Inflammatory arthritis
Inflammatory arthritis includes conditions such as rheumatoid arthritis, Systemic Lupus Erythematosus (SLE), psoriatric arthritis and other connective tissue diseases.
Key facts about inflammatory arthritis:
People with inflammatory arthritis also often have osteoarthritis, especially in the knee.
Sensitisation is very common in inflammatory arthritis.
Chronic or persistent pain is very common in people with inflammatory arthritis.
Whereas localised inflammation rarely persists beyond 6 to 12 weeks in people without inflammatory arthritis, it can persist beyond this time in people with inflamatory arthritis…and this needs a change in approach.
Localised inflammation can cause ongoing peripheral sensitisation (which ends by week 6-12 in non-inflammatory conditions). Peripheral sensitisation leads to more pain and often to more central sensitisation.
Fortunately, with the advent of steroidal anti-inflammatory medication such as prednisolone, disease modifying medications such as methotrexate and sulphasalazine and newer biological medications such as leflunomide and etanercept, effective treatment can often result in complete resolution of inflammation.
But there still might be pain, due to the multiple other reasons outlined in Kneed.
That is – pain can persist without inflammation.
How to manage joint pain if you have inflammatory arthritis:
The key is to recognise whether inflammation is present, that is, whether the inflammatory arthritis is active or inactive.
Red, swollen joints can be the most obvious sign of inflammation, and as inflammatory arthritis affect the whole body, multiple joints will typically be affected at the same time.
Your doctor can do blood tests of inflammatory markers such as CRP and ESR which will be elevated if inflammation is present.
1. If your inflammatory arthritis IS active – speak to your doctor about suitable medication to reduce inflammation.
A bag of ice or a cold pack can do wonders for inflamed joints.
Be careful not to over-exercise inflamed joints, use pain as your guide (see the exercise module for guidance).
2. If your inflammatory arthritis is NOT active – Kneed applies to you too! That is, once you can determine that your condition is not active, you can proceed safely with the Kneed program.
3. This also applies to the knee replacement – look for signs of inflammation and have your doctor or surgeon reassure you that you don’t have an infection (there is an increased risk in people on immunosuppressive medication).
Disclaimer: The Kneed trial only included people with osteoarthritis and not people with inflammatory arthritis. This means that the results from the Kneed trial may not be the same for people with inflammatory arthritis. However, based on clinical practice, Dr Johns would follow the Kneed program the same way for people with inflammatory arthritis (especially as there is no other evidence-based treatment to recommend).
