Rheumatoid arthritis (RA) symptoms come and go during periods of flare-ups (or flares) and remission. Rheumatoid arthritis flare-ups can occur as the result of natural variations in the disease’s activity. As disease activity increases, so does the inflammation that causes the symptoms of RA. The risk of entering a flare increases when a person tapers or stops their typical RA treatments. However, flare-ups are a normal part of living with rheumatoid arthritis, even when you have well-controlled disease.
RA flare-ups can be unpredictable. The severity and frequency of these flares can vary, although joint pain, stiffness, and fatigue are common. These symptoms can be debilitating and have significant impacts on everyday life.
Luckily, there are ways to treat flares. By working with your rheumatologist, you can find the best ways of managing your symptoms, as well as decreasing the frequency of your flares and avoiding long-term joint damage.
“You will know when you are in a flare,” wrote one myRAteam member. “The usual pain that we learn to live with multiplies by an unknown amount.”
As this member stated, RA flare-ups are often apparent because they cause typical RA symptoms to worsen. This may not necessarily be excruciating — as one member in flare described, “It’s not major inflammation or screaming pain, but enough to let me know things are not right.”
Three of the most common symptoms that develop or worsen during RA flares are joint symptoms, fatigue, and fever. A person experiencing an RA flare may also feel generally unwell, as if they are coming down with an illness. “Think I started a flare,” wrote one myRAteam member. “Serious fatigue, low-grade fever, and increased aching joints … like I’m coming down with something.”
Some people with RA find that they experience less typical symptoms while in flare: one member wrote that they have “increased ear fullness/ache,” while another shared that they have had stomach upset — “This flare, I’ve had tons of belly issues! The bloating is so uncomfortable!”
The duration of a flare can vary, as well. When asking how long a flare-up can last, one member received several different responses. “When I was having flares,” one member replied, “they would vary from days, months, and years. I didn’t see a change until three years ago when I got a new doctor and different medication.” Another member found that their flares last for a shorter time: “My flares usually last for two to three days. I love knowing that the pain will usually subside.”
It is important to treat RA flares when they occur. Research has shown that leaving flare-ups untreated can increase the risk of joint damage and can lead to worse long-term health outcomes.
In many cases, people with RA find that a combination of medications and self-management helps lessen their symptoms during flares. “I got some relief from managing my diet and stress,” wrote one myRAteam member, “and new medications.” “I’ve had so many flares, I’ve lost count,” wrote another, “and that’s when the prednisone, ice, or heat help.”
As soon as you start to notice the signs of a flare, talk to your rheumatologist. They will be able to prescribe treatments and recommend at-home management techniques to help improve your symptoms.
One myRAteam member said, “I can’t remember the last time my pain felt out of control or unmanageable. Not because I do not experience pain, but because I have been extremely proactive.”
Like this member shared, one of the best ways to manage RA flares is to prepare for them before they occur. This often means identifying your triggers and building an RA emergency toolkit.
Several factors may trigger RA flare-ups, including stress, infections, overexertion, or lack of sleep. “Recently had a stomach virus,” wrote one member, “and noticed my RA flared as well.” Others who responded said that they had the same experience: “I think many of us would say that being sick can bring on a flare.”
Some members find that their RA worsens in certain types of weather. When asked if they experience flares when the weather changes, one member responded, “Definitely. I can tell you when it is going to rain, snow — any weather change.”
Keeping track of when your flare-ups occur can help you begin to identify what contributes to them. “Hopefully,” wrote one member, “by tracking these triggers, I may determine what is causing my flare-ups.”
As many members have described, finding what works when your RA symptoms flare is crucial. “I feel like I have finally figured this whole thing out,” one wrote. “I have come to fully understand that prevention of pain is just as important as soothing a flare. … It does take discipline, preparation, and an RA toolbox and emergency kit. But, I am living proof that it can be done. We must listen to what our bodies are telling us.”
Once you and your doctor have identified what medications and at-home management approaches work for you, follow through with them.
One of the best things you can do to keep your RA under control is to take your medications as prescribed. Keep in mind, however, that medications like disease-modifying antirheumatic drugs (DMARDs) are not cures — they help keep RA in a low state of disease activity or in remission.
You may need other medications, including steroids and over-the-counter pain relievers, to help manage symptoms during a flare. However, your doctor may also choose to increase the dose of your usual medications. “I can go for a long time without a bad flare, and sometimes they go away on their own,” wrote one myRAteam member. “Other times, the flare persists and is really painful. At those times, I speak to my rheumatologist, who often increases my dose of methotrexate for a while.”
Your doctor might suggest injecting corticosteroids or an anesthetic directly into the joints affected by a flare. These shots may provide near-immediate relief from discomfort for weeks or months.
Some steroids are also available as oral medications. “If symptoms aren’t controlled,” one member wrote, “I’ll usually get a prednisone prescription. I don’t like using it — it causes a lot of side effects — but it helps the joint inflammation, stiffness, and pain. If pain returns, it’s time to change medications or increase treatment.”
Someone with mild aches may only need over-the-counter pain relievers, like aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs). Common NSAIDs include Advil (ibuprofen) and Aleve (naproxen). Those with more moderate symptoms may be prescribed stronger oral NSAIDs to reduce swelling and pain.
Some myRAteam members report that the foods they eat affect their symptoms. Although there is no one diet for rheumatoid arthritis, the Mediterranean diet (also known as the anti-inflammatory diet) has been linked to decreased inflammation in people with RA.
Read more about the anti-inflammatory diet for RA here.
For immediate at-home pain relief, you may want to try hot and cold packs. These won’t affect your underlying rheumatoid arthritis, but they are a nonpharmacological way to manage symptoms during a flare-up. As one myRAteam member wrote, “Flare-up. Can’t walk. I just got up, and I think this heating pad really helped.”
A hot pack can alleviate muscle spasms and improve blood flow, while cold packs can help reduce inflammation.
Getting plenty of rest is critical when experiencing a flare-up. Don’t push yourself to get things done if you can’t, and take breaks when your body tells you it needs them.
The relationship between stress and RA flare-ups is a two-way street: stress can cause flares, and flares can lead to added stress. As one member asked, “Does anyone else find that their conditions flare more when work is stressful?” Another agreed: “I found that stress activated my flare-ups.”
Relaxation techniques like meditation and deep breathing exercises may help reduce stress before and during flares. You may also need to spend more time alone during a flare — and that’s OK. Give yourself the time you need to rest and recover.
Read more about stress and RA here.
Navigating life with RA can be a challenge. The good news? You don’t have to go it alone. On myRAteam, the social network for people diagnosed with rheumatoid arthritis and their loved ones, more than 149,000 members from across the world come together to ask questions, offer support and advice, and share stories of life with RA.
How do you manage your RA symptoms during flare-ups? Share your tips in the comments below or by posting on myRAteam.