Episode 66 Dr Raj Amarnani

Dr Raj Amarnani joins Debbie and Katy to share his unique perspective as someone who not only lives with Axial SpA but also treats Axial SpA patients in his clinical practice. He reflects on developing symptoms at age 11 “lower back pain, alternating buttock pain, out of the blue” and navigating a six‑year diagnostic delay that reshaped his teenage life, forcing him to stop sport and unexpectedly leading him to new passions, including magic.

Raj discusses the relief and validation of finally receiving a diagnosis, how those formative experiences shaped his communication style as a clinician, and why empathy, language, and continuity of care matter so deeply. The conversation then explores physical activity, fear, fatigue, pacing, physiotherapy, hydrotherapy, nutrition, and the complexity of pain, alongside practical advice for getting the most out of short clinical appointments.

Raj also shares insights into personalised medicine, future developments in rheumatology, and how he supports patients who prefer non‑pharmacological approaches, offering a thoughtful blend of lived experience and professional expertise.

Key Topics

• Childhood onset AxSpA and its impact
• Navigating school and teenage life with pain
• Losing sport and discovering new interests (“I joined the Magic Circle…”)
• Relief and validation after diagnosis
• How lived experience influences clinical practice
• Evidence for physical activity in inflammatory arthritis
• Fear, fatigue, pacing and barriers to movement
• How patients can prepare for short clinical appointments
• Hydrotherapy, physiotherapy, and adapting exercise
• Pain complexity and differentiating types of pain
• Nutrition and emerging research
• Personalised medicine and future developments
• Patient preferences around medication
• Treating people as individuals, not just conditions

Key Quotes

• “I’m a firm believer that when one door closes, other doors open.”
• “I used to be a very sporty kid… and essentially overnight all of that stopped.”
• “There’s that validation,  gosh, I’m not making this up.”
• “Fatigue is one of the hardest barriers… even EULAR hasn’t fully cracked it.”
• “Pain is such a complex area — so multifactorial.”
• “Treating the actual person, not just the condition, matters so much.”

Keywords

Axial SpA, AxSpA, AS, juvenile onset, diagnosis delay, fatigue, pain, pacing, physical activity, exercise prescription, hydrotherapy, physiotherapy, personalised medicine, rheumatology, nutrition, patient communication, chronic illness, MSK medicine.

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Disclaimer: Debbie and Katy are not medical professionals. They share personal experiences of living with IA to build connection and community. The podcast is for informational purposes only and is not intended to replace professional medical advice. We talk about our personal health journeys, and the podcast is not intended to provide professional medical advice, diagnosis, or treatment. We are not medical professionals and in no way claim to be medically trained. The podcast does not take responsibility for any losses, damages, or liabilities that may arise from the use of the podcast. The podcast does not assume responsibility for the accuracy of third-party content. For more information, head to https://inflammatoryarthritis.org/

Debbie: Hello and welcome to Inflammatory with Debbie.

Katy: and Katy

Debbie: We’re delighted to be joined by Dr. Raj Amanani today. He is a consultant in MSK, musculoskeletal, sport and exercise medicine. His clinical work spans the NHS, academia and sporting environments. And he himself lives with Axial Spa. So, Raj, thank you so much for joining us today. If you could just go back and start with your journey to diagnosis and what your symptoms were and how you felt at the time.

Raj Amarnani: Absolutely. Debbie and Katy firstly, thank you so much for having me. It’s really such a pleasure to be here with you both. yeah, so so my symptoms actually started probably a lot younger than many others. So I started getting symptoms probably when I was about 11 years old. it started classically as AxSpA does with lower back pain, alternating, alternating buttock pain, out of the blue. So there was no injury, there was no falls, nothing I could remember. and then remember getting sent to all sorts of specialists, doctors, and no one could piece it together really. Sadly, we have of course to know AxSpA has about an eight and a half year delay to diagnosis. And for me it was about six years. So, I had about six years of symptoms. And it was finally seventeen when finally a rheumatologist made the diagnosis and then and then touch wood, I was on the right treatment pretty quickly. And so far, it’s been it’s been all right.

Katy: Wow. So that was throughout your sort of teenage years, essentially. So as

Raj Amarnani: Yes.

Katy: a young boy kind of navigating becoming a teenager, becoming a man, how did these symptoms affect your day-to-day living, your school life and sort of general activities?

Raj Amarnani: It was really difficult, I’m not gonna lie, Katy because of course you so I used to be a very sporty kid. I used to love playing cricket, playing basketball, and essentially overnight that all of that stopped. You know, I remember being in a lot of pain as a kid and just wondering, you know, I really wanted to get back to playing, I really wanted to get back to being outdoors, and just everything stopped. So, I think that challenge, both from a physical but from also a mental health point of view, was a challenge. But I’m a firm believer that actually when one door closes, other doors open. So actually another hobby that I found and I still do today was magic. So I picked up yeah. So so I

Katy: Amazing! A man of many talents! Wow! We didn’t have this in the intro!

Raj Amarnani: No, I thought I thought I’d spring that on you. yeah.

Debbie: Are you part of the magic circle? Wow!

Raj Amarnani: I am actually, yes. So I joined them maybe about seven, eight years ago and even at university I used to run the Magic Society and I now perform, I used to perform quite often at weddings and restaurants and now it’s more common casually amongst friends.

Katy: Incredible!

Raj Amarnani: But again, I wouldn’t have done that because I would have continued playing sport and if it wasn’t for the AxSpA that would have never come in my life. So, it’s blessing in disguise in many ways.

Debbie: Yeah. I, like you, I was diagnosed during my childhood as well. And, but it is really tough though, a teenager though. And how did you tell your friends what was going on? Cause obviously you didn’t have your diagnosis, but trying to tell friends that some days you’re in pain, some days you’re not. Did they understand what did you tell them?

Raj Amarnani: It was really hard because I think for obviously for the first few years when we didn’t even know what it was, it was that even harder to explain. I was I was put on crutches at the time by doctors and people were like, but you didn’t you didn’t have surgery, you didn’t have a fracture, why are you on crutches? And it’s a really difficult diagnosis to explain. I think you know, I don’t think I cracked it up fully. I think I just kind of explained that listen, I’m in pain, I’m not sure where this is coming from. And thankfully I was very blessed to have your really supportive friends and managed to get through it really.

Katy: Wow.

Debbie: How was your school life? Because I know schools can be a bit tricky.

Raj Amarnani: Yeah. Yes, it was. Again, very lucky that a lot of my teachers were understanding. I think physical education classes were always a challenge. I’d have to show multiple doctors’ notes as to why I wasn’t, you know, obviously taking part. But we thankfully had a lift in our school, so I had to have a special lift pass to use the lift, which was again always weirdly embarrassing. But you get through it. I think you find solutions at the time, and you know, in retrospect, of course I was very lucky, I think, in many ways that they that they allow me to get through before I finally had a diagnosis.

Katy: And once you had the diagnosis, can you take us back to sort of how that made you feel? Because I remember for myself, it gave me that sense of relief that finally I knew what was happening. But after six years, how was that for you?

Raj Amarnani: Absolutely. I mean it finally opened the door. I think firstly obviously it opened the doors to treatments that thankfully worked work dramatically for me. but you’re exactly right. That almost that validation like gosh, I’m not making this up. I’ve actually had these symptoms and finally, you know, something my blood work and my imaging kind of finally clicked. but yeah, I think it’s that sense of validation and almost sense of relief in many ways that, you know, finally we kind of know what what’s driving all of this and we can move forward.

Debbie: And how did you then feel kind of mentally because obviously, as you say, it’s good to kind of get the relief that actually it is something you’re not making it up, but then knowing that it’s a lifelong condition.

Raj Amarnani: Yeah, it’s tough, right? I think I think I’m sure I’m sure we’re all in the same boat in that sense that when you know you have a lifelong condition, it’s more about living with it and living well with it and using medication and everything else that we do alongside it to obviously live the best lives we can. But I think in many ways that acceptance and validation have certainly helped that journey. And you know, you know, I back in the day, I think when we were suffering with a lot of pain, I used to think about it day in and day out, but now often I don’t let it control my life and I’m generally happy to, you know, I know it’s there. But I live with it along instead of it letting it control me if that makes sense. Yeah.

Katy: And what do you think helped you in those early days? can you remember sort of specific clinicians that communicated specifically well to you or was it kind of friends and family that were the main support for you?

Raj Amarnani: Yeah, I think it was a combination. I think it started with friends and family. I think, you know, their support and, of course they would they were obviously trying their best. They were trying to take me to various different, specialists to try and get an answer. So, I think I’ve always will always forever appreciate that. But I think remember the kindness of clinicians, you know, in terms of that initial diagnosis, explaining what it actually meant and starting medications or things that that really stuck with me. Equally, I think, you know, I hate to say it, but of course I I’ve come across a lot of clinicians who are very dismissive. And I think in my own clinical practice, it’s also made me recognize that, how to approach a patient in terms of explaining a diagnosis. I think those formative years really shape my clinical practice and is something I harp back to even now when I see patients day in, day out, about how we use language and how we use, that those communication skills. It matters so, so much. Because I you know, those conversations for me were twenty years ago. And I still remember them vividly to today. So, I can only imagine patients I see today, what they’ll think about of me twenty years later. So, I always use that in my clinical practice.

Debbie: Yeah, and I think that leads us on really nicely because you then went into medicine. was it your diagnosis that made you want to go into that type of medicine?

Raj Amarnani: Absolutely. Yeah. So, I again I definitely wouldn’t be doing what I did today if it wasn’t if it wasn’t for the AxSpA diagnosis. And I think, I always knew I wanted to go into s I always enjoyed science. I always knew I’d wanted to go into some way, shape, or form in terms of helping people. So, it kind of flowed very naturally after the diagnosis and from there. And then you know, rheumatology MSK medicine was always in my background. But I remember getting some really good advice in my first few years of university from some mentors saying that, you know, obviously medicine is a lifelong journey. Take your time, work through various different specialties. And if you find yourself at the end of the day back to where you want to be, then then fair enough. But give every specialty its due credit. And that’s what I did. And then eventually we ended up here.

Katy: And what is it about your job and your day-to-day different activities that you’re involved in that you really, really enjoy?

Raj Amarnani: I think it’s the variety. I think the nature of our specialty means that we can do we can hold lots of different hats across clinical work, academia, research, sporting environments. every day is something slightly different and I can meet lots of different people across various different environments and that’s what makes life very, very enjoyable for me.

Debbie: When speaking with other rheumatologists that we’ve had on as well, you see the same patient, you see them throughout their journey

Raj Amarnani: Absolutely. There’s nothing rewarding than seeing that patient come through that journey and get better at the other. And of course, with a lifelong chronic illness, sometimes they will go through flares and there’ll be times where they reach out to you for that support. But I think being able to be that continuity continuous face and clinician can be incredibly rewarding.

Katy: And how do you manage your own physical health and flares whilst having such a busy, busy job?

Raj Amarnani: Yeah. I think I’m sure most people listen to this podcast have various different tips and tricks. I’m always finding colleagues and friends and asking them the same question. But I think it’s one of those things you find ways that work for you. I think I’m very, very lucky that medication has worked dramatically for me. you know, there’ve been ups and downs over the years, and that’s led to different changes to treatment. But so far, I think with a combination of medication, physical activity, which I’m incredibly, incredibly passionate about. And obviously managing work life balance, managing stress and sleep and nutrition, all of those factors of course play into it as well. And I don’t think I’ve struck it perfectly just yet, but every week I learn something new, so I can’t complain.

Debbie: Yeah, it’d great if you have, because think then you can tell everyone else how it works. But think even nowadays, we’re still learning as well. So, you mentioned, you’re very passionate about physical activity, you do a lot of work with sports. What’s your favourite sport?

Raj Amarnani: To play probably basketball, to watch probably cricket. but I’m a big fan of any sport. If there’s any sport on the telly, I’ll watch it and I’ll learn something new. So, I do love it.

Katy: How do you think sport and general physical activity can support people living with inflammatory arthritis?

Raj Amarnani: I’m so I’m so glad you asked that question, Katy because it’s enormous. I think you know, a lot of the research we’ve done over the last few years has shown the evidence base is growing enormously. Year on year there’s more research groups out there, more papers out there showing the evidence around physical activity in inflammatory rheumatic diseases. I think that the challenge has been implementation. So, the challenge has been actually how we, you know, break down those barriers for getting patients active, which I think is a huge hurdle that’s multifactorial. But of course, also breaking down barriers of fear. And I think, you know, when all of us are diagnosed, we all have this misconception, I guess, in many ways that that, you know, arthritis, you know, is gonna damage our joints and you know, potentially physical activity is gonna make that worse. Where actually all the evidence suggests quite the contrary. And think it’s getting over that that initial fear, you know, block per se, that can be such a challenge.

Debbie: Yeah, and it’s also the fatigue as well, So how do you then persuade people that actually you need to go and do this, but even with fatigue, it is so hard.

Raj Amarnani: It is incredibly hard and Debbie, I’m so glad you mentioned that. Exactly that. I think fatigue is one of the hardest barriers to do. So myself and a few colleagues, we worked with EULAR last year and EULAR finally addressed the fatigue guidelines on rheumatic disease. So that came out and there’s some papers out there on it. But even with that, even with such a large group, I don’t think we fully cracked it, to be honest. Because I think fatigue in and of itself, there’s so many facets to it. There’s so many contributors to it. but I think the biggest thing is finding your balance around fatigue and I think recognizing, accepting fatigue is you is there. It’s part of the condition. And finding those good days versus those bad days and finding ways to incorporate it into your lifestyle without letting it overcome you. But it it’s such a challenge.

Katy: And how do you help patients sort of get over that barrier of whether it’s fatigue, whether it’s pain, whether it’s fear, what are the sort of things you will recommend and how to start?

Raj Amarnani: Absolutely. So, we traditionally try and explore three main themes. So, what their motivators are for being active, what the facilitators are. So, what are the things that they want to be able to do and what support do they have around them? And then potentially what those barriers are. And I think, of course, patients will come in with various different, you know, obviously, challenges in terms of their disease, in terms of their lifestyle, in terms of their work. And it’s about taking the time to understand what they want to be able to do. So I always start backwards. I almost kind of say, you know, what is the function, what is that end goal that you want to do, you know, is that, you know, take part in gardening once a week. Is that playing more with your grandchildren, whatever that case may be? And then how do we work backwards from there? And how do we overcome those barriers together? How we pace your activity, how we you know some patients want to be a bit more prescriptive. So how you actually almost give you an exercise prescription. But again, varies widely from patient to patient. But I think that’s why I love what I do because you get to you know understand what makes patients tick and what they want to be able to do. And it’s incredibly rewarding.

Debbie: And do you think that attitude is changing? Because it was always, no, you can’t do that. You know, when I then have, I’ve got back issues and they’re like, no, you can’t do running, you can’t do this and you can’t do that. It’s like, actually I want to do that. I think even when Katy then got diagnosed, she was told, no, you can’t go running. And then you went and run a marathon. Not many people would do that.

Katy: Yeah. Yeah, I ignored their advice.

Debbie: But do you think that attitude is changing because this is also why we’re trying to do with the charity is to make sure that inflammatory arthritis that it shouldn’t be that barrier to do whatever you want in life.

Raj Amarnani: Absolutely I could not agree more with that. Exactly that. And I think I think it’s on the clinicians sometimes to they almost have a duty to say, actually if this is what you want to do, let’s find a way to get you there. And I think that’s gonna be key. Instead of saying actually instead of building barriers, we need to break them down. and it may not be exactly what they want to be able to do, but at least if we can w start working towards that, you know, at least we’re trying. Yeah.

Katy: Yeah, Debbie’s talked previously about her GPS theory of life, that you might have a goal and there’s a direction of travel, but you won’t always get there in that straight line. There might be multiple routes to reach it. So I think that speaks to that. And I just wondered as patients ourselves and people sort of listening to this, what can we do to try and be a little bit more forthcoming with our clinicians about what we want to do? Cause I think sometimes when you’ve got that 10 minute appointment, you can’t always, there’s so much that the clinician has to go through, but then there might be things on our list that we want to go through, but then you miss it because maybe the conversation’s gone somewhere else. What can we do as patients to, I guess, get the most out of our appointments and then, you know, reach our goals?

Raj Amarnani: Absolutely, Katy. That’s a really, really good question. I think the first thing is of course is I do this as a patient myself. I write all the questions I have before I come out. And you know, some clinicians love that. Maybe some style away from it. but I personally I feel like I love it when the patient becomes you know with the list of things that they want to talk about. And I often start there because ultimately I you know, I want them to get as much out of the consultation as they possibly can. And I hope that’s a patient, I ask for the same I hope for the same for my clinician. But yes, I think I think the first step is writing everything down so you don’t forget. As always, as always, because again, in that consultation, there can be so many things happening. You know, sometimes you have blood tests, observe you know, blood pressure checks before all sorts. So having something there in writing can be really helpful. And then also recognizing, like you said, sometimes if there isn’t enough time, you know, perhaps in between consultations you have an appointment with the rheumatology nurses, physiotherapists, and then maybe other people in that team that may be better placed to answer those questions. Also recognizing what potential parts of the team you may have access to, which I appreciate varies from hospital to hospital.

Debbie: Yeah, no, that’s a really good tip. And I also actually write voice, have voice notes on my phone as well. So sometimes

Raj Amarnani: Yeah.

Debbie: When I can’t write

Debbie: And if I’m just, sometimes it just comes to me, if I’m walking the dog or something, I was like, I need to talk to my rheumatologist about this. I’ll actually just do a voice note either to myself or just put it in a, in a folder on my phone. So that’s something else that I, you know, sometimes I’m quite useful. Not all the time.

Katy: That’s a really good idea, I wouldn’t think to do that.

Raj Amarnani: Absolutely. That is I’m again we learn something new every week. Thank you, Debbie. I’m gonna take note of that as well. I’m gonna start doing that myself.

Katy: Yeah.

Debbie: No problem.

Katy: Even know if I know how to send myself a voice note. Anyway, that’s for another time.

Debbie: Other, yes, I’ll show you offline. But then what I, you know, obviously you mentioned having physios and that as part of your team and not everyone has that were you referred to physio and how did that work?

Raj Amarnani: Yeah. So I was fortunately referred to physiotherapy by hospital, but at times when I needed them. So when I was in flair, for example, I then got referred to sessions of hydrotherapy and physiotherapy, which I found incredibly helpful because they again they broke down those barriers and gave me the confidence to be active. But it’s not something I see regularly. And I think again that will, you know, depend from hospital to hospital. But certainly, thankfully where I am, is that access to physiotherapy and hydrotherapy certainly is there in moments of flair, which is certainly very helpful for me.

Debbie: Because when my daughters were actually given physiotherapy, because one has juvenile arthritis and one has hypermobility, but actually it was hard because the exercises, they were causing them a lot of pain. And I suppose when you were talking about the fear and everything, that is a massive fear for us as patients because our brains can’t distinguish between what is inflammatory arthritis pain and what it’s just normal, like muscular pain, just getting used to doing something. So how, can we get over that fear.

Raj Amarnani: It it’s really challenging, Debbie, and you’re right. I think to answer the second part of your question, differentiating between various types of pains I think your clinicians struggle with massively because often there’s no way of telling in between unless you use certain investigations which can be we can certainly be challenging. Again, how we get over those barriers. I think it’s about starting slow. I think, you know, if certain exercises are too much, it’s about dialling them way back and saying, okay, if I can’t do that exercise, can I adapt it? Can I do something slightly different that doesn’t flare up my symptoms as much? And can I potentially build towards that? Or is that exercise just not for me and I need to find another route? And I think sometimes it’s trial and error, sometimes it’s about finding again things that work for you. But it sometimes can be a really slow process until you find that perfect fit.

Katy: That’s interesting. And something I’m really keen to understand is because obviously you sit on both sides of the fence because being a patient and a clinician yourself. So how does that work when you are the patient, and you’re getting a consultation, how do you change your mindset? Cause you know, you know all the clinical side as well.

Raj Amarnani: It’s a real and I think that’s changed over the years, I think, Katy I think from being pre you know medical and I think the more knowledge you have, it’s kind of changes your perception. But I think one rule I’ve kind of kept myself to say is I’m allow myself to be vulnerable in a clinician and allow myself to embrace that patient role because I also don’t want my preconceived notions to affect the clinician’s judgment. So, I very much come in as a patient and I go with their advice. I never kind of impose my thoughts and ideas ’cause and so far that’s worked for me. Because I’ve been very lucky to have incredible clinicians look after me. but that’s how I’ve handled it so far. Yeah.

Katy: No, it’s interesting because I think that must be so hard

Debbie: But you do sit on many groups as well just going through your bio it’s impressive because you are the president of the rheumatology and rehabilitation section of the Royal Society of Medicine, you’re the chair of the British Society of Rheumatology, Physical and Activity, Special Interest Group and you’ve done a lot of work as you said with EULAR as well. What’s been the most exciting part of any of those roles?

Raj Amarnani: Gosh, I think it’s the privilege of working with people, Debbie, if I’m honest. I think, you know, very, very lucky to have met some incredible colleagues, clinicians, researchers from all around the world through those positions. And I think the one thing has taught me that we know we can’t work in silos. I think we’re all doing your people all over the world are doing some incredible work and we all need to share thoughts, share ideas of how we can best, you know, help our patients. So, I think that for me has been the biggest blessing and really been privilege and lucky to be able to go through that. But I think what really amazes me about where medicine is headed is the personalization of what we’re doing. I think especially rheumatology I think, you know, you know, year on year there’s new medications coming, there’s new there’s new research coming out there. But the fact that we can target your certain areas that depend that that can be really tailored to the patient in front of us is incredibly exciting. And I think that’s the thing that’ll change how we practice over the next ten to fifteen years. Yeah.

Katy: Okay. And how long do you think it will take for that to be something that actually happens? obviously it can, these things take time and they have to go through so much approval. What do you think that time scale looks like? I know you said 10 to 15 years, but is that to it to get approved?

Raj Amarnani: I think it’ll start slow. I think it’ll depend on certain conditions first. I think of course the immunology sector and cancer research has kind of led the field in that sense so far. But I think it will slowly start coming to rheumatology and I think, you know, it’s hard to pinpoint a certain time. But I think somewhere in the next ten years, hopefully, we’ll start to see some changes.

Katy: How amazing.

Debbie: Yeah, that’s our hope as well. Because I think, as you say, that everyone is very different. But I also think it’s how the NHS has been sort of set up and that you just go to see that that’s one specialist, and that we don’t treat each other as humans. And this is what I’m hoping will change as well.

Raj Amarnani: Absolutely. I couldn’t agree more. And I think you’re right. I think the challenges that come with changing clinicians, sometimes you go for various appointments, and you see different colleagues, different clinicians and day in and day out. And you’re right, that that treating the patient in front of you as a person can sometimes get lost in and amongst the medical notes and the research and the medication, they’re on and everything else. But I think you’re absolutely right. Treating the actual person and what how they’re experiencing their condition. Because the thing, as you said, right, we all experience the same, even though it’s the same condition, we experience it also differently.

Katy: And we all judge different symptoms in a different way depending on, I think it goes back to just how we’re all made so differently.

Raj Amarnani: Absolutely.

Katy:  So, I think it’s so hard, like one person will say it’s a 10 out 10 pain, for example, but to somebody else that might be a two out of 10 pain.

Raj Amarnani: Exactly. And pain is such a complex area. It’s so multifactorial in nature. And you’re right, how we how we piece that out really, really matters to the patient in front of us.

Debbie: And just getting back to what you were saying at the beginning as well, it’s the treatment, but also you were talking about nutrition as well.

Katy: Yes.

Debbie: And do you think that plays a really big part in how you look after yourself as well?

Raj Amarnani: Yes, absolutely, Debbie. So, I think I can certainly speak from a from a personal experience. I know, I’ve often found that certain foods, certain diets will flare up my joints very, you know, personally.  But again, I know that doesn’t apply to everyone. I know the research is very sporadic when it comes to nutrition and inflammatory conditions. But I think your patients will try various things and depends on what works for you, certainly is never a wrong thing. So, I think it’s sometimes, yeah, it’s a tricky field to in terms of understanding what actually works. But I think that’s another exciting thing in terms of research that I think will change steadily change practice hopefully in due course when we actually recognize which foods may cause certain patterns of disease. Yeah.

Katy: Yeah, because it’s interesting. Think nutrition is the piece I don’t think I’ve ever had a clinician actually talk to me about, but that’s because I guess there isn’t the research to back anything up as of yet. it’s a bit like exercise. When I was first diagnosed 15 years ago, I was told, don’t run, you might damage your joints. And then obviously that has completely changed over 15 years. I think it’s really interesting to see what’s going to happen. And I just wondered, as a patient and a clinician, what’s your biggest sort of hope over the next 10 to 20 years?

Raj Amarnani: Gosh.

Katy: Big question. Very open.

Debbie: I’m glad you’re answering that.

Raj Amarnani: Well, I think for all of us, I think of course I know it’s about No, no, exactly. I you know, I think of course if I had to choose one thing, of course it would be a cure for a lot of the conditions we have. Because sadly we know a lot of our conditions, are you are lifelong conditions. So, I think that would be the gold standard. But I think a step below that and the more realistic as we touched upon, I think is having targeted medication, targeted drugs that can be individualized to the person in front of you. I think we’re very lucky in our specialty to have lots of drugs or available to us. but of course, as that grows and as individualization grows, I think that will be really exciting to see. And hopefully that brings down your symptoms, fatigue, pain, and we get over those barriers easily. But it’s a challenge. Yeah.

Katy: Yeah, 100 %

Debbie: Yeah. And I was just thinking, you know, going back to the nutrition side, do you actually have, now speaking to you as a clinician, do you actually have people come in and they don’t want to take the medications? They want to just go down the more, natural route, because I think everyone wants that sort of quick fix and some of the drugs, are immune suppressants and people can be scared of that. what do you then say as a clinician?

Raj Amarnani: Of course. And it’s a really challenging conversation at that point, Debbie, because I think of course, we always respect the patient choice and patient autonomy. And I think that always sits at the top of the consultation. And of course, if they’re not keen on medication, I we still need to help them. So we need to try and find ways we can adapt it through other methods. I think, you know, diet coming back to nutrition and diet, there is emerging research around a few inflammatory arthritis conditions. And I think that evidence is growing year on year. But I think at the moment there’s not much that we can, you know, pin our hats on and say this particular thing will definitely work. And I think sometimes patients will come in and they’ll have tried something that works for them. And I think my take has always been if that works for you, and as long as it’s safe and it’s generally healthy, there shouldn’t be anything wrong with that. And I think it’s hard for us to then say, actually, no, you’re wrong, that doesn’t work when it is working for them. So I think it’s about finding that balance. But it’s a challenge.

Debbie: I completely agree. Because I think, you know, you were probably told when you were diagnosed, take turmeric or, don’t eat this, this and this and it will be fine. But actually, it is so personalised. And again, I think getting back to the theme of what we’ve been talking about is, the personalisation side for the treatment and for the exercise and for nutrition. But just thinking everyone is humans and that we are all so, different. And that’s what makes us human though, isn’t it?

Raj Amarnani: Exactly. Exact funny story in turmeric actually though. That was one thing my my parents made me try a lot of. I had so much turmeric that my fingers turned yellow at one point when I was seventeen. So, I still remember that very fondly. but it’s funny it’s funny that you should mention that today.

Debbie: Gosh, and it didn’t cure you. What a surprise.

Raj Amarnani: Unfortunately. Unfortunately.

Debbie: Gosh. Well, thank you so, so much for your time today. It’s been absolutely fascinating listening to you as a patient and then having that diagnosis and going into what you do as a job now. And I must say you are the under 21 and first team doctor for West Ham United. I am so sorry for you. I think as an Arsenal fan, I’m allowed to say that. Yeah, well,

Raj Amarnani: Absolutely, absolutely.

Debbie: Fingers crossed for a better season next year. but again, thank you so, so much for your time. Please do follow us on social media. We are on Facebook, LinkedIn, Instagram, and Blue Sky. You can sign up to our newsletter at inflammatoryarthritis.org and you’ll get the most up-to-date information about anything going on with inflammatory arthritis. And we may have some new events coming up as well. Another reason to sign up. So again, thank you so much Raj and yeah, it’d be great to have you back on at some point if you’d like to.

Raj Amarnani: Absolutely. It’s been such a pleasure. Thank you so much again and always happy to come back.

Debbie: Brilliant, well thank you so much and until next time Katy it’s goodbye.

Katy: Goodbye.