Managing pain when you have inflammatory arthritis

What is inflammatory arthritis? 

Inflammation is your body’s natural response to injury. Inflammatory arthritis is a group of conditions where your immune system causes inflammation in your joints when it’s not needed.  

The main types of inflammatory arthritis are: 

• rheumatoid arthritis
• psoriatic arthritis
• axial spondyloarthritis, previously known as ankylosing spondylitis (axSpA)
• juvenile idiopathic arthritis (JIA). 

What are the symptoms of inflammatory arthritis? 

All forms of inflammatory arthritis can lead to pain, swelling and stiffness in your joints. Symptoms are often worse in the morning or after resting. 

Common causes of pain in inflammatory arthritis include: 

• inflammation of the joints 
• changes to how your nervous system processes pain 
• damage to the joints 
• irritation of your nerve endings. 

You may notice that your pain: 

• comes and goes (flare-ups) 
• is worse at certain times of day 
• is linked with fatigue or poor sleep. 

The inflammation can also affect other parts of your body, such as your eyes, skin or gut. 

Pain may be a constant part of life if you’re living with inflammatory arthritis, or it could come and go. But treatments, support and self-management can help you live well with pain. 

Talking about pain with your healthcare team 

Working out what could be causing your pain can help you and your healthcare team choose the most helpful options for you. Treatments aim to reduce inflammation, protect your joints and help you stay active and well. Finding the right approach can make a real difference to how you feel.  

But pain can still be a problem, even when inflammation is being treated. Medicines may not be enough on their own. Keeping active, pacing yourself and looking after your general health can also help. 

Your healthcare team should ask about your pain as part of your inflammatory arthritis care, so they can understand what support you may need.  

They may ask you to rate your pain on a scale from 0-10 and say how well you feel able to manage it. 

If your pain is not well controlled, you may need a more detailed review so your healthcare team can work out what is causing it. 

What is shared decision-making? 

Your healthcare team should take a whole-person approach to your care. This means looking at how your condition affects all areas of your life. 

They may ask you about: 

• your mood and mental health  
• sleep problems 
• fatigue 
• how your symptoms are impacting your daily activities. 

You should be involved in decisions about your treatment and support. This is called shared decision-making. 

You may find it helpful to think about your symptoms before your appointments and take along a list of questions or concerns. 

You could make a note of: 

• where your pain is 
• what it feels like 
• when it is better or worse 
• if it affects your sleep 
• how it makes movement more difficult. 

It’s OK to ask whether the way your pain is being managed could be reviewed. 

Medicines that treat inflammation 

When inflammation is well controlled, many people notice that their pain, stiffness and swelling improve. 

Medicines such as disease-modifying anti-rheumatic drugs (DMARDs), biologic therapies and targeted treatments calm the immune system and reduce inflammation, which can help reduce pain and prevent joint damage. 

Pain relief may be used along with these treatments to help you manage your symptoms. 

Your healthcare team should review your pain relief regularly. If a medicine is not helping, is causing side effects or is no longer needed, they can work with you to find the safest and most helpful options.

Keeping active 

Staying active is an important part of managing pain from inflammatory arthritis. It can feel difficult to stay active when you’re in pain. You might worry that movement will make things worse, but the right kind of activity is usually helpful and safe. 

Being active can: 

• reduce pain and stiffness
• improve joint movement
• strengthen the muscles around your joints
• support your health and wellbeing. 

There’s no need to do intense exercise. Gentle activity is often easier to keep up over time. 

You might like to try: 

• walking 
• stretching
• swimming or other movement in water
• strength training. 

At times when your symptoms make even gentle movement difficult, just do what you can. It's normal to have days when you need to take things more slowly. When your pain is worse, some gentle movement is usually better than complete rest, although you may need to reduce or adapt your activities. The aim is to see gradual progress over time. 

A physiotherapist can offer advice, support and tailored exercise, and show you how to move safely and adapt your routine during flare-ups. 

You may find activities in your local community, such as walking groups, swimming or water-based exercise classes, and strength and balance classes. Your local leisure centre or council may be able to help you find activities, too. 

Pacing your activities can help you manage your energy. The key is to avoid doing too much on a ‘good day’ then needing to recover for a long time afterwards. Pacing can be helpful if you have fatigue or pain, especially if it’s more severe some days than others. 

If you have new symptoms, or your symptoms become much worse, speak to your healthcare team. 

Healthy weight and diet

Eating well supports your general health and can help you manage your condition. 

Keeping to a healthy weight may help to: 

• reduce pain 
• improve how well you can move 
• reduce pressure on weight-bearing joints, such as the hips and knees. 

Managing your weight can be difficult when your arthritis symptoms make it harder to be active. But even small changes can make a difference. 

There’s no single diet that has been proven to reduce pain from inflammatory arthritis. Some people do find that certain foods affect how they feel, though. 

A balanced diet should include: 

• fruit and vegetables
• wholegrain foods, such as wholemeal bread, oats and wholewheat pasta
• sources of protein, such as beans, pulses, fish, eggs, lean meat and tofu
• healthy fats, such as olive oil, nuts, seeds and oily fish. 

If you would like support with weight management or diet, speak to your healthcare team.  

You can also find out more about keeping to a healthy weight on the NHS website:

Getting support with your pain 

Getting the right support can help you manage the impact of pain in your life. 

Support may include: 

• talking therapies
• mindfulness, breathing exercises and other relaxation techniques
• structured pain management programmes. 

Pain management programmes can help you develop skills for living with pain. This may include learning how to: 

• pace yourself 
• manage flare-ups 
• get better sleep 
• find ways to cope with the impact of pain on your daily life. 

Specialist pain services or pain clinics can assess more complex pain and work with you to find ways to manage it. Your healthcare team can advise whether referral to a specialist pain service may be helpful. 

Support with your mental health 

Your mental health can affect how you experience pain, sleep and fatigue. It's common to feel stressed, anxious or low when living with inflammatory arthritis.  

Looking after your mental health is an important part of managing pain. If these feelings are affecting your daily life, speak to your healthcare team. They can discuss the support on offer. 

NHS Talking Therapies can support people with anxiety or depression. In many areas, you can refer yourself without seeing your GP, although this varies depending on where you live. 

Support from others can also make a difference. This might include family, friends, healthcare professionals or connecting with other people living with arthritis. Sharing experiences and advice can help you feel less alone and more confident about managing your pain. 

You can find local support groups and services through Arthritis UK and connect with others through the Arthritis UK online community. Arthritis UK also offers support to children and young people with juvenile idiopathic arthritis – a form of inflammatory arthritis that affects young people – and their families. 

Other organisations provide information and support for people with inflammatory arthritis. These include the National Rheumatoid Arthritis Society (NRAS), National Axial Spondyloarthritis Society (NASS), Psoriasis and Psoriatic Arthritis Alliance (PAPAA) and Juvenile Arthritis Research (JAR). 

Some people find digital tools such as symptom-tracking apps help them manage their condition. These may help you build routines that work for you and learn ways to manage your arthritis. 

When you’re using digital tools or looking for health information online, choose websites you can trust such as the NHS, health charities and professional health organisations. The PIF TICK logo is the only trust mark for health information in the UK – look out for their badge on webpages, too. 

Support at work

If work is becoming difficult, speak to your employer about whether workplace adjustments could help.  

You may also find Arthritis UK's Work Adjustment Planner useful for planning conversations with your employer about support. 

You can find practical advice on managing work with inflammatory arthritis through the free WORKWELL Digital programme.

Making everyday tasks easier 

Small changes to how you do things can help reduce strain on your joints and make daily tasks easier to manage.  

You do not have to push through pain or do things in the same way you always have. Finding new ways to do things can help you stay independent and save your energy for what matters most. 

You might find some or all of these helpful:

• changing how you carry out certain tasks
• using equipment or aids to reduce strain
• planning your day to balance activity and rest
• breaking tasks into smaller steps and taking breaks. 

You can buy some simple aids, such as jar openers and kettle tippers, online or in shops. 

Ask your healthcare team for a referral to an occupational therapist if you feel you would benefit from extra support getting your house or routine better set up for you. 

You may be offered splints or orthotics, such as insoles or supportive footwear. These may help support your joints, reduce strain or make some activities more comfortable. 

Arthritis UK has information on joint protection, pacing and ways to make daily tasks easier. You may find the free MSKHUB Looking After Your Joints resource helpful, too.

You might also be interested in the Arthritis UK information on Footcare and Footwear.

Making a pain management plan

You might want to think about creating a pain management plan or toolkit. This involves listing the approaches, support and treatments that help you manage your pain. 

A pain management plan can help you feel more in control when your pain is particularly bad. 

Some of the approaches discussed in this booklet that you might include in your pain management plan are:  

• medicines that help you manage your symptoms 
• ways to stay active and adapt activities when needed 
• pacing your activities to manage your energy 
• things that help you relax and improve your sleep 
• what you do to take care of your mental health when you’re in pain 
• changes or equipment that can make tasks easier 
• who you contact when you need some extra support. 

It can take time and support to find what works best for you. Keeping track of changes in your pain and symptoms, such as what seems to work and what no longer does, can help you to review and adapt your plan. 

Research and new developments 

Researchers funded by Arthritis UK are working to better understand and treat pain in inflammatory arthritis. This includes why pain can continue even when inflammation is well controlled, and how it can be managed more effectively. 

TOPPIA: improving understanding of pain in inflammatory arthritis 

Arthritis UK is funding a major research programme called TOPPIA (Targeting of Peripheral Pain in Inflammatory Arthritis), led by researchers at King’s College London. 

The project is exploring why pain can continue over time, how it can be better recognised in care, and how treatment and support can be improved. It brings together researchers, healthcare professionals and people living with arthritis from across the UK. 

The aim is to help improve how pain is recognised and managed in the future.  

Renee’s story 

At first, I thought I’d just got a virus, but after feeling achy for weeks I went to the GP. They found psoriasis on my knees that I’d not noticed, and they were pretty sure I had psoriatic arthritis. 

A consultant confirmed the diagnosis of psoriatic arthritis, then my local hospital put me on methotrexate tablets.  

Within the first year I was in excruciating pain daily, needed a walking frame and wheelchair and wasn’t sleeping. This fairly quickly led to depression. 

It had a big impact on my family. Although I did try to do stuff, got a mobility scooter for the school run and had carers in at times, my oldest kids had to take on a lot of the things I couldn’t do, and I still feel guilty about that. 

As the pain got worse, I ended up spending time in bed because I couldn’t face anything. That led to weight gain because I was so inactive, which only made my physical and mental health worse. 

Two massive factors changed everything for me. Firstly, I started doing a Zoom chair exercise class and, as I wouldn’t leave my bedroom at that point, I got a dining chair brought upstairs and I'd do the class – even on days I didn’t feel like it. 

Secondly, we decided to get a dog, which motivated me. At that time, I could only walk 100 metres with a frame, slowly and uncomfortably, so I needed to build myself up to be able to walk the dog. My son Barney was 12 at the time and, to be honest, I would not be where I am now if not for Barney. He'd walk with me down the close and back, then a little further, and a little further.  

I committed to taking the dog out every day and some of those days were hard and very painful, but I built up to walking 3 kilometres. I didn’t see progress immediately but by making small changes and being consistent I got fitter. 

I found being outdoors also helped with my mental health. I'm not in continuous pain any longer - that pain really wore me down in the past. I do have flare-ups, but less and less since I’ve got fitter. 

It’s been life-changing because the pain and depression left me so isolated and my world incredibly small, but as I’ve got better, I’ve made lots of friends and have an amazing social life. 

That’s why I want other people with arthritis to know that they are not stuck forever. Little changes can all add up – those tiny steps can make a huge difference.

Everyone’s experience of inflammatory arthritis is different. Your symptoms and the way they affect you may be different from Renee’s.

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