How to deal with arthritis pain
The pain that comes with arthritis is one of the most debilitating parts of the disease, regardless of the type of arthritis you have. My patients often tell me that as pain becomes chronic, it can be incredibly draining and start to affect mood, work, sleep and relationships.
The good news is that there are lots of ways to manage and improve arthritis pain. In this article, I'll look at treatments that can help regardless of the type of arthritis you have, before discussing specific strategies for inflammatory arthritis.
One of the most important things is understanding exactly what type of arthritis you have, as treatment differs considerably when it comes to preventing joint damage and long-term disability. That's why it's important to see a rheumatologist and obtain an accurate diagnosis.
Exercise for arthritis pain
Exercise is one of the most effective treatments we have for arthritis pain, and yet it is often the treatment that patients are most worried about.
A common concern I hear is that exercise will wear the joints out further or make the arthritis worse. In reality, the opposite is usually true. Regular exercise helps strengthen the muscles around the joints, improves flexibility and reduces stiffness. It can also improve fatigue, sleep and overall wellbeing.
For osteoarthritis, exercise remains one of the most effective non-drug treatments available. For inflammatory arthritis, staying active can help maintain joint function and reduce the impact the disease has on day-to-day life.
The best form of exercise is usually the one you enjoy enough to keep doing. Walking, swimming, cycling, Pilates, yoga and strength training can all be excellent options. If you are experiencing significant pain or uncertainty about where to start, working with a physiotherapist can be very helpful.
Painkillers for arthritis pain
Over-the-Counter Treatments
Paracetamol for arthritis pain
Paracetamol is readily available over the counter. However, a large analysis published in the British Medical Journal (BMJ) showed that although paracetamol reduced patients' pain scores, the average improvement was only around 0.3 points on a 10-point pain scale, which is generally not considered clinically significant.
In inflammatory arthritis, paracetamol is not usually recommended as a standalone treatment and has been shown to be less effective than non-steroidal anti-inflammatory drugs (NSAIDs).
That said, paracetamol remains a very safe medication for most people when used appropriately. If it helps your symptoms, that's great, but in my experience it is often insufficient on its own for arthritis pain.
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
NSAIDs are a group of medications that target some of the molecules responsible for inflammation in the body. There are many different types. Some are available over the counter, such as ibuprofen, whilst others require a prescription. They can be taken as tablets or applied directly to affected joints as creams or gels.
Regardless of the type of arthritis you have, NSAIDs can be extremely effective when used safely. In inflammatory arthritis, however, they are rarely sufficient on their own. Whilst they can help control pain and stiffness, they do not alter the underlying disease process or prevent long-term joint damage.
A meta-analysis involving more than 100,000 patients found that NSAIDs reduced osteoarthritis pain by approximately 10%, which represents a meaningful improvement for many people. There is also very strong evidence that NSAIDs are more effective than placebo at reducing arthritis pain.
The caveat is that NSAIDs are not suitable for everyone. Long-term use is associated with a small increase in the risk of cardiovascular disease, kidney disease and bleeding from the gastrointestinal tract.
NSAIDs can also interact with other medications, particularly blood thinners, increasing the risk of bleeding. In some circumstances, doctors prescribe a stomach-protecting medication such as a proton pump inhibitor (PPI) alongside NSAIDs. If you're considering taking NSAIDs regularly, it's important to discuss this with your doctor first.
For patients where oral NSAIDs are not ideal, topical NSAID gels can be an excellent alternative. They are particularly useful in osteoarthritis, where fewer joints are commonly affected. Contrary to popular belief, topical NSAIDs are generally very safe and can often still be used if you've had a stomach ulcer, stomach bleed or inflammatory bowel disease.
The trade-off is that they may be slightly less effective than tablets, particularly if multiple joints are involved. Most topical preparations can be used up to four times a day.
Specific Treatments for Inflammatory Arthritis
Disease-Modifying Anti-Rheumatic Drugs (DMARDs)
Disease-modifying anti-rheumatic drugs (DMARDs) remain the first-line treatment for many forms of inflammatory arthritis. Whilst methotrexate was first developed in the 1950s, its widespread use in rheumatoid arthritis began in the 1980s, and it remains one of the most effective treatments we have available today.
Methotrexate works by affecting pathways involved in inflammation, helping to suppress the activity of immune cells that contribute to joint inflammation and damage. Although the science behind this is complex, the key point for patients is that methotrexate treats the underlying cause of inflammation rather than simply masking the pain.
The benefits extend far beyond pain relief alone. Studies show that people with rheumatoid arthritis experience, on average, around a 30% reduction in pain when treated with methotrexate. However, the effect is not just on pain. Swollen and tender joints typically improve, stiffness often reduces, and patients frequently find they can return to activities that had become difficult.
Perhaps most importantly, there is now extensive long-term evidence showing that methotrexate can slow down, and sometimes prevent, irreversible joint damage. The earlier inflammatory arthritis is treated, the better the long-term outcomes tend to be. This is one of the reasons I encourage anyone concerned about persistent joint swelling or inflammation to seek specialist assessment sooner rather than later.
It is also important to remember that methotrexate is only one of several DMARDs available. Other commonly used options include sulfasalazine, leflunomide and hydroxychloroquine. Depending on your diagnosis, medical history and individual circumstances, one of these may be more suitable.
One notable exception is inflammatory back pain, which we refer to as axial spondyloarthritis. Traditional DMARDs have not been shown to be particularly effective for inflammation affecting the spine, which is one of the reasons different treatments are often required for these conditions.
As these medications affect immune pathways throughout the body, they require regular monitoring to ensure they remain safe and effective. They are not suitable for everyone and, like all medications, can cause side effects.
For example, up to 60% of patients taking methotrexate experience some degree of gastrointestinal side effects, such as nausea or stomach upset. In many cases these symptoms can be improved by increasing folic acid supplementation, adjusting the dose, or changing from tablets to injections. However, some patients will require an alternative treatment.
The reassuring news is that if methotrexate is not tolerated, or is not controlling the disease adequately, there are now many other highly effective treatment options available.
Advanced Therapies, Including Biologics
Advanced therapies have transformed the treatment of inflammatory arthritis over the last 25 years. Since the first biologic treatments were introduced in the late 1990s, they have helped millions of people worldwide achieve better disease control and improved quality of life.
In the UK, there are now numerous advanced therapies approved for use in conditions such as rheumatoid arthritis, psoriatic arthritis and axial spondyloarthritis. These include biologic medications and newer targeted synthetic treatments.
Unlike traditional DMARDs, which have broader effects on the immune system, advanced therapies work by targeting specific molecules involved in inflammation. By focusing on key drivers of the disease, these treatments can often provide more effective control of symptoms and inflammation.
Many patients experience significant improvements in pain, stiffness and fatigue after starting an advanced therapy. However, the biggest benefit is often what patients cannot see or feel directly. These treatments can reduce ongoing inflammation and help protect joints from long-term damage.
There is no single biologic that is universally "best". Different treatments work better for different people, and the choice of medication depends on several factors, including the pattern of arthritis, other medical conditions, previous treatments and individual preferences. Choosing the right therapy is therefore very much a shared decision between you and your rheumatologist.
Interestingly, some patients continue to have pain despite their inflammation being much better controlled. Even in these situations, advanced therapies may still be providing significant benefits by reducing the risk of future joint damage and disability.
There is also growing evidence that treating inflammatory arthritis aggressively and early in the course of the disease improves the likelihood of achieving remission. In simple terms, the earlier inflammation is brought under control, the better the long-term outlook tends to be.
The Importance of Early Treatment in arthritis
One of the most significant advances in rheumatology over the last few decades has been our understanding of how important early diagnosis and treatment are.
Many forms of inflammatory arthritis can now be controlled extremely effectively. The challenge is making the diagnosis before inflammation has had the opportunity to cause irreversible joint damage.
If you have persistent joint swelling, prolonged morning stiffness, or symptoms that are impacting your daily life, it is worth discussing them with your GP or seeking specialist assessment.
Being seen promptly and receiving a thorough evaluation gives you the best chance of receiving the right treatment early. For many patients, that means less pain, less joint damage, a reduced risk of disability and a much better quality of life in the years ahead.
Weight Management and Arthritis Pain
For people with arthritis affecting weight-bearing joints such as the knees, hips, ankles and feet, weight can have a surprisingly large impact on pain levels.
I appreciate that weight loss is often easier said than done, especially when joint pain is making it difficult to exercise. However, even modest weight loss can make a meaningful difference. Studies have shown that losing as little as 5-10% of body weight can significantly improve pain and function in osteoarthritis.
The reason is fairly simple. Every step you take places force through your joints. Excess weight increases that force, particularly across the knees and hips. Reducing weight decreases the load on those joints, which can help reduce pain and improve mobility.
It's important not to think of weight management as simply eating less and exercising more. Many factors influence weight, including sleep, stress levels, medications and underlying health conditions. If weight is contributing to your arthritis symptoms, it is worth discussing this with your GP or specialist so that a realistic and sustainable plan can be developed.
Importantly, weight loss is not a cure for arthritis. However, for many people it is one of the most effective ways of improving symptoms and reducing the need for pain medication.
Managing Arthritis Flares
Most forms of arthritis tend to fluctuate over time. It is very common to experience periods where symptoms are relatively settled, followed by flare-ups when pain, stiffness and fatigue become noticeably worse.
One of the most common questions I am asked is whether patients should rest completely during a flare. Whilst it may be sensible to temporarily reduce activity, complete rest is rarely the answer.
During a flare, I usually recommend finding a balance between rest and gentle movement. Keeping joints moving within comfortable limits can help reduce stiffness and maintain mobility. Prolonged inactivity often leads to joints becoming even stiffer and muscles becoming weaker.
Many patients also find simple measures such as heat packs helpful for relieving stiffness, whilst ice packs can sometimes reduce swelling and discomfort in particularly inflamed joints.
If your flare is significantly worse than usual, affecting new joints, associated with fever, or not settling after a reasonable period of time, it is worth seeking medical advice. Sometimes a flare may indicate that treatment needs adjusting or that something else is contributing to your symptoms.
For patients with inflammatory arthritis, frequent flares are often a sign that the underlying inflammation is not being adequately controlled. In those situations, simply increasing pain relief is rarely the best long-term solution. The focus should be on improving control of the disease itself.
When Should I See a Rheumatologist?
Many aches and pains will improve on their own and do not necessarily mean that you have arthritis. However, there are certain symptoms that should prompt consideration of a rheumatology assessment.
One of the most important warning signs is persistent joint swelling. Swollen joints are often a clue that inflammation is present and should not be ignored, particularly if symptoms have been ongoing for several weeks.
Morning stiffness can also be very informative. Most people feel a little stiff first thing in the morning, but stiffness lasting longer than 30 minutes may suggest an inflammatory arthritis rather than simple wear and tear.
You should also consider seeking specialist advice if:
- Joint pain has persisted for more than six weeks.
- Multiple joints are affected.
- Symptoms are progressively worsening.
- There is associated psoriasis.
- You have inflammatory bowel disease such as Crohn's disease or ulcerative colitis.
- There is a strong family history of autoimmune disease.
- You are struggling to perform normal day-to-day activities because of your symptoms.
One of the benefits of seeing a rheumatologist early is that inflammatory arthritis can often be treated very effectively when diagnosed promptly. Early treatment can improve symptoms, prevent joint damage and reduce the risk of long-term disability.
If you're unsure whether your symptoms warrant specialist assessment, it is usually better to seek advice rather than wait. In rheumatology, obtaining the correct diagnosis early can make a significant difference to long-term outcomes.
Frequently Asked Questions
What is the best painkiller for arthritis?
Unfortunately, there is no single answer. The most effective treatment depends on the type of arthritis you have, your medical history and any other medications you may be taking.
For osteoarthritis, NSAIDs are often more effective than paracetamol. For inflammatory arthritis, controlling the underlying inflammation is usually far more important than relying on painkillers alone.
Are NSAIDs safe to take every day?
NSAIDs can be very effective, but they are not suitable for everybody. Long-term use can increase the risk of stomach ulcers, bleeding, kidney problems and cardiovascular disease.
Many people take them safely, but I would always recommend discussing regular use with your doctor first.
Can exercise make arthritis worse?
This is one of the most common misconceptions about arthritis.
Whilst exercise may temporarily cause some discomfort when you first start, regular physical activity is one of the most effective treatments we have for arthritis pain. In most cases, exercise helps strengthen the structures around the joint, improves flexibility and reduces stiffness.
The key is finding the right type and intensity of exercise for you.
What's the difference between osteoarthritis and rheumatoid arthritis?
Osteoarthritis is primarily a condition affecting cartilage and joint structures over time. It is often described as a "wear and repair" process, although the reality is more complex than simple wear and tear.
Rheumatoid arthritis is an autoimmune condition where the immune system mistakenly attacks the joints, causing inflammation.
The treatments for these conditions are very different, which is why obtaining the correct diagnosis is so important.
Can arthritis pain improve over time?
Yes. Many people assume arthritis inevitably gets worse, but this is not always the case.
Symptoms often fluctuate over time, and many patients experience significant improvements with the right combination of exercise, medication, weight management and treatment of any underlying inflammation.
For inflammatory arthritis in particular, modern treatments have transformed outcomes and can allow many people to lead very active lives.
When should I worry about joint pain?
You should seek medical advice if you develop persistent joint swelling, prolonged morning stiffness, unexplained weight loss, fever, significant loss of function, or pain that continues for more than a few weeks without obvious explanation.
Although most joint pain is not caused by a serious condition, it is always worth investigating symptoms that are persistent, worsening or affecting your quality of life.