harassedacademic

There's a real push to develop good treatments for arthritis, and other painful conditions at the moment. This is not just because there are lots of people round the world who have chronic pain, but also because some of the pain killers that are used have the problem that people can become dependent on them. The opioids are presenting such a problem, especially in the United States, where there are lots of things being done to enable the development of new pain killers. Of course, considering prednisone, which is used to try and control the disease and not just as a pain killer there are additional challenges in trying to get better replacements.

The ultimate aim would be to try and tackle the arthritis disease process, as well as the pain. As I said in an earlier reply there isn't a direct relationship between the joint damage and the pain people experience, so joint damage can be present without pain, and vice versa. Trying to stop the disease process depends on the type of arthritis - osteoarthritis and rheumatoid arthritis are very different, but there are new treatments in development that are aiming to stop disease and/or deal with the pain. There are lots of fairly new biotech companies doing really interesting work in this area, developing better pain killers, and early work in tissue engineering and regeneration is working on repairing the damage. For rheumatoid arthritis, there are biologic drugs that, that in many people can control the disease and hence the joint damage. Unfortunately drug development is a length process, but there are new drugs coming through clinical trial at the moment, such as the anti-nerve growth factor treatments for osteoarthritis pain, that look very promising.

Interesting question, and a topical area considering the wide discussions on diet and health. Most of the investigation and evidence in this area is indeed limited, because these interactions are very complicated. It's clear that there are some associations between diet and rheumatoid arthritis. Some diets such as the Mediterranean diet rich in wholegrains, legumes, fruit, vegetables, good olive oil and low red meat intake MAY be associated with a lower risk of rheumatoid arthritis. We must remember that an association is not the same as a cause - so we couldn't say, for example that a particular diet causes rheumatoid arthritis or makes it worse. As far as the influence of diet on rheumatoid arthritis itself goes, there is some evidence that, for example n-3 polyunsaturated fats (PUFA) supplementation might reduce inflammation and help rheumatoid arthritis in that respect, but many of these trials are limited because of the complex nature of the interactions between the disease and diet.

There is growing evidence for a contribution for gut bacteria influencing chronic inflammatory and autoimmune diseases, such as arthritis, and particularly rheumatoid arthritis, yes. Again, this sort of evidence gives us information on associations between the diseases and the gut bacteria - most of these diseases have many different factors that influence them, but the evidence is certainly growing that gut bacteria are something that we should not ignore!

Joint pain can certainly happen without any evidence of any changes in the joints themselves, and it's very difficult for people when this happens, as I am sure it is for you. If there is no active joint disease, and inflammation, many investigations will detect very little, and X-rays can often show no change in joints even when pain is present. Blood tests are looking for specific things, and again pain can be present without any of those changes being able to be detected in the blood.

We always associate pain with something going wrong - that's what we believe drove the evolution of the nervous system ability to signal damage with this sort of sensation, so we would know that we might or had damaged ourselves, and we'd be able to protect ourselves from further injury. When we have pain and can find no obvious cause it is really difficult, because the pain is a real experience but there is no concrete event or injury that it can be linked to. Sometimes people in pain are not believed, just because of this lack of evidence of any obvious 'cause', and that is a very difficult thing to deal with.

All I can suggest is that you keep talking to your doctor, and maybe discuss whether you should be referred to a rheumatologist?

There's certainly a lot of work going on in this area at the moment, in regenerative medicine, and so I don;t think it's too soon to be thinking about it as a possible treatment. There are some very early stage clinical trials on this, still at the point of working out whether it's safe, whether it will be effective as a treatment, and whether it is feasible in terms of getting real repair to the joint. Many people are very hopeful about this approach but it's early days. Of course, we don't yet have any ways to stop or modify the disease and joint damage in osteoarthritis, and no way yet to repair the damage done, so this is a really important research area to pursue.