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Living Well with Inflammatory Arthritis

IA patients frequently report significant pain and fatigue in spite of good disease control.Our project aims to improve their ability to manage these symptoms through non-pharmacological interventions

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  • Proposal
  • 2019

Meet the team


  • Dr Sandeep Mukherjee
  • Darren Cains
  • Phoebe Prock
  • Frances Coldstream
  • Meherzin Das
  • Ann Smith

What is the challenge your project is going to address and how does it connect to your chosen theme?

About 50% patients with IA could report significant pain despite disease modifying therapy and up to 20% could have pain hypersensitivity due to central sensitization. The severity of pain does not correlate with joint damage or disease activity measures. Pain can also be associated with fatigue and psychological distress and these factors heavily impact on patients’ lives and their utilisation of health resources including clinic appointments and telephone advice line usage.

We know that the best way to manage these patients with persistent pain is with a combination of education, access to ‘graded exercise’ options and psychological interventions.

Our current outpatient clinics have limited capacity in time and personnel to adequately address these complex issues. We therefore wish to offer a new approach that would improve the quality of life of this group of patients and empower them to self-manage their symptoms in a better way as well as reduce the demand on scarce NHS resources.

What does your project aim to achieve?


Rheumatology patients who have had treatment for IA for 2+ years and have had their joint inflammation brought under control with medications but continue to report significant pain.


· Improve patients’ experience by addressing pain and suffering

· Provide a holistic service dealing with physical, emotional, psychological and social aspects of pain

· Offer an alternative to traditional OP appointments

Patients who are likely to benefit will be identified during OP clinics. Those willing to take part will be referred to an ‘Orientation Session’ from where they be able to try 1 or more options:

1. Exercise programme

2. Pain management education

3. CBT and/or mindfulness sessions

We will conduct baseline survey of potential patients to identify the likely demand.

We expect the project will improve patients’ confidence and ability to manage their pain and fatigue and we would like to demonstrate this by undertaking a survey of the participants both before and after their enrolment.

How will the project be delivered?

The project will be developed and delivered by a multidisciplinary team involving:

· Patient Representative

· Consultant Rheumatologist

· Rheumatology Practitioners

· Physiotherapist

· Clinical Psychologist and Lead for Dorset Pain Management Service (Q member)

· Physiotherapist for Dorset Pain Management Service

· Improvement Facilitator (Q member)

· Rheumatology Specialty Doctor (BACP registered counsellor)

We have full support of the senior management team and Directorate. We have a governance structure to deal with any risks.

We will be working closely with members of the Dorset Pain Management Service team who won Health Foundation’s Shine award for Innovation in HealthCare in 2011 for improvement initiative about prevention of chronic back pain and will draw on their experience of implementing quality improvement.

Moreover, given the planned changes in delivery of healthcare across Dorset the project has potential for being spread out to the whole of the county in the future.

What and how is your project going to share learning throughout?

· At a local level we would be looking at providing regular feedback to departmental colleagues throughout the project, for example, the findings from the patient surveys

· We would aim to present the project at our Directorate’s half yearly Governance symposium on Quality Improvement and also at our Trust’s annual Patient Quality and Safety Conference

· The learning could be shared more widely within Dorset with our healthcare partners including Poole Hospital NHS Foundation Trust and Dorset Healthcare University NHS Foundation Trust

· The innovation can be shared via Q for those who would be looking to reshape their outpatient services for such patients who are also suffering from chronic pain

· Finally we would aim to do poster and oral presentations at national conferences and submit articles for publication in peer reviewed journals

How you can contribute

  • We would like to find out from other Q members if they have any information regarding the following:
  • • Do you already run a service like this for inflammatory arthritis patients?
  • • Do you have any previous learning from developing pain management tools or services for inflammatory arthritis patients that would be relevant to us?
  • • Do you know someone who is driving innovation like this already and, if yes, can put us in touch?
  • • Do you have any suggestions or advice with regards to our improvement initiative?

Plan timeline

13 Nov 2019 Funding decision announced at Q Conference
20 Nov 2019 Identification of 1st Patient Cohort (and patient representa
2 Jan 2020 Baseline Patient Survey to identify likely demand
3 Feb 2020 Co-design Workshop: Mapping of Alternative Pathway
17 Feb 2020 Mapping of resources begins
28 Feb 2020 Start of pilot
24 Apr 2020 End of pilot and evaluation
1 May 2020 Conclusions, experience sharing and onward plan
15 May 2020 Co-designed Knowledge Sharing Event (tbc)
5 Jun 2020 Identification of 2nd cohort of patients


  1. Hi Rachel,

    not sure if Escape Pains covers inflammatory arthritis too, but as a model for improvement that you could learn from, it may be worth a look. If you google it you will find it has rolled out from the HIN in South London to other areas. It has third sector support which is key to raising awareness I often find.

    Good luck

    best wishes

    Anna 😊

    1. Thank you Anna - we've had a look at Escape Pain on your recommendation and definitely think there are some areas we can draw upon. Thank you very much!

  2. References

    1. Rifbjerg-Madsen S, et al. (2017) Pain and pain mechanisms in patients with inflammatory arthritis: A Danish nationwide cross-sectional DANBIO registry survey. PLOS ONE 12(7): e0180014.

    2. Sokka T, et al. Scores for functional disability in patients with rheumatoid arthritis are correlated at higher levels with pain scores than with radiographic scores. Arthritis Rheum. 2000;43(2):386–389

    3. Ferreira R, et al. Suppressing inflammation in rheumatoid arthritis: does patient global assessment blur the target? A practice-based call for a paradigm change. Arthritis Care Res 2018;70:369–78

    4. McWilliams D., (2017). Pain mechanisms in rheumatoid arthritis. Clin. Exp. Rheumatol. 35(Suppl. 1), 94–101.

    5. Morley S, et al. New developments in the psychological management of chronic pain. Can J Psychiatry. 2015;60:168–175.

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