Don’t wait for swollen fingers before seeking help for arthritis

Published on 9 March 2026

At a glance

• Inflammatory arthritis can lead to permanent joint damage and deformity if not treated early.
• Starting appropriate therapy soon after symptoms appear can reduce pain and protect the joints from further harm.
• The TARGET Arthritis Clinic at NUH enables faster assessment and coordinated care to improve patients’ quality of life.

When your fingers swell so much that you cannot slip on a ring or hold your child’s hand, something is clearly wrong. Yet for many people with inflammatory arthritis, that moment comes only after months of brushing off early warning signs.

Madam Karin Tan was in her late 30s when stiffness and swelling began to creep into her fingers. At first, the symptoms were mild and easy to ignore. Over time, the swelling worsened. The creases over her finger joints disappeared, and the pain became increasingly hard to bear.

By the time she sought care at National University Hospital (NUH), even everyday tasks had become difficult. She was eventually diagnosed with psoriatic arthritis, a form of inflammatory arthritis linked to psoriasis – an immune-related skin condition that causes red, scaly patches on the skin.

Mdm Tan was prescribed methotrexate, a commonly used medication for inflammatory arthritis. She responded well, experienced no significant side effects, and saw her symptoms improve within a few months.

Her experience reflects a wider shift in how inflammatory arthritis is treated today. Doctors now aim to diagnose the condition earlier, monitor disease activity closely, and adjust treatment promptly, before permanent joint damage can take hold.

Why early treatment matters

Rheumatoid arthritis and psoriatic arthritis are autoimmune conditions in which the immune system mistakenly attacks the joints, leading to inflammation, pain and stiffness. Left untreated, this ongoing inflammation can cause irreversible joint damage and deformity.

However, early intervention can change that trajectory. Starting appropriate therapy soon after symptoms appear helps to reduce pain, protect the joints and improve long-term quality of life. For many patients diagnosed early, remission, which is defined as little or no active disease, becomes a realistic goal.

This proactive approach to care is known as Treat-to-Target (T2T). Doctors and patients agree on a clear treatment goal, typically remission or very low disease activity. Patients are reviewed regularly, and treatment is adjusted in a structured, step-by-step manner until that target is achieved. 

Adj A/Prof Manjari Lahiri, Senior Consultant, Division of Rheumatology and Allergy, Department of Medicine, NUH, said the evidence supporting Treat-to-Target is clear.

“T2T has been a well-established paradigm for the treatment of rheumatoid arthritis and psoriatic arthritis for more than a decade,” she explained. “Multiple clinical trials have shown that it leads to better patient outcomes, including improved symptom control, less joint damage, better physical function and improved quality of life. It can also reduce the risk of cardiovascular complications such as heart disease and stroke.”

At the Division of Rheumatology and Allergy at NUH, several systems are already in place to support this model of care. Referrals are triaged on the same day, allowing urgent cases to be seen promptly. Pharmacists run dedicated clinics to help fast-track safe medication adjustments, while point-of-care ultrasound scans are used to detect inflammation that may not be apparent on physical examination. Nurses also play a key role, providing counselling to help patients understand their condition, treatment options and blood test results.

For patients like Mdm Tan, being heard matters as much as the medicine itself. She recalled feeling relieved that her doctor took time to listen to her concerns, including her worry about relying too heavily on medication, and worked with her to develop a treatment plan she felt comfortable with.

A joint effort with a new clinic

Since October 2025, NUH has taken this approach further with the TARGET (Timely Arthritis Response and Guided Escalation of Treatment) Arthritis Clinic.

Running weekly on Mondays, the clinic aims to provide early assessment and treatment for suitable patients, typically within two to four weeks of referral. It is staffed by a dedicated multidisciplinary team comprising five rheumatologists, three nurses and two pharmacists, all with a special interest in inflammatory arthritis. 

Adj A/Prof Amelia Santosa, Senior Consultant, Division of Rheumatology and Allergy, Department of Medicine, NUH, shared that collaboration is central to the clinic’s success.

“We’ve been working closely with our primary care colleagues to identify patients who may benefit from early assessment for arthritis,” she explained. “While this remains a work in progress, we greatly appreciate their ongoing collaboration and commitment to improving early detection and referral, and are encouraged by the progress made so far.” 

Patients seen at the TARGET Arthritis Clinic undergo regular blood tests, usually every two to four weeks. These results guide pharmacists and doctors in adjusting medication doses in line with clearly defined treatment targets.

Prof Lahiri added that the clinic is also developing new ways to track patient progress. “We are working towards an electronic ‘outcomes dashboard’ to visualise clinic outcomes, so that we can continually troubleshoot problems and improve care,” she said.

“To our knowledge, this is the first attempt in Singapore to combine early review with a Treat-to-Target approach.”

Living well after diagnosis

Now 54, Mdm Tan is more active than she was in her younger days, after receiving the right care to control her psoriatic arthritis. A regular at the gym, she does cardiovascular exercise several times a week and lifts weights of up to 40kg. Her experience illustrates how early, coordinated care can preserve quality of life, and in some cases, even improve it. 

For those experiencing early symptoms, the message is simple: do not wait until pain becomes disabling or joints are permanently damaged. Early assessment and timely treatment can make a lasting difference.

In consultation with Adj A/Prof Manjari Lahiri, Senior Consultant, and Adj A/Prof Amelia Santosa, Senior Consultant, Division of Rheumatology and Allergy, Department of Medicine, NUH.