What is inflammatory arthritis?
Patients come to see me with inflammatory arthritis; this is a condition that causes pain, morning stiffness and can also lead to joint damage, if not treated.
There are lots of different types of inflammatory arthritis. Probably the commonest type is rheumatoid arthritis, which affects about 1% of the population. Rheumatoid arthritis usually starts in your 30s or 50s and often starts in the small joints of the hands and the feet. The joint become stiff in the morning for more than one hour and become painful and swollen.
Depending on the distribution of the joints involved, we can usually decide what type of inflammatory arthritis is causing the pain and swelling.
It’s very important to treat these conditions as early as possible; if untreated, they can lead to permanent joint damage. Starting medication early can arrest progression and abrogate the need for joint replacement surgery.
With modern treatment, we can often put patients into remission. What that means is that patients take medicines to suppress the inflammation and in time, the condition goes away.
These include psoriatic arthritis, which is a type of arthritis that affects up to 30% of people who have a skin condition called psoriasis.
Psoriasis causes a scaling rash on the elbows, knees and trunk and can also cause flaking of the scalp. The inflammatory arthritis can either affect the spine and sacroiliac joints or can involve the peripheral joints. It tends to cause asymmetric joint involvement. It can also cause tendonitis and enthesitis.
This is a separate condition, where patients develop inflammation in the spine and it often involves the large joints rather than the small joints.
Patients may also get inflammation in their spine, specifically the sacroiliac joints, which are the joints where the pelvis joins onto the base of the spine. Ankylosing spondylitis can also affect other joints in the spine. It usually starts with back pain below the age of 40 and is associated with significant morning stiffness in the spine. It often wakes patients in the middle of the night with stiffness or pain in the buttocks.
There are different ways to differentiate between these conditions. Patients come to visit me, and they will often sit and have a chat for 20 minutes; your medical history is quite important in soliciting what is actually the cause of your symptoms.
I’ll listen to you to ensure that you can get across what is causing your problem. I will then examine you. This usually involves you getting undressed to have all your joints and skin examined. A thorough physical examination is carried out including listening to your heart and lungs, as autoimmune disease can involve organs other that the joints. Conditions that cause arthritis can often cause systemic manifestations which may give a clue to the diagnosis.
After your appointment, you may also have blood tests, X-rays and scans on the same day.
If you require an MRI scan to look at a joint that is particularly inflamed, this can usually be organised very quickly; sometimes you’ll come back for some additional investigations depending on your preference.
If one joint is particularly swollen, I can aspirate that and take some fluid from the joint for diagnostic purposes and inject it with some steroid and anaesthetic on the same day. This simple procedure will often give enormous almost immediate relief. The benefits of the injection can often last for several months.
We’ll give around 95% of patients some form of treatment on the same day. The treatment that we offer in rheumatology is often medication; we have a pharmacist on site, too, so you can pick up your medication on the same day.
If you require a steroid injection into the joint, or an intramuscular injection, which is an injection which gives benefit to many joints, these can be done at your first appointment. These short treatments can settle the condition that is causing your joint pain while we’re working out what is causing the problem.
In some cases, it’s quite obvious from the first appointment that it’s rheumatoid arthritis, psoriatic arthritis or ankylosing spondylitis. In those cases, we might start you on a drug called a disease modifying drug to control your condition until it’s in remission.
We would look at reducing the dose of the drug you’re taking to maintain the improvement and in some cases to stop the drug completely.
In terms of aftercare, you would usually return to see us between one and two weeks after the initial appointment. This is to allow time to see how things settle or have improved. We’ll then decide at that point which other drugs you may require.
We would carry on seeing you approximately every four to eight weeks, until your condition has either improved or you are in remission. In people with rheumatoid arthritis, a single appointment and a single follow-up is all that’s required, to reach your diagnosis.
A vast majority of patients with all of these conditions now enjoy a very good quality of life. We aim to try and put your disease into remission as quickly as possible.