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Inflammatory arthritis

Key points about inflammatory arthritis

Inflammatory arthritis is long-term inflammation of your joints.
It happens when your body mistakenly uses its immune system to attack the area around your joints.
There are different types of inflammatory arthritis eg rheumatoid arthritis, psoriatic arthritis.
Symptoms include joint swelling, pain and stiffness but can also include tiredness, rash and weight loss.
It's treated with medicines to reduce swelling and pain.

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Inflammatory arthritis is long-term joint inflammation. Your body mistakenly uses its immune system to attack the area around your joints. This can damage your joints, and cause joint pain and loss of joint function.

Types of inflammatory arthritis are:

rheumatoid arthritis (RA)
psoriatic arthritis
enteropathic arthritis (related to inflammatory bowel disease)
reactive arthritis (follows an infection)
spondyloarthritis

Woman massaging sore hands Image credit: Canva

The symptoms of inflammatory arthritis are:

joint pain, tenderness, redness and swelling
stiffness lasting longer than 30 minutes when getting up in the morning or after periods of inactivity
other symptoms not related to the joints, eg, tiredness, skin changes and weight loss.

However, these symptoms can also occur in other forms of arthritis and other diseases.

Inflammatory arthritis can be difficult to diagnose as other conditions can have the same symptoms. Your healthcare provider will ask you about your symptoms and any other health conditions. They'll examine your affected joints. They may want to rule out other conditions such as septic arthritis (a bacterial joint infection) and gout.

If your doctor suspects you have inflammatory arthritis, or is concerned about your symptoms, they will suggest you have some blood tests. These include tests for antibodies in the tissues around your joints. You may also have joint X-rays to see if your joints are being damaged. An MRI scan may be done to look at your joints in more detail.

You are likely to be referred to a rheumatology specialist to confirm the diagnosis.

Changes to your symptoms over time help to work out what is happening. It can take many months to become clear what type of inflammatory arthritis you have, but treatment of your symptoms can start straight away.

Medicines for inflammatory arthritis are used to relieve pain, reduce swelling and slow or stop joint damage. Each person responds differently to arthritis medicines. This means you need to work with your rheumatologist (a doctor who specialises in arthritis and related conditions) to identify the treatment that works best for you.

When your arthritis symptoms are well controlled, your care will often be transferred back to your GP or nurse practitioner. They will monitor your treatment and refer you back to a rheumatologist if necessary.

Common medicines for rheumatoid arthritis include:

pain relief medicines such as paracetamol and codeine
non-steroidal anti-inflammatory drugs (NSAIDs)
oral corticosteroids (also called steroids)
disease-modifying anti-rheumatic drugs (DMARDs).

Pain relief medicines

Pain relief medicines such as paracetamol and codeine are often used along with other medication.

Non-steroidal anti-inflammatory drugs (NSAIDs)

NSAIDs such as ibuprofen, diclofenac and naproxen reduce inflammation and swelling of your joints. They start working quickly and relieve pain and swelling but do not reduce damage to your joints.

Taking NSAIDs is safe, but extra care is needed if you have high blood pressure, high cholesterol, diabetes, stomach ulcers, kidney problems or if you smoke.

Corticosteroids (also called steroids)

Corticosteroids are used at the start of treatment to reduce the pain and swelling of your joints, while waiting for other medicines to take effect. They may also be used to treat sudden flare-ups.

You may take these as tablets, such as prednisone, or as injections directly into the joint.

Disease-modifying anti-rheumatic drugs (DMARDs)

These medicines change the underlying condition rather than just treating the symptoms. They slow down the disease and its effects on your joints.
DMARDs should be started as early as possible after inflammatory arthritis has been diagnosed. They can only be started by a rheumatologist and you will need to have regular blood and urine tests to look for possible side effects and assess how well the medicine is working.

There are 2 main groups of DMARDs – conventional DMARDs and biological therapies.

- Conventional DMARDs include methotrexate, hydroxychloroquine, sulfasalazine, leflunomide and azathioprine. Most people are started on methotrexate because it's often the most effective and is well studied. It may take 2 to 6 months of treatment before the medicine is fully effective.
- Biological therapies, also called biologics, include tumour necrosis factor (TNF) inhibitors (infliximab, adalimumab, etanercept), rituximab, tocilizumab and secukinumab. They can be used if other treatments haven't worked well, and are usually used in combination with other DMARDs.

Important to know

If you take an ACE inhibitor or angiotensin II receptor blocker (ARB) (eg, cilazapril, enalapril, quinapril, losartan or candesartan) and a diuretic (eg, furosemide or bendroflumethiazide), taking a non-steroidal anti-inflammatory drug (NSAID) such as ibuprofen or aspirin in high doses) could harm your kidneys. The term for this is "triple whammy". Read more about the triple whammy and safe use of NSAIDs.(external link) Check with your doctor, practice nurse or pharmacist if you're not sure if you're taking an ACE inhibitor or angiotensin II receptor blocker (ARB) and a diuretic.

Although there's no cure for inflammatory arthritis, there are many things you can do to reduce pain and stiffness and to help prevent joint damage and disability.

Have regular check-ups with your doctor or nurse practitioner. They can advise you on treatment options and other things you can do to help reduce pain, swelling and inflammation. Your healthcare provider will monitor you after you start on preventative maintenance treatment, and you'll need to have regular blood tests.
Try some non-drug treatments, such as physiotherapy(external link), hydrotherapy(external link) and occupational therapy(external link). Ask your GP, nurse practitioner or rheumatologist about these options, and how you can access them.
Stop smoking as this can increase your risk of inflammatory arthritis.
Eating well(external link) and aiming for a healthy weight(external link) can improve your overall health and wellbeing.
Keep physically active(external link) to help keep your joints flexible and your muscles strong. Your healthcare provider will be able to give you general advice about physical activity. Tai chi, walking, swimming and gentle exercise classes are all excellent for arthritis. Your healthcare provider can refer you to Green Prescription for help to get more active, or to a physiotherapist for more detailed advice on specific exercises.
Also see Arthritis NZ – physical activity(external link) for more information about the benefits of keeping active.
Contact Arthritis New Zealand(external link). They offer a range of services to people who are affected with all types of arthritis, and several programmes that cover aspects of managing this group of conditions. You can also discuss individual self-management with a trained arthritis educator.