What is the appropriate medical intervention for a given condition?

Management of Chronic Pain in Inflammatory Arthritis and Osteoarthritis

For patients with chronic pain from inflammatory arthritis or osteoarthritis, implement a stepwise approach beginning with patient education and self-management, progressing through physical interventions and psychological support, with pharmacological therapy reserved for later stages when non-pharmacological measures prove insufficient. 1

Stepwise Treatment Algorithm

Step 1: Initial Assessment and Education (All Patients)

• Provide immediate access to educational materials including written brochures and online resources that specifically address staying active and sleep hygiene guidelines 1
• Deliver psychoeducation during clinical encounters to explain the pain mechanisms and expected treatment trajectory 1
• Offer self-management interventions either through online platforms or face-to-face programs to empower patients in their own care 1

Step 2: Physical and Lifestyle Interventions (If Indicated)

Physical Activity and Exercise

• Appraise the patient's ability to initiate physical activity independently before determining the level of intervention needed 1
• Refer to a physiotherapist for individually tailored graded physical exercise or strength training if the patient cannot initiate activity without professional guidance 1
• Consider multidisciplinary intervention including cognitive-behavioral therapy when psychosocial factors such as fear of movement or catastrophizing cognitions underlie sedentary behavior 1

Orthotics and Assistive Devices

• Offer orthotics (splints, braces, gloves, sleeves, insoles, shoes), daily living aids, or assistive devices (canes, rollators) when pain during activities of daily living impedes functioning 1
• Refer to an occupational therapist who will educate about joint protection, assess orthotic needs, provide training in device use, and arrange for customized fitting 1

Weight Management

• Explain that obesity contributes to pain and disability when the patient is obese 1
• Discuss accessible weight management options including referral to dietitian, psychologist, community lifestyle services, or bariatric clinic/surgery 1

Step 3: Psychological and Social Support (If Indicated)

• Provide basic social and psychological management support or refer to specialized services (psychologist, social worker, self-management program, CBT, multidisciplinary treatment) when social variables or psychological factors interfere with effective pain management 1
• Discuss treatment options with the patient and primary care physician when psychopathology such as depression or anxiety is present 1

Sleep Interventions

• Inquire about specific causes (pain, persistent worrying, poor sleep habits) when sleep disturbance is reported 1
• Offer education about good sleep hygiene practices as initial management 1
• Refer to a sleep-focused therapist, program, or specialized sleep clinic if sleep remains severely disturbed despite basic interventions 1

Step 4: Pharmacological and Joint-Specific Treatment (If Indicated)

• Ask about existing use of prescribed and over-the-counter pain relief including homeopathic remedies to assess for safe dosing and appropriate frequency 1
• Refer for specialist or medical advice if concerns exist about current medication use or if additional pharmacological treatment may be indicated 1
• Follow disease-specific pharmacological recommendations as the evidence for specific pain treatments differs by disease type 1

Step 5: Multidisciplinary Treatment (If Indicated)

• Consider multidisciplinary intervention when more than one treatment option is indicated (e.g., psychological distress combined with sedentary lifestyle) and monotherapy has failed 1

Common Pitfalls and Caveats

• Do not delay specialist referral when multiple treatment options are indicated or when initial interventions fail 1
• Avoid prescribing orthotics without proper occupational therapy assessment and training, as improper use may worsen symptoms 1
• Do not overlook psychosocial factors such as fear of movement or catastrophizing, which require specific cognitive-behavioral interventions rather than purely physical approaches 1
• Recognize that treatment effects vary by specific disease type (inflammatory arthritis vs. osteoarthritis), so recommendations should be interpreted within the context of the patient's specific diagnosis 1