A five-year, £3m research programme, led by King’s College London, aims to tackle one of the most persistent and under-recognised challenges in inflammatory arthritis: chronic pain. This horizon horizon-scanning feature explains more.
Inflammatory arthritis encompasses a range of autoimmune conditions, including rheumatoid arthritis, psoriatic arthritis and axial spondyloarthritis, affecting more than one in 100 people in the UK.
Symptoms commonly include swollen joints, stiffness, fatigue and pain, often resulting in lower mobility, reduced ability to work and impaired quality of life.
Chronic pain and unmet needs in inflammatory arthritis
Although advances in disease-modifying therapies have transformed outcomes for many patients, chronic pain remains a major unmet clinical need. Current treatment strategies are largely focused on suppressing inflammation and achieving remission.
However, clinicians increasingly recognise that inflammation and pain do not always correlate directly, with many patients continuing to experience debilitating pain despite apparently successfully controlling inflammatory activity.
This growing recognition has also prompted concern around analgesic prescribing in inflammatory arthritis. Studies have identified widespread long-term prescribing of opioids and gabapentinoids in patients with inflammatory arthritis, despite limited evidence supporting their effectiveness for chronic inflammatory pain and increasing awareness of associated harms.
At the same time, emerging evidence suggests persistent pain in inflammatory arthritis may involve nociplastic and neuropathic mechanisms in addition to active inflammation, requiring more nuanced and individualised treatment approaches.
What the guidelines say
This shift in understanding is increasingly reflected in both UK and European guidance.
Researchers involved in the forthcoming British Society for Rheumatology guideline on pain management in inflammatory arthritis note that care has often relied heavily on pharmacological approaches, while access to non-drug interventions such as physiotherapy, psychological support and pain education remains inconsistent.
Recommendations from the European Alliance of Associations for Rheumatology emphasise the importance of person-centred care and multidisciplinary pain management that incorporate physical activity, psychological support, education and self-management strategies alongside pharmacological treatment.
The TOPPIA consortium and inflammatory arthritis
Funded by the charity Arthritis UK, the Targeting of Peripheral Pain in Inflammatory Arthritis (TOPPIA) consortium brings together researchers, clinicians and patient representatives to better understand why pain persists in many patients, even when inflammation appears to be controlled.
It comprises researchers from King’s College London, Guy’s and St Thomas’ NHS Foundation Trust, King’s College Hospital NHS Foundation Trust, University College London, Great Ormond Street Hospital for Children NHS Foundation Trust, Cardiff University, University of Oxford, University of Birmingham, University of Glasgow and The Rockefeller University in the US.
The TOPPIA consortium will investigate the biological mechanisms underpinning persistent pain while also examining how psychological and social factors may contribute to symptom burden.
Importantly, it has been designed in partnership with patients, including children and young people, as well as adults. People living with inflammatory arthritis will contribute directly to research priorities and study design, helping to ensure future interventions address real-world experiences and unmet needs.
Due to begin in Autumn 2026, the study will focus on four key areas:
- Testing new treatment targets for pain
- Creating a biobank of joint samples linked to clinical pain data
- Improving tailored diagnosis and care
- Advocating for prioritising pain in clinical care and research.
‘A large, united effort’
Commenting on the consortium, lead researchers Professor Leonie Taams, professor of immune regulation and inflammation, and Dr Franziska Denk, reader in neuroscience, both from King’s College London, said: ‘Pain is one of the most devastating symptoms for many people living with arthritis.
‘It requires a large, united effort, where everyone is pulling in the same direction to improve drug development, patient stratification and advocacy.
‘Together, we will deepen our understanding of the drivers of pain, identify new therapeutic targets, improve treatment strategies and champion the inclusion of pain as a core priority in both research and clinical care for inflammatory arthritis.’