Latest Advancements in Arthritis Treatment and Management

Arthritis can be a debilitating condition that can have a significant impact on many aspects of a person’s life. Arthritis is a condition that affects a person’s joints and can cause symptoms such as pain, inflammation, stiffness and reduced range of motion. Arthritis can get progressively worse over time and can cause chronic pain and difficulties performing everyday tasks, including walking, climbing stairs, sitting down and gripping. In severe cases, arthritis can cause permanent changes to the joints.

More than 10 million people in the UK have arthritis, equating to one in every six people. With arthritis having a significant impact on people’s lives, advancements in arthritis treatment and management are vital to improve quality of life and reduce the burden on the NHS.

The evolving landscape of arthritis treatment

Over the years, the field of arthritis treatment has changed from primarily focusing on pain relief to a more comprehensive approach. Traditional methods, such as nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids, still play a role, but the emphasis has moved towards more personalised and targeted therapies. The change in arthritis treatment and management is driven by an increased understanding of the different types of arthritis and the recognition that a one-size-fits-all approach may not be effective.

Traditionally, arthritis treatment followed a symptom-based approach that aimed to help people manage pain and inflammation. As research has advanced, there’s been a growing emphasis on understanding the underlying causes of arthritis, which can vary widely among individuals. Different types of arthritis, such as rheumatoid arthritis and osteoarthritis, have different causes and symptoms and require different treatments and more personalised therapeutic strategies.

Technological advancements in diagnostic tools, such as advanced imaging techniques and biomarker identification, help medical professionals to make a faster and more accurate diagnosis. This can enable doctors to develop more targeted treatment plans based on a more thorough understanding of the progression and severity of the person’s arthritis.

As the landscape of treatment changes, biologics, disease-modifying medicines and precision medicine have become more popular. Treatment is now tailored more to an individual patient’s needs, with medical professionals recognising that arthritis can manifest differently in different people. Medical professionals are now more likely to consider factors such as the patient’s age, overall health, lifestyle and personal preferences to create a tailored treatment plan to meet their specific needs. Known as the patient-centric model, this ensures individuals receive treatment that is not only effective but also takes into account their unique circumstances.

The evolving landscape of arthritis treatment also now embraces a multidisciplinary approach. In addition to medications, healthcare providers now work together with other professionals such as physical therapists, occupational therapists and nutritionists. This holistic approach allows medical professionals to focus on many different aspects of arthritis, including joint function, mobility and overall well-being.

The treatment of arthritis has evolved from a narrow focus on symptom relief to a more comprehensive, personalised and targeted approach. This change not only aims to treat the symptoms but also aims to slow the progression of arthritis, improve overall well-being and enhance the quality of life for individuals living with arthritis.

Biologics and disease-modifying drugs

The introduction of biologic drugs and disease-modifying antirheumatic drugs (DMARDs) has revolutionised arthritis treatment. Unlike traditional medications that usually suppress the whole immune system, biologics and DMARDs specifically target the key components of the immune system that are involved in the inflammatory response. They can create a targeted approach that not only improves the effectiveness of the medication but also minimises side effects, compared to other types of treatments. Recent advancements in biologic therapies include new medications with improved effectiveness and good safety profiles, as well as innovations in medication delivery methods, which can make taking medication more convenient for patients.

DMARDs work by targeting the arthritis itself, rather than just treating the symptoms. Sometimes known as immunosuppressants or immunomodulators, DMARDs change how the immune system works and can reduce pain and inflammation, reduce joint damage and bone erosion, preserve the joint’s functioning and slow the spread of arthritis.

There are multiple different types of DMARDs, including:

• Traditional synthetic DMARDs: This medication has been a popular arthritis treatment for many years. It can help to reduce inflammation and slow down damage to the joints.
• Biologic DMARDs: This type of DMARD specifically targets the immune system.

Biologic drugs are a type of DMARD derived from living organisms. They target specific components of the immune system or inflammatory pathways. In inflammatory arthritis, where the immune system mistakenly attacks the joints, biologics can intervene at key points to manage the inflammatory response.

There are multiple different types of biologics, including:

• Tumour necrosis factors (TNF) inhibitors: TNF plays an important role in the inflammatory process. Inhibiting TNF reduces inflammation in the joints, providing relief from symptoms and slowing the progression of arthritis.
• Interleukin inhibitors: This medication targets specific interleukins and helps to regulate the immune response. This can reduce inflammation in the joints.
• B-cell inhibitors: Targeting B-cells helps to reduce the production of antibodies that contribute to joint damage.
• Janus kinase (JAK) inhibitors: This medication interferes with the signalling pathways inside cells, which can control your body’s immune response and reduce inflammation.

Recent advancements in biologic therapies have focused on improving efficacy, safety and patient convenience. Some important developments include:

• The development of new biologics which target different cytokines and different pathways.
• Innovations in medication delivery methods, including subcutaneous injections and oral medication.
• Research into combination therapies, where different biologics are combined or biologics are combined with DMARDs, is underway.

Precision medicine and biomarkers

The rise in popularity of the precision method represents the change from a one-size-fits-all approach to arthritis. Healthcare providers now consider individual variations that are unique to each patient with arthritis. This includes:

• Genetic factors: Genetic factors can make some individuals more susceptible to arthritis than others. Genetic factors can also affect how different patients react to treatment. Precision medicine considers genetic factors and identifies genetic markers that are associated with an increased risk of arthritis. Medical professionals can then tailor treatments accordingly.
• Disease subtypes: There are more than 100 different types of arthritis, with each type having distinct mechanisms. Precision medicine classifies patients based on their subtype, allowing for targeted treatment.
• Tailored treatment plan: Rather than offering a generic treatment plan, healthcare providers will create a tailored treatment plan, that considers factors such as your age, comorbidities, lifestyle and your preferences.

Precision medicine allows for early identification of those at risk of arthritis and early intervention before serious joint damage occurs. Early treatment can alter the trajectory of the disease and improve long-term outcomes.

Biomarkers are measurable indicators that provide information about the physiological state of an individual. In arthritis, biomarkers play a crucial role in predicting disease progression and treatment response. These markers can be detected in blood, synovial fluid or imaging studies. Biomarkers help in the early diagnosis of arthritis. Additionally, certain biomarkers can help predict the likely course and progression of arthritis, which can help to predict prognosis and allow healthcare professionals to adjust your treatment plan accordingly.

Monitoring biomarkers during treatment allows for real-time assessment of the effectiveness of the treatment and the body’s response to anti-inflammatory medication and can help doctors make quick adjustments to treatment plans. Understanding an individual’s genetic make-up can predict their response to specific medications. Biomarkers guide doctors to choose medications based on their likelihood of success in a particular patient. This minimises the trial-and-error approach and allows patients to receive the most effective treatments from the beginning.

Innovations in pain management

Pain is a debilitating symptom for many people with arthritis. Innovations in pain management techniques can help to improve a patient’s quality of life. Some pain-relief techniques and medications that may become more popular include:

• Radiofrequency ablation
  Radiofrequency ablation involves using radiofrequency energy to heat and disrupt the nerves transmitting pain signals from the affected joint. This is a minimally invasive procedure that can provide long-lasting relief for certain types of arthritis-related pain.
• Peripheral nerve stimulation
  This technique involves implanting electrodes near peripheral nerves to deliver electrical impulses, which can disrupt pain signals. This is a new area of pain management that is being considered for certain individuals with arthritis.
• Neurostimulation
  Spinal cord stimulation and peripheral nerve stimulation devices are implanted to control pain signals and provide pain relief. These advanced interventions may be an effective pain relief for individuals with severe arthritis pain.
• Advanced analgesics
  Medications such as duloxetine and pregabalin, which were initially developed for other conditions, have proven effective in managing chronic pain, including the pain associated with arthritis. They modulate nerve signals and can be effective as part of a comprehensive pain management plan.
• Platelet-rich plasma (PRP) therapy
  PRP therapy involves injecting a concentrated form of the patient’s own blood into the affected joint. The growth factors in PRP can stimulate tissue repair and reduce inflammation, potentially providing pain relief.
• Cannabinoids
  Cannabinoid-based medications, such as medical cannabis, have gained attention for their potential role in pain management. Some individuals with arthritis report relief from pain and improved sleep with the use of cannabinoids.

Lifestyle and diet modification

Lifestyle changes can play an important role in reducing the symptoms of arthritis and the impact the disease has on a person’s life. These changes can help to reduce inflammation, reduce pain and improve quality of life. Some changes you can make include:

Improvements to your diet

Making changes to your diet and healthier eating can help to improve the symptoms of arthritis in multiple ways. Some food changes you could make include:

• Anti-inflammatory foods: A diet high in anti-inflammatory foods, such as fruits, vegetables, whole grains, fatty fish, nuts and seeds, can help to reduce inflammation.
• Omega-3 fatty acids: Foods high in omega-3 fatty acids, such as fatty fish, flaxseeds and chia seeds can also help to reduce inflammation.
• Vitamins and minerals: A diet rich in vitamins and minerals can help relieve the symptoms of arthritis. For example, vitamin D can help to reduce inflammation and calcium can help to support bone health.
• Limiting processed food: Highly processed foods, sugary drinks and excessive intake of red meat may contribute to inflammation. Limiting these foods and opting for a diet with more plant-based and whole foods can be beneficial.
• Hydration: Staying hydrated is essential for joint health. Water supports the lubrication of joints and helps maintain overall bodily functions.

Exercise

Regular exercise, including low-impact activities such as walking, swimming and cycling, helps maintain joint flexibility and range of motion. These exercises are gentle on the joints and can improve cardiovascular health and overall well-being. Strength training can strengthen the muscles around the affected joint, reducing the stress on the joint. Weight-bearing exercises, such as walking or moderate aerobics, contribute to maintaining bone density and supporting joint health.

Weight management

Excess body weight places additional stress on weight-bearing joints, such as the knees and hips. Weight management is crucial in arthritis as it can alleviate pain, slow down joint damage and improve mobility. Losing excess weight can also help to reduce inflammation in the body, which can reduce the symptoms of arthritis.

Rest and sleep

Ensuring you get enough rest and quality sleep is essential for managing the symptoms of arthritis. Arthritis can cause fatigue and exhaustion, making it even more important that you get enough sleep and rest throughout the day. Sleep also helps to support your mental health and your overall physical health and can help with pain management.

Assistive technology and devices

Assistive devices, including specially adapted equipment, can help to improve the quality of life for people with arthritis and allow them to be more independent. Assistive devices can help you perform everyday tasks with less pain. Adaptive equipment can also help to protect your joints from damage. There are many different types of assistive devices available, depending on which joint is affected and how severe your arthritis is.

Assistive devices for arthritis of the hands, fingers and wrists:

• Extended handle tools: These tools have a gripping mechanism, making it easier to grip and reducing the strain on your hands and wrists.
• Touch-activated light switches: To reduce the pressure on your hands and fingers.
• Lever handles: Levers are attached to door knobs and handles to make it easier to open and close doors and cupboards.
• Foam pipe insulation around utensils: This makes utensils, such as kitchen tools and hairbrushes, easier to grip.
• Rocker knives: Rocker knives have two handles and rock side to side, making chopping vegetables more manageable.
• Chopping boards with spikes: This secures the vegetables in place, reducing the pressure on your hands.
• Electrical tin opener and jar openers: Reduces the stress on your hands and wrists.
• Adapted kitchen utensils: Utensils with larger handles and angled handles can help if you have a weak grip or need to keep your wrist in a neutral position.
• Kettle tipper and two-handled teapot: These items can reduce the strain of gripping and holding the weight of a kettle or teapot when making a cup of tea.
• Button hooks and zipper pulls: To help you fasten and unfasten buttons and zips, making it easier to get dressed independently.
• Long-handled shoe horns: To help you take your shoes on and off without putting excess pressure on your hands and wrists and without needing to bend down (also protecting your back).
• Key turners: This increases the grip on the keys to make holding and turning the key more manageable.
• Tap turners: These are placed over taps to increase the area for gripping.
• Pen grippers: Pen grippers can make it easier to control the pen and can reduce the strain on the hands when you are writing.
• Self-opening scissors: These specially adapted scissors have a spring to make them easier to open and a larger grip for the handles.

Assistive devices for arthritis of the back, knee and hip:

• Handrails in the bathroom: This allows you to get out of the bath or shower safely.
• Mobility devices: A mobility device or aid, such as a cane, crutches or a walker, may be recommended to remove the pressure on your hip, knee or feet. They are also recommended if your arthritis affects your balance.
• Shoe inserts: If you have arthritis in your knee or feet, shoe inserts can ease the pain and slow down joint degeneration.
• Orthopaedic shoes: These are customised shoes that support your feet. They may also be required if arthritis has caused deformities in your feet or toes.
• Braces and splints: A brace can help to align your joint, ease pain and provide your joint with support. A splint can prevent the joint from flexing or rolling.
• A raised toilet seat: This can make it easier to stand up and sit down.
• Compression garments: Compression socks provide targeted compression and support to swollen or inflamed joints, relieving pain and stiffness associated with arthritis while promoting circulation. Compression gloves and sleeves can also be used for arthritis in the hand or elbow.

Specialised assistive technology:

• Voiced-activated home automation: Voice-controlled smart home devices, such as thermostats, lights and door locks, allow individuals with arthritis to control household appliances and adjust environmental settings easily, reducing the need for manual manipulation and physical exertion.
• Assistive computer accessories: Ergonomic keyboards, computer mice and trackpads with larger keys, tactile feedback and customisable settings accommodate individuals with arthritis-related hand pain or stiffness, allowing them to use computers and electronic devices more comfortably.
• Activity trackers: Wearable fitness trackers equipped with motion sensors and activity monitors can help you set and track daily exercise goals, monitor physical activity levels and maintain a healthy lifestyle. They can also encourage regular movement and exercise.

Telehealth and remote monitoring

Technology-enabled care services (TECS), also known as telehealth, is the use of technology, specifically technology devices and apps, to support patients remotely. The increase in telehealth and remote monitoring in arthritis care has increased, particularly in response to the COVID-19 pandemic. These technologies have transformed the way healthcare is delivered and provide multiple benefits, including increased accessibility to care for individuals with arthritis.

Some telehealth and remote monitoring practices that can be effective in arthritis care include:

• Virtual consultations
  People with arthritis can consult with their doctors remotely via online video platforms. This reduces the need for in-person appointments and can make seeing a doctor more accessible for people with arthritis. It also ensures continuity of care, allowing patients to receive timely follow-up appointments, medication management and ongoing support. Virtual consultations can also be beneficial to people living in remote areas, who may have to travel long distances to see an arthritis specialist.
• Remote monitoring
  Healthcare providers can remotely monitor arthritis symptoms, disease progression and treatment adherence through telehealth platforms. Patients can report changes in symptoms, medication side effects or disease flare-ups, which can encourage quick intervention and allow doctors to adjust treatment plans as needed.
• Patient education and counselling
  Telehealth offers patients access to education and counselling sessions online. This empowers people with arthritis to learn about their condition and learn the importance of self-management strategies and lifestyle modifications from the comfort of their homes.
• Digital health platforms
  Integrated digital health platforms offer secure communication channels, access to electronic health records and telemedicine capabilities, which can facilitate improved collaboration and communication between patients, healthcare providers and multidisciplinary care teams.
• Medication reminders
  Medication reminders help individuals with arthritis manage their treatment effectively. Automated alerts can remind people to take their medication and refill notifications can remind people that their medication is running low and can reduce the risk of missed doses.

Telehealth and remote monitoring offer improved convenience and flexibility for people with arthritis. It can be particularly beneficial for people with mobility issues and transportation challenges. Telehealth allows quick access to arthritis care, which enables prompt evaluation, diagnosis and treatment. This can help to reduce the risk of the disease progressing, minimise joint damage and improve long-term outcomes.

For some patients, telehealth can improve their engagement and encourage them to participate in their care, track their health metrics and communicate with their healthcare providers proactively. This can lead to improved health outcomes and an improved quality of life for people with arthritis. However, telehealth and remote monitoring will not work for every patient. Some people with arthritis struggle to engage with online treatment so it is important to assess the appropriateness of this type of care before prescribing it.

Clinical trials and research breakthroughs

Ongoing clinical trials and research breakthroughs in arthritis treatment are continually expanding our understanding of arthritis and paving the way for new and improved therapeutic interventions. Several promising therapies are currently in development, which target various aspects of arthritis. Although many of these treatment options are not yet available to people with arthritis, they represent a promising future for arthritis treatment.

Some clinical trials and research that are currently ongoing are:

• Janus kinase (JAK) inhibitors
  JAK inhibitors have proven effective in treating rheumatoid arthritis by inhibiting specific Janus kinase enzymes involved in the inflammatory process. Ongoing clinical trials are evaluating their safety and efficacy in other forms of arthritis, including psoriatic arthritis and ankylosing spondylitis.
• Interleukin inhibitors
  As mentioned earlier, biologic therapies targeting interleukins have shown promise in treating psoriatic arthritis and axial spondyloarthritis. New agents are being investigated in clinical trials for their potential to provide improved arthritis control and improved symptoms.
• Gene therapies
  Gene therapy is designed to modify the underlying genetic factors that contribute to arthritis. For example, engineered chimeric antigen receptor (CAR) T cells are being tested to target and eliminate autoreactive immune cells implicated in the pathogenesis of rheumatoid arthritis. Gene editing has the potential to correct genetic mutations that may be causing arthritis, controlling immune responses and preventing disease development in at-risk individuals.
• Small molecule inhibitors
  Small molecule inhibitors are being explored as potential treatments for various forms of arthritis. These agents target specific signalling pathways involved in inflammation and joint destruction.
• Stem cell therapy
  Stem cell therapy is a promising treatment option for regenerating damaged joint tissue and managing the body’s immune response in arthritis. Clinical trials are investigating the safety and efficacy of stem cell transplantation in conditions like osteoarthritis and rheumatoid arthritis.
• Nanomedicine
  Nanotechnology-based drug delivery systems offer the potential to enhance the efficacy and safety of arthritis treatments. Nanoparticle formulations of anti-inflammatory drugs can improve drug targeting and tissue penetration while minimising side effects.
• Epigenetic modulators
  Epigenetic modulators, such as histone deacetylase inhibitors and DNA methyltransferase inhibitors, are being investigated for their ability to regulate gene expression and control inflammatory responses in arthritis. These agents have the potential to provide disease-modifying effects and long-term remission.
• Microbiome modulation
  Emerging evidence suggests that dysbiosis of the gut microbiome may contribute to arthritis pathogenesis. Therapies aimed at controlling the microbiome composition, such as probiotics, prebiotics and faecal microbiota transplantation, are being investigated for their potential to alleviate arthritis symptoms and restore immune homeostasis.

Patient-centric care

Arthritis treatment has changed over the years to include a strong focus on patient education and empowerment and patient-centred care. Informed patients are better equipped to actively participate in their care, make lifestyle modifications and follow their treatment plans. This collaborative approach can create a feeling of empowerment and lead to improved symptom management and improved long-term outcomes.

Patient-centred care should prioritise a patient’s preferences, their quality-of-life goals and personal health goals. Arthritis is a complex condition that can affect various aspects of a person’s life, including their physical, emotional and mental health and social well-being. Patient-centric care acknowledges this complexity and addresses each individual’s needs comprehensively. A holistic approach to the patient experience can also consider comorbid conditions and how these may impact treatment options and care.

Patient-centred care should aim to engage patients in their care, from start to finish. When patients feel heard, respected and involved in their care, they are more likely to actively engage in their treatment. Patient-centric care promotes trust, communication and collaboration between patients and healthcare providers, which can lead to better treatment outcomes. Open communication can also strengthen the relationship between the patient and the healthcare provider, building trust and increasing engagement.

As part of patient-centred care, healthcare professionals should:

• Focus on shared decision-making and educating patients with arthritis knowledge to empower them to make informed decisions about their care.
• Respect patients’ preferences, priorities and goals and consider how different treatments (including their side effects) can align with preferences.
• Work with patients to set realistic and achievable treatment goals.
• Ensure continuous and open communication with patients and encourage patients to ask any questions or express any concerns they may have.

Looking ahead

Arthritis treatment has increased exponentially in recent years, making the disease more manageable and improving long-term outcomes. However, there is still a lot of work to be done, with many people with arthritis still living in pain and having a reduced quality of life.

Looking ahead, the future of arthritis treatment looks promising, with ongoing research and advancements having the potential to significantly improve the symptoms of arthritis or even offer a cure for this debilitating condition. As well as the clinical trials and research breakthroughs listed above, further developments in precision medicine will hopefully lead to more personalised and targeted treatment for arthritis. Genetic profiling, biomarker identification and advanced imaging techniques will enable healthcare providers to tailor treatment plans to each individual’s unique disease characteristics and treatment responses.

Additionally, innovative immunomodulatory therapies will continue to emerge, targeting specific components of the immune system involved in arthritis. These therapies aim to better control arthritis with fewer side effects by controlling the body’s immune responses more selectively. Regenerative medicine approaches, including stem cell therapy, tissue engineering and growth factor-based interventions, may one day be able to repair damaged joint tissue and promote regeneration in arthritis. These therapies may offer alternatives to traditional joint replacement surgery and help preserve joint function in the long term.