Rheumatoid arthritis pain
Living with rheumatoid arthritis (RA) can mean dealing with much more than occasional joint discomfort. Pain, swelling and stiffness may fluctuate from day to day, and during a flare even relatively simple activities—walking, getting dressed, using your hands or sleeping comfortably—can become difficult. Although modern treatments can control rheumatoid arthritis extremely effectively, some patients continue to experience significant pain even when the underlying disease is being appropriately managed.
Rheumatoid arthritis is an inflammatory autoimmune condition. Unlike osteoarthritis, which is predominantly associated with changes within an individual joint, rheumatoid arthritis occurs when the immune system mistakenly attacks the lining of the joints. This produces inflammation, swelling and stiffness and, if inadequately controlled, can eventually cause damage to the joint itself.
The hands, wrists, feet, knees and shoulders are commonly affected, although rheumatoid arthritis can involve many different joints. A characteristic symptom is prolonged stiffness after waking, together with aching, tenderness and swelling. Symptoms may occur on both sides of the body and can be accompanied by fatigue and a general feeling of being unwell during inflammatory flares.
The most important part of rheumatoid arthritis treatment is controlling the underlying inflammatory disease. This is usually managed by a rheumatologist using disease-modifying treatments, including conventional or biological therapies. Pain treatment should complement this care rather than replace it.
However, pain can sometimes persist even when inflammation is well controlled. Previous inflammation may have produced structural changes within a joint, surrounding muscles and tendons may become painful, or the nervous system itself can become increasingly sensitive after experiencing pain for a prolonged period. This is where a specialist Pain Medicine assessment can provide an additional perspective.
Treatment is tailored to the reason for your ongoing pain and may include several approaches:
Rehabilitation and pain management
● Individualised physiotherapy and strengthening programmes
● Maintaining joint movement and physical activity wherever possible
● Carefully selected pain medication
● Strategies to improve sleep, pacing and management of persistent pain
● Working alongside your rheumatology team to ensure inflammatory
disease remains appropriately controlled
Image-guided joint treatments
When one particular joint remains troublesome despite otherwise good control of rheumatoid arthritis, a targeted joint injection may sometimes help. Depending on the joint involved, I may use ultrasound or X-ray guidance to ensure treatment is delivered accurately.
Injections may be considered for painful knees, hips, shoulders or other appropriate joints, particularly when local inflammation or secondary degenerative change is contributing to symptoms. The purpose is to reduce pain sufficiently to improve movement and allow rehabilitation to progress more effectively.
Treating pain around the joint
Not all pain in rheumatoid arthritis comes directly from inside the joint. Tendons, bursae, muscles and surrounding nerves can also become painful. Ultrasound-guided injections, peripheral nerve blocks or trigger-point treatments may therefore occasionally be more appropriate than injecting the joint itself.
Radiofrequency treatment
For selected patients with severe persistent pain from a damaged knee or hip, particularly where surgery is unsuitable, needs to be delayed or has not completely resolved the pain, diagnostic nerve blocks followed by radiofrequency treatment may be considered. This targets the small sensory nerves carrying pain signals from the joint without removing or replacing the joint itself.
The key is recognising that rheumatoid arthritis pain can have more than one cause. Treating active inflammation is essential, but persistent pain deserves its own careful assessment rather than simply increasing painkillers.
My role as a Pain Specialist is therefore to work alongside your rheumatology care, identify what is continuing to generate your pain and determine whether rehabilitation, medication or a carefully targeted intervention could help. The aim is not simply to lower a pain score—it is to help you move more comfortably, maintain independence, sleep better and continue doing the things that are important to you.