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Person applying pain relief patch to neck while seated comfortably at home in natural afternoon light, demonstrating convenient self-care

<p>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.</p><p><br>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.</p><p><br>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.&nbsp;</p><h2>Exercise for arthritis pain</h2><p>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.&nbsp;</p><p><br>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.&nbsp;</p><p><br>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.&nbsp;</p><p><br>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.&nbsp;</p><h2>Painkillers for arthritis pain<br></h2><h3>Over-the-Counter Treatments&nbsp;</h3><h3>Paracetamol for arthritis pain</h3><p><br>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.&nbsp;</p><p><br>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).&nbsp;</p><p><br>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.&nbsp;</p><h3>Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)&nbsp;</h3><p><br>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.&nbsp;</p><p><br>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.&nbsp;</p><p><br>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.&nbsp;</p><p><br>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.&nbsp;</p><p><br>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.&nbsp;</p><p><br>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.&nbsp;<br>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.&nbsp;</p><h3>Specific Treatments for Inflammatory Arthritis</h3><h3>Disease-Modifying Anti-Rheumatic Drugs (DMARDs)</h3><p><br>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.</p><p>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.</p><p>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.</p><p>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.</p><p>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.</p><p>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.</p><p>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.</p><p>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.</p><p>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.</p><h3>&nbsp;<br>Advanced Therapies, Including Biologics</h3><p><br>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.</p><p>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.</p><p>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.</p><p>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.</p><p>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.</p><p>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.</p><p>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.</p><h3>&nbsp;<br>The Importance of Early Treatment in arthritis</h3><p><br>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.</p><p>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.</p><p>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.</p><p>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.</p><h3>Weight Management and Arthritis Pain&nbsp;</h3><p><br>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.&nbsp;</p><p><br>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.&nbsp;</p><p><br>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.&nbsp;</p><p><br>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.&nbsp;<br>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.&nbsp;<br>&nbsp;</p><h3>Managing Arthritis Flares&nbsp;</h3><p>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.&nbsp;</p><p><br>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.&nbsp;</p><p><br>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.</p><p><br>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.&nbsp;</p><p><br>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.&nbsp;</p><p><br>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.&nbsp;<br>&nbsp;</p><h3>When Should I See a Rheumatologist?&nbsp;</h3><p><br>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.&nbsp;</p><p><br>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.&nbsp;<br>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.&nbsp;<br></p><p>You should also consider seeking specialist advice if:&nbsp;</p><ul><li>Joint pain has persisted for more than six weeks.</li><li>Multiple joints are affected.</li><li>Symptoms are progressively worsening.</li><li>There is associated psoriasis.</li><li>You have inflammatory bowel disease such as Crohn's disease or ulcerative colitis.</li><li>There is a strong family history of autoimmune disease.</li><li>You are struggling to perform normal day-to-day activities because of your symptoms.&nbsp;</li></ul><p><br>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.&nbsp;</p><p><br>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.&nbsp;<br>&nbsp;</p><h3>Frequently Asked Questions&nbsp;</h3><p><br><strong>What is the best painkiller for arthritis?&nbsp;</strong><br>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.&nbsp;</p><p><br>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.&nbsp;</p><p><br><strong>Are NSAIDs safe to take every day?&nbsp;</strong><br>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.&nbsp;</p><p><br>Many people take them safely, but I would always recommend discussing regular use with your doctor first.&nbsp;</p><p><br><strong>Can exercise make arthritis worse?&nbsp;</strong><br>This is one of the most common misconceptions about arthritis.&nbsp;<br>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.&nbsp;<br>The key is finding the right type and intensity of exercise for you.&nbsp;</p><p><br><strong>What's the difference between osteoarthritis and rheumatoid arthritis?&nbsp;</strong><br>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.&nbsp;<br>Rheumatoid arthritis is an autoimmune condition where the immune system mistakenly attacks the joints, causing inflammation.&nbsp;</p><p><br>The treatments for these conditions are very different, which is why obtaining the correct diagnosis is so important.&nbsp;</p><p><br><strong>Can arthritis pain improve over time?&nbsp;</strong><br>Yes. Many people assume arthritis inevitably gets worse, but this is not always the case.&nbsp;</p><p><br>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.&nbsp;</p><p><br>For inflammatory arthritis in particular, modern treatments have transformed outcomes and can allow many people to lead very active lives.&nbsp;</p><p><br><strong>When should I worry about joint pain?&nbsp;</strong><br>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.&nbsp;</p><p><br>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.&nbsp;<br>&nbsp;<br>&nbsp;</p>

How to deal with arthritis pain

Macro close-up of anatomical spine model with dust-filled light, warm studio lighting and shallow focus.

<h2>When is back pain more than just back pain?<br></h2><p>Back pain is very common. In the UK, the chance of experiencing an episode of back pain during your lifetime is almost 60%. Whilst most cases are caused by muscular strain or mechanical problems, chronic back pain in young adults can sometimes be a sign of an underlying inflammatory condition called axial spondyloarthritis (axSpA).</p><p><br>The type of back pain associated with axial spondyloarthritis is known as inflammatory back pain and behaves very differently from the mechanical back pain that most people experience.</p><p><br>In the vast majority of cases, back pain is mechanical in nature and settles with time, movement and simple treatments. However, in a minority of people, persistent inflammatory back pain can be a symptom of axial spondyloarthritis.<br></p><h2>What is axial spondyloarthritis (axSpA)?<br></h2><p>Axial spondyloarthritis is an autoimmune condition in which the body's immune system mistakenly attacks healthy tissues, causing inflammation in the joints of the spine and sacroiliac joints.</p><p><br>Inflammation affecting the sacroiliac joints is known as sacroiliitis, and it is one of the characteristic features of axial spondyloarthritis. Other areas of the body can also be affected.</p><p><br>This inflammation can lead to pain, stiffness (particularly in the morning or after periods of rest) and loss of mobility. If left completely untreated, it can progress and cause significant loss of mobility as joints in the spine become damaged and begin to fuse together.<br></p><h2>Who is affected by axial spondyloarthritis?<br></h2><p>Axial spondyloarthritis affects up to 1% of the population and most commonly develops before the age of 45.</p><p><br>Historically, we thought it affected men more commonly, but we now know that it can affect men and women equally.</p><h2><br>I have heard the term ankylosing spondylitis. Is it the same thing as axial spondyloarthritis?<br><br></h2><p>Ankylosing spondylitis is the historic name given to the condition when doctors identified certain changes on X-rays.</p><p><br>As we have become better at diagnosing the condition earlier, these X-ray changes are not always present. Modern treatments can also prevent the disease progressing to this stage.</p><p><br>Axial spondyloarthritis is now used as the umbrella term and includes both people who have X-ray changes and those who do not. Patients previously diagnosed with ankylosing spondylitis fall within the broader spectrum of axial spondyloarthritis.<br></p><h2>Why does axial spondyloarthritis occur?<br></h2><p>The truth is we do not really know, but it is likely to be caused by a combination of genetic and environmental factors.</p><p><br>A gene called HLA-B27 is associated with the condition. Among people of White ethnicity who are diagnosed with axial spondyloarthritis, around 85% carry this gene. This association is slightly lower in South Asian populations and lower still in Black populations, where approximately 50% of patients carry the gene.</p><p><br>It is important to understand that this is only an association. Being positive for the gene does not mean you have axial spondyloarthritis. Similarly, if you do not carry the gene, it does not mean you do not have the condition.<br></p><h2>Does axial spondyloarthritis run in families?<br></h2><p>There is a genetic component to axial spondyloarthritis, which means it can sometimes run in families.</p><p><br>Having a close family member with axial spondyloarthritis, ankylosing spondylitis, psoriasis, inflammatory bowel disease or uveitis may increase your risk of developing the condition. However, many people diagnosed with axSpA have no known family history.</p><p><br>Similarly, carrying the HLA-B27 gene does not mean you will develop the disease. It is simply one factor that may increase the likelihood.<br></p><h2>What are the symptoms of axial spondyloarthritis (AxSpa)?<br></h2><p>The main symptom is chronic back pain, usually lasting more than three months. This is typically felt in the lower back or buttocks and is often described as a deep ache.</p><p><br>The symptoms of inflammatory back pain often develop gradually over months or even years and are frequently mistaken for ordinary muscular back pain.</p><p><br>The pain is usually worse in the early morning and can sometimes wake you from sleep. Many people notice that symptoms are at their worst during the second half of the night or first thing in the morning.</p><p><br>Stiffness is also a hallmark symptom. Sometimes patients tell me they feel as though they have aged ten years in the space of a few months. The stiffness usually lasts for more than 30 minutes in the morning and can make simple activities, such as getting out of bed and getting dressed, feel difficult.</p><p><br>Unlike mechanical back pain, people with axial spondyloarthritis often find that exercise and stretching improve their symptoms. Many of my patients remain active for this reason and do not like sitting still for prolonged periods.</p><p><br>The pain may partially respond to anti-inflammatory medications, but it rarely disappears completely. Over time, other areas can also be affected, including the upper back, neck and hips.<br></p><p><strong>You may also experience other symptoms:</strong><br></p><ul><li>Swelling and stiffness in other joints or tendons. Achilles tendon pain and knee tendon pain are common.</li><li>Skin psoriasis, often appearing as a flaky, silvery rash on the elbows, knees or groin.</li><li>Episodes of eye inflammation (uveitis).</li><li>Bowel symptoms, including abdominal pain, cramps and bloody diarrhoea.<strong><br></strong></li></ul><h2>What is inflammatory back pain?<br></h2><p>One term you may come across when researching axial spondyloarthritis is inflammatory back pain.</p><p><br>This is the type of back pain caused by inflammation within the joints and tissues around the spine. It behaves very differently from the mechanical back pain that most people experience at some point in their lives.<br></p><p><strong>Inflammatory back pain typically:</strong></p><ul><li>Starts before the age of 45.</li><li>Comes on gradually rather than after an injury.</li><li>Improves with movement and exercise.</li><li>Feels worse after periods of rest.</li><li>Causes morning stiffness that lasts longer than 30 minutes.</li><li>Can wake you during the second half of the night.<br></li></ul><p>This pattern of symptoms is often one of the biggest clues that there may be an underlying inflammatory condition such as axial spondyloarthritis.&nbsp;</p><h2>When should I see a doctor about back pain?<br></h2><p>Most back pain is mechanical and improves with time, exercise and simple pain relief. However, there are certain features that should prompt you to seek medical advice.</p><p><strong>You should consider seeing a doctor if:</strong></p><ul><li>Your back pain has persisted for more than three months.</li><li>You regularly wake in the early hours because of pain.</li><li>You experience significant morning stiffness lasting more than 30 minutes.</li><li>Exercise improves your symptoms but resting makes them worse.</li><li>You have psoriasis, inflammatory bowel disease or a history of uveitis.</li><li>A close family member has been diagnosed with ankylosing spondylitis or axial spondyloarthritis.</li></ul><p><br>Unfortunately, axial spondyloarthritis is often diagnosed later than it should be. Many patients are initially told they have mechanical or muscular back pain because they are otherwise young and healthy. Recognising the symptoms early can help people access treatment sooner and achieve better outcomes.</p><h2>How is axial spondyloarthritis diagnosed?<br></h2><p>Firstly, it is a clinical diagnosis. This means you need to see a rheumatologist, such as myself.</p><p><br>Rheumatologists are specialists in diagnosing and treating conditions such as axial spondyloarthritis, ankylosing spondylitis and other inflammatory forms of back pain.</p><p><br>A rheumatologist will take a detailed history, discuss your symptoms and perform an examination. We also use blood tests and imaging, such as X-rays and MRI scans, to help support the diagnosis.<br></p><p><strong>Tests usually include:</strong></p><ul><li><strong>HLA-B27 and CRP blood tests</strong> to assess for inflammation in the body and check for the gene association discussed earlier.<br></li><li><strong>MRI of the sacroiliac joints and the whole spine</strong>. Most people develop changes that are visible on MRI within the sacroiliac joints near the base of the spine. However, some patients develop inflammation elsewhere in the spine. Scanning the whole spine helps us understand where inflammation is present and how active it is. It can also show signs of previous inflammation, even when symptoms have improved.<br>MRI scans are particularly useful because they can detect inflammation before permanent damage becomes visible on X-rays.</li></ul><p><br><strong>A note about MRI scans:</strong></p><p><br>MRI scans are extremely useful for identifying inflammation within the sacroiliac joints and spine. However, it is important to understand that no single test can diagnose axial spondyloarthritis on its own.</p><p><br>Occasionally, patients have symptoms strongly suggestive of axial spondyloarthritis but their MRI scan does not show obvious inflammation. In these situations, rheumatologists look at the overall clinical picture, including symptoms, examination findings and blood tests, rather than relying on any one investigation in isolation.<br></p><h2>Is axial spondyloarthritis (AxSpa) treatable?<br></h2><p>The great thing about reaching a diagnosis is that this is a very treatable condition.</p><p><br>Like any autoimmune disease, it cannot currently be cured. However, there are many effective treatments available that can help control symptoms and prevent progression.</p><p><br>At diagnosis, we discuss a treatment plan aimed at putting the condition into remission. The goal is to help you return to a full quality of life and enjoy the activities you did before your symptoms began.<br></p><h2>What does treatment for axial spondyloarthritis look like?</h2><p>Treatment focuses on three main strategies:</p><p><br><strong>Physiotherapy and exercise</strong><br>This remains the cornerstone of treatment and has done for many years. Research consistently shows benefits in pain, fatigue and overall function. Supervised physiotherapy tends to be more effective than exercising alone, but both can help.</p><p><br>The best exercise is ultimately something you enjoy and can maintain long term. Exercise does not damage your joints, and both aerobic exercise and strength training are beneficial. A combination of the two is usually best.</p><p><br><strong>Anti-inflammatory medications</strong><br>Examples include ibuprofen and naproxen, although doctors often prescribe longer-acting anti-inflammatory medications such as etoricoxib.<br>These medications can be very effective, and around one-third of patients achieve good symptom control with anti-inflammatory treatment alone.</p><p><br><strong>Advanced biologic therapies</strong><br>Biologic therapies have transformed outcomes for patients with axial spondyloarthritis in recent years. These medications target specific parts of the immune system to reduce inflammation.</p><p><br>Examples include adalimumab, although several other biologic treatments are now available. Approximately 60-70% of patients respond well to these therapies.</p><p><br>Historically, these treatments were expensive, but as many have come off patent they have become increasingly accessible.</p><h2><br>What are biologic therapies like?<br></h2><p>Many people feel anxious when they first hear the term "biologic therapy", but in reality these medications have transformed the outlook for many patients with axial spondyloarthritis.</p><p><br>Most biologic medications are given as injections that can be administered at home, while some are given as infusions within a hospital setting. Your rheumatology team will discuss the most appropriate option for you based on your symptoms, lifestyle and medical history.</p><p><br>For many patients, these treatments significantly reduce pain and stiffness, improve quality of life and help prevent long-term joint damage.<br></p><h2>Living with axial spondyloarthritis<br></h2><p>Lifestyle measures can play an important role alongside medical treatment.<br>Maintaining regular physical activity, avoiding smoking, achieving a healthy weight and performing exercises recommended by your physiotherapist can all help improve symptoms and long-term outcomes.</p><p><br>Many patients find that a combination of appropriate medication, regular exercise and ongoing support from their rheumatology team allows them to continue leading full and active lives.<br></p><h2>What is the prognosis for axial spondyloarthritis?<br></h2><p>Axial spondyloarthritis is a chronic condition, but it is highly treatable. Modern therapies can provide significant symptom relief and help prevent long-term damage.</p><p>Many people with axial spondyloarthritis go on to lead active, fulfilling lives with appropriate treatment and support. Early diagnosis and treatment are particularly important, as they can significantly improve long-term outcomes.</p><p><br>It is also important to remember that the severe spinal fusion often seen in historical images of ankylosing spondylitis is now much less common. Earlier diagnosis, improved physiotherapy programmes and the development of biologic therapies have dramatically changed outcomes for many patients.<br></p><h2>When should I seek urgent medical attention?<br></h2><p>While most back pain is not caused by a serious medical condition, there are some symptoms that require urgent assessment.</p><p>You should seek immediate medical attention if you develop:</p><ul><li>New weakness in one or both legs.</li><li>Loss of bladder or bowel control.</li><li>Numbness around the genitals or buttocks.</li><li>Unexplained weight loss.</li><li>Persistent fevers or night sweats.</li></ul><p><br>These symptoms may indicate a different underlying condition and should be assessed urgently.<br></p><h2>Frequently Asked Questions<br></h2><h3>Can axial spondyloarthritis be cured?</h3><p><br>At present there is no cure for axial spondyloarthritis. However, modern treatments can be very effective in controlling inflammation, reducing symptoms and preventing long-term damage.</p><h3><br>Can I exercise if I have axial spondyloarthritis?<br></h3><p>Absolutely. Exercise remains one of the most important parts of treatment. Most patients find that regular movement improves pain, stiffness and overall wellbeing.</p><h3><br>Is axial spondyloarthritis hereditary?</h3><p><br>There is a genetic component, and the condition can run in families. However, not everyone with a family history develops the condition, and many people diagnosed have no affected relatives.</p><h3><br>Will I need an MRI scan?</h3><p><br>Many patients will undergo MRI scanning as part of their assessment, particularly if X-rays are normal. Whether you need an MRI will depend on your symptoms, examination findings and previous investigations.</p><h3><br>Can axial spondyloarthritis cause neck pain?</h3><p><br>Yes. Although symptoms often begin in the lower back or buttocks, inflammation can affect other areas of the spine, including the neck.</p><h3><br>Can axial spondyloarthritis be missed on an X-ray?</h3><p><br>Yes. Many patients have symptoms for years before changes become visible on X-rays. This is one reason MRI scanning has become such an important tool for diagnosis.</p><h3><br>Is axial spondyloarthritis the same as ankylosing spondylitis?</h3><p><br>Ankylosing spondylitis is part of the axial spondyloarthritis spectrum. The term axial spondyloarthritis is now used more commonly because it includes people with the condition both before and after X-ray changes develop.<br></p>

Back Pain and Axial Spondyloarthritis (axSpA): Symptoms, Diagnosis and Treatment

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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>

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How to deal with arthritis pain

Back Pain and Axial Spondyloarthritis (axSpA): Symptoms, ...

Avacopan controversy: could this vasculitis treatment be ...

EULAR 2026: 5 Key Breakthroughs in Arthritis and Rheumato...

What is enteropathic arthritis?

Is arthritis getting you down? Free patient event recording