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Addressing Inflammatory Arthritis: A Focus on Rheumatoid Arthritis and Solutions

Updated: Apr 22


In this blog I want to address a topic that affects millions of people worldwide, yet often remains misunderstood – difficult-to-treat rheumatoid arthritis. Although I'll be focusing on rheumatoid arthritis, the information I'm about to share applies to various forms of inflammatory arthritis, such as psoriatic arthritis, ankylosing spondylitis, gout, and more. The goal is to help you better understand why some cases of rheumatoid arthritis are challenging to manage and explore possible solutions.

It's important to note that when we use the term "difficult to treat," it's a medical phrase, not a judgment on the patient. No one is a difficult patient, but some medical conditions pose unique challenges that require careful consideration. In this blog, we'll explore why some forms of rheumatoid or inflammatory arthritis can be tough to manage and what can be done to address these challenges.

Defining Remission

In the world of rheumatoid arthritis, achieving remission is the ultimate goal. But what does remission mean? It means having no joint pain, morning stiffness, or swelling of the joints. If you meet these criteria, you're considered to be in disease remission. Your rheumatologist assesses these factors by examining your joints, asking about pain and morning stiffness. Complete remission is the aim, where the disease no longer affects your daily life except for taking your medications.

Shedding light on “Difficult to treat Rheumatoid Arthritis”

There are many reasons to continue to have pain and not achieve disease remission. Some of the most common include the following:

  • Wrong diagnosis: In my experience, one of the most common reasons to not achieve disease remission is that the diagnosis of rheumatoid arthritis is not actually correct. In this case wrong and patients may have another type of inflammatory arthritis which needs a different type of treatment. This is something I pay particular attention to when patients have been diagnosed with “seronegative '' rheumatoid arthritis.

  • Comorbid Conditions: Another challenge is that patients may have comorbid conditions, like osteoarthritis, alongside their rheumatoid arthritis. These secondary conditions can cause pain that isn't responsive to immunosuppressive treatments. Early diagnosis and intervention are crucial to prevent Osteoarthritis secondary to rheumatoid arthritis. Fibromyalgia or small fiber neuropathy can also mimic rheumatoid arthritis symptoms, causing widespread pain and deep skin discomfort. These conditions require different treatment approaches. Finally Gout and Pseudogout can sometimes coexist with gout or pseudogout, leading to similar inflammatory joint symptoms. Differentiating these conditions is crucial for effective treatment.

  • Medication Dependence: Patients may become dependent on medications like Prednisone, causing pain when attempting to decrease their dosage. It's essential to work closely with your rheumatologist to taper medications safely.

  • Psychological Factors: Chronic fatigue, depression, and other psychological factors can exacerbate pain perception, making it seem as though rheumatoid arthritis isn't under control.

  • Medication Tolerance: Some patients may experience side effects with multiple medications, leading to apprehension about trying new treatments. In these cases the issue is not so much that the medications are not helping, the issue is that patient cannot tolerate treatments. Open communication with your rheumatologist is key to finding the most suitable options for you.

In Summary

If you or someone you love is dealing with "difficult-to-treat" rheumatoid arthritis, there is a lot of hope and you should still aim to achieve disease remission. Excellent treatment options and lifestyle modifications are available to help you achieve full disease remission. It's essential to take the time to ensure your pain truly stems from your rheumatologic condition. Additionally, understanding your medications and working closely with your rheumatologist can make a significant difference.


Difficult-to-treat rheumatoid arthritis is a complex challenge, but it's a journey that can lead to remission and a better quality of life. I'm thrilled to be a part of this journey as a concierge care rheumatologist in Denver, Colorado, and I'm currently accepting new patients. I'd love to guide you toward remission and be your partner in this process.

Don't hesitate to reach out, and remember, there's always hope on the path to better health. Thank you for reading, and I hope this information has been valuable to you. If you have any questions or need clarification, please feel free to reach out.

You can watch the video related to this blog on our Rheumatology 101 Youtube channel

Are you, or someone you love, looking for a rheumatologist? Are you looking for a highly skilled and trusted physician who can finally help you find what you have whether autoimmune or inflammatory? Maybe you queried Google for the “best rheumatologist in Denver” and felt that no other arthritis clinic in Denver really seemed personable. Or maybe you are simply looking for a doctor who will listen to you and work with you to achieve disease remission? We think that UnabridgedMD has the best rheumatologist in Denver and the best rheumatology practice in Colorado and we would love to work with you.

You can schedule your first appointment at or schedule a free 15-minute discovery call with Dr. Amigues herself so that we can make sure we are the right fit for you, here is the LINK to do so.

We cannot wait to welcome you to the UnabridgedMD family!

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