results of the BE-BOLD trial:</h3><p><br>After 16 weeks, 49% of patients taking Bimekizumab achieved a 50% improvement in symptoms, compared with 38% taking Risankizumab.</p><h3>What the BE-BOLD trial results mean:</h3><p><br>Overall, Bimekizumab may offer stronger and faster symptom relief in psoriatic arthritis.</p><p>That said, this is only one trial, and it will be important to see whether these benefits persist beyond 16 weeks. As always, treatment decisions remain highly personalised. For example, Risankizumab can be used in patients who also have inflammatory bowel disease, whereas Bimekizumab can not.</p><h2>3. Weight Loss Medications Improve Arthritis Outcomes</h2><p>We have all seen the amount of coverage weight-loss drugs such as Mounjaro and Ozempic are getting in the media.</p><p>Researchers in a major clinical study called TOGETHER-PsA wanted to understand what happens when you treat both inflammation and body weight at the same time.</p><p>The trial focused on adults with active psoriatic arthritis who were overweight or obese. The average BMI was 38, with an average weight of over 100 kg.</p><p>Each group included over 130 patients. They received either:</p><ul><li>Ixekizumab (an advanced therapy targeting interleukin-17A)</li><li>Ixekizumab plus Tirzepatide (a GLP-1 weight-loss medication known in the UK as Mounjaro)</li></ul><h3>Key findings from the TOGETHER-PsA trial:<br></h3><p>In the group receiving both medications:</p><ul><li>More patients achieved a 50% improvement in joint pain and swelling</li><li>There was greater improvement in skin psoriasis</li><li>Patients successfully lost 10% or more of their body weight, which helps reduce pressure on joints</li><li>No new safety concerns were identified</li></ul><h3>Why the TOGETHER-PsA trial matters:</h3><p>Excess weight can worsen arthritis and reduce treatment effectiveness. This study suggests that targeting both weight and inflammation together leads to significantly better outcomes.</p><p>What remains unclear is whether these improvements are purely due to weight loss, or whether drugs like Mounjaro also have direct anti-inflammatory effects.</p><h3>4. Effects of Menopause on Rheumatoid Arthritis</h3><p>As a rule of thumb, most rheumatological conditions are more common in women. However, the impact of menopause on disease activity has not been studied in detail.</p><p>The BIOPURE registry tracked over 2,600 patients in Italy with rheumatoid arthritis, examining the effect of menopause in women starting advanced treatments.</p><h3>Key findings of the BIOPURE registery:<br></h3><p>More severe disease after menopause:</p><ul><li>Higher levels of autoantibodies (rheumatoid factor and anti-CCP)</li><li>Greater rates of joint damage (erosions)</li><li>Increased inflammation markers (CRP)</li></ul><p>Reduced response to treatment:</p><ul><li>Lower remission rates<ul><li>53.6% in postmenopausal women vs 64.9% in premenopausal women</li><li>Importantly, remission was still possible if patients were treated early and appropriately</li></ul></li></ul><h3>Why does menopause cause more severe disease in rheumatoid arthritis?</h3><p><br>Oestrogen appears to have natural anti-inflammatory effects. As levels fall during menopause, inflammation can increase and arthritis may become more active.</p><p>However, it is not yet clear whether hormone replacement therapy (HRT) improves outcomes.</p><h3>Key takeaway from the BIPURE registry and rheumatoid arthritis after menopause:</h3><p>Arthritis may become more difficult to control after menopause.&nbsp;<br>However, early and appropriate treatment remains effective, and early intervention is still key.&nbsp;</p><h2>5. CAR T-Cell Therapy: A Potential Future Cure?<br></h2><p>For my final highlight, I have chosen to focus not on a single study, but on a new and evolving treatment approach: CAR T-cell therapy.</p><p><br>This advanced treatment works by reprogramming your immune system to target the cells causing autoimmune disease.</p><h3><br>How CAR T-Cell Therapy works:</h3><p>In autoimmune conditions, the process follows a targeted, step-by-step approach:</p><ul><li>Cell collection: A patient’s white blood cells are collected via a process called leukapheresis</li><li>Genetic modification: T cells are engineered to carry a synthetic receptor (CAR)</li><li>Targeting: These cells are designed to recognise markers such as CD19 or BCMA on B cells</li><li>Preparation: Chemotherapy is used to prepare the immune system</li><li>Infusion: The modified cells are reintroduced to destroy the harmful immune cells</li></ul><p>There are promising results from early CAR T-Cell studies.</p><h3>Severe lupus CAR T-Cell study (CARLYSLE Study) results:</h3><ul><li>Rapid improvement in disease activity</li><li>Strong results in patients with kidney involvement</li></ul><h3>Rheumatoid arthritis CAR T-Cell study (COMPARE Trial) results :</h3><ul><li>Significant reduction in inflammation</li><li>Over 90% reduction in harmful antibodies</li><li>Many patients achieved drug-free remission</li></ul><h3>Scleroderma CAR T-Cell study results:</h3><ul><li>Halted skin thickening and lung disease progression</li><li>Evidence of a deep “immune system reset”</li></ul><h3>What CAR T-Cell therapy means for the future of autoimmune treatment:<br></h3><p>CAR T-cell therapy is still in its early stages. It is complex, expensive, and not without risk, but it shows real potential to transform – and possibly even cure – severe autoimmune disease in the future.<br></p><h3>Final Thoughts - the key messages from EULAR 2026 are clear</h3><ul><li>Exercise is a core treatment for arthritis – regardless of type</li><li>New biologic drugs continue to improve outcomes, and we are finally seeing head-to-head studies</li><li>Weight management medications may also help control rheumatic disease</li><li>Hormonal changes influence disease severity</li><li>Advanced therapies such as CAR T-cells may reshape the future of treatment<br><h3>Book a Rheumatology Consultation with Dr Simran Grewal</h3>If you found these updates helpful and are experiencing:</li><li><br></li><li>Joint pain or swelling</li><li>Morning stiffness</li><li>Psoriasis with joint symptoms</li><li>Worsening symptoms around menopause</li></ul><p><br>I offer specialist rheumatology consultations at London Independent Hospital and The Blackheath Hospital, with a focus on accurate diagnosis and personalised treatment.</p><p><br></p>

EULAR 2026: 5 Key Breakthroughs in Arthritis and Rheumatology

Close-up of a human spine model with red disc

<p>Enteropathic arthritis is a type of <strong>inflammatory joint disease</strong> linked to inflammatory bowel disease (IBD), including Crohn’s disease and ulcerative colitis.</p><p>It sits within a group of conditions called spondyloarthritis<em> </em>and causes inflammation in the joints, spine, and tendon attachments.</p><p>As the enteropathic arthritis lead at Barts Health NHS Trust, I work closely with gastroenterology colleagues (specialists who look after digestive diseases) to manage these complex patients. I have also presented this work at the British Society of Gastroenterology.</p><h2>How common is joint pain in inflammatory bowel disease (IBD)?</h2><p><strong>Musculoskeletal symptoms are very common in IBD:</strong><br></p><ul><li>Around 60% of patients report joint or muscle pain when asked</li><li>Around 12% develop true inflammatory arthritis</li></ul><h2>Types of enteropathic arthritis</h2><p>There are two types of enteropathic arthritis, <strong>peripheral</strong> and <strong>axial</strong>.&nbsp;</p><h3>Peripheral arthritis:</h3><ul><li>Affects knees, ankles, wrists, elbows</li><li>Can be linked to how active the bowel disease is, dependent on the pattern of the joints involved</li></ul><h3>Axial arthritis:<br><br></h3><ul><li>Affects spine and sacroiliac joints</li><li>Similar to ankylosing spondylitis</li><li><em>Can occur independently of gut symptoms</em></li></ul><h2>Why do people with inflammatory bowel disease (IBD)&nbsp; get joint pain?</h2><p><strong>Systemic inflammation </strong>can occur when the immune system attacks the intestines.&nbsp; Inflammatory proteins release into the bloodstream, which can promote inflammation in the joints, causing swelling and stiffness far from the digestive tract. While joints are most commonly affected, this inflammation can reach other parts of the body like the eyes and skin. These problems are called <strong>extra-intestinal manifestations (EIM).</strong></p><p>The physical toll of chronic illness often leads to <strong>muscle loss and deconditioning</strong>. As fatigue or flare-ups reduce your activity levels, the muscles that normally support and stabilize your joints weaken, forcing the joints to absorb more physical stress and resulting in mechanical pain.&nbsp;</p><p>Living with a chronic illness like inflammatory bowel disease can change how the body processes pain. This can make people more sensitive to discomfort, and conditions such as <strong>fibromyalgia</strong> are more common in people with IBD.</p><p>Finally, many patients develop very early <strong>pre-clinical</strong> <strong>inflammation</strong>, where the immune system begins irritating the tissues around the joints at a microscopic level. This causes real, physical discomfort even if the inflammation is not yet advanced enough to be detected on a standard X-ray or MRI.</p><h2>Symptoms of enteropathic arthritis</h2><h3>Joint symptoms:<br></h3><p>IBD-related joint symptoms generally follow this pattern:</p><ul><li><strong>Pain, Swelling, and Stiffness</strong>: Inflammatory fluid builds up in the joints, causing visible puffiness and a "tight" sensation that often moves between different areas like the knees or wrists.</li><li><strong>Morning Stiffness</strong>: You may feel "locked" or heavy upon waking. Unlike typical aches, this inflammatory stiffness usually requires 30 minutes or more of movement to ease.</li><li><strong>Flares</strong>: Joint pain often mirrors gut activity, worsening during an IBD flare. However, joints can also flare independently even when digestive symptoms are quiet.</li></ul><h3>Enthesitis:</h3><p><strong>Enthesitis</strong> is a specific type of IBD-related inflammation where tendons or ligaments attach to the bone. Common signs include:</p><ul><li><strong>Heel and Plantar Foot Pain:</strong> Inflammation often targets the Achilles tendon at the back of the heel or the plantar fascia on the bottom of the foot, making walking particularly painful.</li><li><strong>Insertion Site Tenderness</strong>: Pain occurs specifically at "insertion sites", the exact points where connective tissue meets bone. Common spots include the elbows, hips, or knees.</li></ul><h3>Back pain:</h3><p>Enteropathic arthritis back pain often stems from inflammation in the spine or sacroiliac joints. It typically follows this pattern:</p><ul><li><strong>Chronic Lower Back Pain</strong>: This is a persistent ache located at the base of the spine or in the buttocks. Unlike a pulled muscle, it is usually deep and dull rather than sharp.</li><li><strong>Worse with Rest:</strong> The pain is most intense after long periods of inactivity, particularly first thing in the morning or after sitting for a while.</li><li><strong>Improves with Movement:</strong> A key sign of inflammatory back pain is that it feels better once you start moving. Physical activity helps "warm up" the joints, whereas rest makes the stiffness return.</li></ul><h3>Eye symptoms (uveitis):</h3><p><br><strong>Enteropathic eye inflammation</strong>, or <strong>uveitis</strong>, is a serious symptom that requires prompt medical attention. It typically presents with:</p><ul><li><strong>Redness and Pain</strong>: The eye may appear bloodshot and feel deep, throbbing, or achy. This is different from the "gritty" feeling of common dryness or allergies.</li><li><strong>Light Sensitivity:</strong> You might find yourself squinting or experiencing sharp discomfort in bright environments (photophobia), as the inflamed iris struggles to react to light.</li><li><strong>Blurred Vision:</strong> Inflammation can cloud your sight or create "floaters," making it difficult to focus on details even with corrective lenses.</li></ul><h2>Does arthritis follow bowel disease severity?</h2><p>IBD-related joint pain doesn't always follow the same timeline as digestive issues. The relationship depends on the type of joint involved:</p><ul><li><strong>Peripheral arthritis</strong>: This affects the "outer" joints like the knees, ankles, or wrists. It typically tracks with flares, meaning your joint pain often gets worse exactly when your gut symptoms flare up and improves once your IBD is treated. However, when the small joints are involved and in a symmetrical way, then this might not be the case.&nbsp;</li><li><strong>Axial disease</strong>: This affects the spine and sacroiliac joints. It is usually independent of gut activity. This means your back or neck may continue to hurt even if your IBD is in complete remission, often requiring its own specific management.</li></ul><p><br></p><h2>Why does diagnosis matter?</h2><p>Getting an accurate diagnosis is essential because the medications used for IBD and joint pain often overlap, but they don't always work the same way:</p><ul><li>Many biologics and immunosuppressants can effectively shut down inflammation in both your digestive tract and your joints simultaneously.</li><li>Some medications used for joint conditions, such as<strong> IL-17 inhibitors</strong>, can actually trigger or worsen IBD symptoms. Proper diagnosis ensures you avoid drugs that might fix your joints but damage your gut.</li><li>Knowing exactly what is causing the pain allows your doctors to choose a plan that protects your long-term mobility without compromising your digestive health.</li></ul><h2>What treatment options are available?</h2><p>Managing IBD and joint pain together requires a strategy that addresses inflammation throughout the entire body. Common treatment options include:</p><ul><li><strong>Anti-inflammatory medications: </strong>These are often the first line of defense to reduce swelling and provide quick pain relief. While common, some types (like certain NSAIDs) must be used cautiously as they can occasionally irritate the gut lining. This is particularly the case in Crohn's patients. Anti-inflammatories are usually tried in milder cases.&nbsp;</li><li><strong>DMARDs (disease-modifying anti-rheumatic drugs)</strong>: These medications work by slowing down the overactive immune system. They have widespread effects on the immune system, and act as a blanket to try and put out the inflammation. They help prevent long-term damage to the joints and can often help manage IBD symptoms at the same time.</li><li><strong>Biologic therapies</strong>: These are targeted treatments designed to block specific proteins that cause inflammation. Because these proteins are often active in both the gut and the joints, biologics are frequently used to treat both conditions simultaneously.</li><li><strong>Combination advanced therapies</strong>: In complex cases, we may use a combination of different advanced medications to hit the inflammation from multiple angles.</li></ul><h2>Do I have enteropathic arthritis?</h2><p>Determining if you have enteropathic arthritis requires a formal medical evaluation, but you should consider seeing a specialist if you experience the following:</p><ul><li><strong>Persistent joint pain or swelling</strong>: You have ongoing discomfort, puffiness, or warmth in joints like your knees, ankles, or wrists that doesn't resolve with rest.</li><li><strong>Heel or tendon pain</strong>: You notice specific tenderness where tendons meet the bone (enthesitis), particularly at the back of the heel, around the knee or the arch of the foot.</li><li><strong>Back pain or stiffness</strong>: You experience deep aching in the lower back or buttocks that is worst in the morning and improves when you move around.</li><li><strong>Eye symptoms</strong>: You have developed redness, pain, or blurred vision, which can indicate related inflammation (uveitis) outside of the joints.</li><li><strong>Unexplained symptoms</strong>: Your physical discomfort persists even when your IBD is in remission, or the pain feels more severe than what would be expected from a typical digestive flare.</li></ul><h2>Frequently asked questions</h2><p>Here are some common questions patients ask me:</p><p><strong>Q:</strong> <strong>Is all joint pain inflammatory? </strong></p><p><strong>A:</strong> <strong>No</strong>. While IBD can cause inflammatory arthritis, pain can also stem from "mechanical" issues like osteoarthritis, old injuries, or simple wear and tear. Joint pain can also occur in chronic pain conditions like fibromyalgia.&nbsp;</p><p><strong>Q: Can joint symptoms come before IBD? </strong></p><p><strong>A: Yes.</strong> In some cases, joint pain or stiffness can appear months or even years before any digestive symptoms develop.</p><p><strong>Q: Will treating IBD help my joints?</strong> </p><p><strong>A: Sometimes</strong>. If you have peripheral arthritis (knees, wrists), clearing up a gut flare often helps the joints. However, spinal symptoms (axial disease) and certain types of peripheral arthritis may require their own specific treatment. If the joints and gut are inflamed it is important the rheumatologist and the gastroenterologist work together</p><p><strong>Q: What is enthesitis?</strong></p><p><strong>A: It is inflammation at the specific spot where a tendon or ligament attaches to the bone</strong>, such as the back of the heel.</p><p><strong>Q: What is uveitis? </strong></p><p><strong>A: This is inflammation inside the eye.</strong> It is considered a medical emergency because it can cause permanent damage if not treated immediately by a specialist.</p><p><strong>Q: Are treatments safe? </strong></p><p><strong>A: Modern treatments are safe and well-monitored</strong>. The key is careful selection, as some medications that help joints can actually make IBD worse.</p><h2>Specialist assessment for enteropathic arthritis</h2><p>I am a consultant rheumatologist and enteropathic arthritis lead at Barts Health NHS Trust, working closely with gastroenterology colleagues. </p><p>My work focuses on inflammatory arthritis in IBD, and I have presented at the British Society of Gastroenterology.</p><p><br></p>

What is enteropathic arthritis?

VFX Joint and Knee Pain Augmented Reality Render. Close Up of a Person Experiencing Discomfort in a Result of Leg Trauma or Arthritis. Massaging the Muscles to Ease the Injury.

<p>Dr Grewal hosted a live patient event covering the latest insight into arthritis treatments, what happens in the body when arthritis occurs and real patient stories.&nbsp;</p><p><a data-mce-href="https://event.eu.on24.com/wcc/r/8000183912/CC1267D44EF2E7FDCF851591DB420559" href="https://event.eu.on24.com/wcc/r/8000183912/CC1267D44EF2E7FDCF851591DB420559" title="Is arthritis getting you down?">Register and watch the event recording for free here.</a></p>

Is arthritis getting you down? Free patient event recording

Doctor showing X-ray of patient's hand on laptop in clinic.

<h2>Introduction to Rheumatology</h2><p>Preparing for your first rheumatology appointment can be a bit daunting. Whether you're experiencing joint pain, stiffness, or other symptoms, a specialist who can help diagnose and manage conditions affecting your joints, muscles, and bones. This guide will help you feel prepared and confident for your visit.</p><figure id="figure-5zca9hqo3nmmj93ttr" class=""><img id="5zca9hqo3nmmj93ttr" src="https://cdn.durable.co/getty/35FtvjDJjUtCEiuex70h9DjIs46pxcvHuscY6l7hf1yOdLWwVJGXLKNJs3V0CyCu.jpeg" alt="rheumatology clinic" class="object-cover bg-gray-100 rounded-sm md:rounded-md lg:rounded-lg" style="aspect-ratio: 16/9;" data-mce-src="https://cdn.durable.co/getty/35FtvjDJjUtCEiuex70h9DjIs46pxcvHuscY6l7hf1yOdLWwVJGXLKNJs3V0CyCu.jpeg" data-mce-style="aspect-ratio: 16/9;"></figure><h2>Gathering Your Medical History</h2><p>Before your appointment, it's important to gather your medical history.&nbsp;</p><p>This includes any previous diagnoses, surgeries, and family history of autoimmune diseases. Having this information readily available will help your rheumatologist make an accurate assessment.</p><p>Make a list of all medications and supplements you are currently taking. Include the dosage and frequency. This ensures that your doctor can evaluate potential interactions and adjust treatments as necessary.</p><h2>Documenting Symptoms</h2><p>Be prepared to discuss your symptoms in detail. Consider keeping a symptom diary in the weeks leading up to your appointment. Note when symptoms occur, their intensity, and any potential triggers. This pattern can provide valuable insights into your condition.</p><figure id="figure-prk7wwhk3dmmj93xpi"><img id="prk7wwhk3dmmj93xpi" src="https://cdn.durable.co/getty/3aIulmSoIzSMWXcSRr5KrAkfPKoaMpWWGa9mPUnYXDDUix7GjI5m95l6GV8V4FYY.jpeg" alt="joint pain" class="object-cover bg-gray-100 rounded-sm md:rounded-md lg:rounded-lg" style="aspect-ratio: 16/9;" data-mce-src="https://cdn.durable.co/getty/3aIulmSoIzSMWXcSRr5KrAkfPKoaMpWWGa9mPUnYXDDUix7GjI5m95l6GV8V4FYY.jpeg" data-mce-style="aspect-ratio: 16/9;"></figure><h2>Questions to Ask Your Rheumatologist</h2><p>Arrive at your appointment with a list of questions. Here are some ideas:</p><ul><li>What could be causing my symptoms?</li><li>What tests will I need?</li><li>What are the treatment options?</li><li>How can I manage symptoms at home?</li></ul><p>These questions can help you gain a clearer understanding of your health and the path forward.</p><h2>Understanding Diagnostic Tests</h2><p>Your rheumatologist may order various tests to diagnose your condition accurately. Common tests include blood tests, X-rays, and MRIs. Understanding what these tests involve can alleviate any anxiety and help you prepare mentally.</p><figure id="figure-e9rn3zh4ulmmj940y4"><img id="e9rn3zh4ulmmj940y4" src="https://cdn.durable.co/getty/2nLDeK3A3lxHaUIiGV6NPb36PcNrEAYfbScowS9nTy0UnEXgIGeRNq5KG3oJNmM4.jpeg" alt="blood test" class="object-cover bg-gray-100 rounded-sm md:rounded-md lg:rounded-lg" style="aspect-ratio: 16/9;" data-mce-src="https://cdn.durable.co/getty/2nLDeK3A3lxHaUIiGV6NPb36PcNrEAYfbScowS9nTy0UnEXgIGeRNq5KG3oJNmM4.jpeg" data-mce-style="aspect-ratio: 16/9;"></figure><h2>Preparing for Lifestyle Changes</h2><p>Depending on your diagnosis, your rheumatologist may recommend lifestyle changes. These could include dietary adjustments, physical therapy, or exercise routines tailored to your condition. Being open to these changes can significantly enhance your quality of life.</p><p>Consider joining support groups or online communities for individuals with similar conditions. Sharing experiences and tips can be incredibly beneficial.</p><h2>Follow-Up and Ongoing Care</h2><p>After your initial appointment, follow-up visits will likely be essential to monitor your progress. Keep track of any changes in symptoms and communicate these with your rheumatologist. Consistent communication is key to effective management and treatment.</p><figure id="figure-uv88u00l0mmmj944c2"><img id="uv88u00l0mmmj944c2" src="https://cdn.durable.co/getty/6LEHpshgJ30PIMJyWk9XIMcavRtOMGurPGCvOxfMQvWBMoycZxCBwWcsnowrOrSp.jpeg" alt="doctor patient consultation" class="object-cover bg-gray-100 rounded-sm md:rounded-md lg:rounded-lg" style="aspect-ratio: 16/9;" data-mce-src="https://cdn.durable.co/getty/6LEHpshgJ30PIMJyWk9XIMcavRtOMGurPGCvOxfMQvWBMoycZxCBwWcsnowrOrSp.jpeg" data-mce-style="aspect-ratio: 16/9;"></figure><h2>Conclusion</h2><p>Preparing for your first rheumatology appointment involves gathering information, understanding your symptoms, and being ready to discuss potential lifestyle changes. With the right preparation, you can take a proactive role in your healthcare journey, leading to better outcomes and improved well-being.</p><figure id="figure-rmr82t67ummj962nt" class=""><iframe id="rmr82t67ummj962nt" class="w-full bg-gray-100 h-80 rounded-sm md:rounded-md lg:rounded-lg" style="aspect-ratio: 16/9;" frameborder="0" allow="accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share" referrerpolicy="strict-origin-when-cross-origin" allowfullscreen="" data-url="undefined" data-corners="default" data-fullwidth="false" data-mce-style="aspect-ratio: 16/9;"></iframe></figure><p><br></p>

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