Who manages inflammatory arthritis?

Management of Inflammatory Arthritis: A Multidisciplinary Team Approach

Inflammatory arthritis is primarily managed by rheumatologists, who lead a multidisciplinary team that includes nurses, physiotherapists, occupational therapists, podiatrists, psychologists, and nutritionists to provide comprehensive care. 1

Core Management Team Structure

Primary Care Provider

• Initial identification of inflammatory arthritis symptoms
• Referral to rheumatologist for definitive diagnosis and treatment planning
• Ongoing co-management of comorbidities

Rheumatologist

• Leads the multidisciplinary team approach
• Responsible for:
  • Definitive diagnosis of inflammatory arthritis
  • Disease activity monitoring using composite measures (tender/swollen joint counts, ESR, CRP)
  • Prescription and management of disease-modifying antirheumatic drugs (DMARDs)
  • Regular assessment at 1-3 month intervals until treatment targets are reached 1

Rheumatology Nurse Specialist

• Interface between patients and other team members
• Provides critical functions:
  • Patient education about disease and treatments
  • Self-management support
  • Psychosocial support
  • Monitoring of disease-modifying treatments
  • Telephone advice lines
  • In some regions, may perform extended roles (injections, drug prescriptions) 1

Extended Team Members

Physiotherapist

• Provides:
  • Mobility exercises (recommended for 91-98% of patients)
  • Strengthening exercises
  • Patient education on physical activity
  • Assessment of inflammatory vs. non-inflammatory conditions 2, 3

Occupational Therapist

• Focuses on:
  • Maintaining ability to work
  • Adaptive equipment
  • Joint protection strategies

Other Specialists

• Podiatrists: Foot care and specialized footwear
• Psychologists: Support for mental health aspects
• Nutritionists: Weight management and dietary advice
• Surgeons: Consulted when surgical intervention is needed for joint damage 4

Patient Self-Management Support

Self-management is a critical component of inflammatory arthritis care that involves:

• Patient education about disease and treatments
• Problem-solving skills development
• Goal setting strategies
• Cognitive behavioral therapy when needed
• Physical activity promotion
• Lifestyle advice (smoking cessation, weight control)
• Mental health support 1

Treatment Decision Algorithm

1. Initial Diagnosis: Rheumatologist confirms inflammatory arthritis through clinical examination, laboratory tests, and imaging
2. Treatment Initiation: Rheumatologist prescribes appropriate DMARDs (e.g., methotrexate for rheumatoid arthritis) 5
3. Regular Monitoring: Disease activity assessed at 1-3 month intervals
4. Treatment Adjustment: Based on disease activity measures
5. Multidisciplinary Support: Engagement of appropriate team members based on individual needs

Common Pitfalls to Avoid

1. Delayed Specialist Referral: Physical therapists and primary care providers should promptly refer suspected inflammatory arthritis to rheumatologists to prevent irreversible joint damage 2

2. Underutilization of Team Members: Failure to engage appropriate specialists can lead to suboptimal outcomes

3. Overlooking Self-Management: Patient education and self-management strategies are essential components of care, not optional extras 1

4. Inadequate Treatment Monitoring: Regular assessment of disease activity using standardized measures is crucial for optimal outcomes 1

5. Neglecting Comorbidities: Cardiovascular disease and mental health conditions are common in inflammatory arthritis and require proactive management 1

The management of inflammatory arthritis has evolved significantly with new therapeutic options, but the multidisciplinary team approach with rheumatologist leadership remains the cornerstone of effective care to improve mortality, morbidity, and quality of life outcomes 6.