Management of Pain in Inflammatory Arthritis

Article kindly written by Lindsay Turner, Clinical Guidelines Programme Manager, British Society for Rheumatology

Pain is a common problem for people with inflammatory arthritis (IA), with many experiencing daily pain and reporting dissatisfaction with their arthritis pain. Optimising pain care in people with IA will therefore improve the lives of a substantial number of people across the UK.

The British Society for Rheumatology has convened a wide multi-professional working group with experts across rheumatology nursing, physiotherapy, occupational therapy, psychology, pharmacy, general practice and rheumatology consultants and resident doctors, with adult, paediatric and adolescent specialisms and also experts by experience.

The Guideline Working Group (GWG) clinical questions

A scoping exercise was carried out by the guideline working group (GWG) and the now published scope document outlines the clinical questions that will be answered across three key areas: 

• Assessment of pain, including what should be measured and how.
• Pharmacological treatments for pain, including analgesics, neuromodulators and immunosuppressants.
• Non-pharmacological treatments for pain, including exercise and physical therapy, psychological therapies, and ergonomics.

The scope also emphasises that people with IA require holistic pain care (reflecting the multidimensional and multifactorial nature of pain) and may present with pain-related symptoms in all healthcare settings, including primary care. Non-rheumatology specialist practitioners may feel less confident in assessing disease activity, making the MDT approach especially important. Collaborative working across healthcare boundaries, and ensuring equitable access to MDT services, is therefore crucial to providing evidence-based, equitable pain management.

Upon publication of the full guideline, the GWG will also provide commissioner-friendly dissemination materials, engage with specialist societies and Royal Colleges in guideline implementation and develop relevant audit and quality improvement tools to measure and improve pain care across the healthcare system.

The impact of the clinical questions

Rebecca Beesley is one of the Expert by Experience members of the working group, who has juvenile idiopathic arthritis (JIA), as well as a child with JIA. Rebecca said:

“Knowing that so many people of all ages, including children and young people, are affected by pain whilst living with inflammatory arthritis, I'm hopeful that this important BSR guideline will enable those people (myself included) to get the holistic approach to care that is so needed." 

Guideline working group (GWG) Co-Chair, Ian Scott, said:

“I am excited to be working with Experts by Experience and colleagues from across the rheumatology multidisciplinary team on this important guideline."

What's next?

The guideline will be developed using the methods and processes outlined in the  Creating Clinical Guidelines: British Society for Rheumatology Protocol. 

• The full scope can be accessed now in the BSR open-access journal, Rheumatology Advances In Practice, here.
• The full guideline is expected to be published in 2026.
• Access all the BSR guidelines via the guidelines homepage.