RHEUMATOID ARTHRITIS FLARE-UPS: WHAT TO KNOW AND HOW TO COPE

Medically Reviewed by Dr. Sony Sherpa, (MBBS) - August 19, 2024

Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease that affects the joints and other parts of the body. Symptoms of RA include pain, stiffness, swelling, and reduced mobility in the affected areas, which often involve the fingers, wrists, elbows, and knees. RA flare-ups are periods of increased disease activity with often painful symptoms that can vary in severity and duration.

Living with RA can be challenging and frustrating, especially when flare-ups interfere with daily life. Flare-ups can affect your ability to work, exercise, socialize, and enjoy your hobbies. They can also be a cause of anxiety, depression, and low self-esteem. If unattended, RA flares might eventually result in joint degeneration and raise the possibility of physical impairment.

Understanding and managing RA flare-ups is important for slowing down disease progression and improving your quality of life. By recognizing the signs of a flare-up, keeping track of triggers, seeking medical treatment, and practicing RA self-care, you can reduce the impact of flare-ups on your health and well-being.

Recognizing the Signs of RA Flares

Early detection and management of RA flares can help lessen their intensity and duration. Therefore, it is essential to be aware of common symptoms and indications of a flare-up.

Flare symptoms or signs of rheumatoid arthritis getting worse include:

• Increased joint pain, stiffness, and severity of other symptoms
• Reduced range of motion or function in affected joints
• Fatigue or weakness
• Fever, chills, or night sweats
• Loss of appetite or weight
• Difficulty sleeping or concentrating
• Mood changes or irritability

Some symptoms may be more noticeable or bothersome than others, depending on the individual and the situation. Symptoms may also differ from flare to flare. Use a smartphone app or keep a symptom journal to track your symptoms over time and look for patterns or changes.

If you notice that your symptoms are getting worse or lasting longer than usual, you should contact your doctor as soon as possible. You should also seek medical attention if you develop new or unusual symptoms, such as chest pain, shortness of breath, eye problems, skin rashes, or infections.

Rheumatoid Arthritis Triggers and Causes

RA is brought on by an aberrant immune response that targets the joints, particularly the fluid-filled synovial joints. Despite the joints being the most affected, the disease is considered systemic, which is why symptoms can be non-specific, manifest in other body compartments, and increase the risk for other chronic lifestyle diseases such as heart disease.

The exact cause of this faulty immune response is unknown, yet the interaction of genes with environmental exposures is believed to play a prime role in RA onset and flares.^[1]

RA flares are episodes of increased inflammation and immune system activity that worsen your symptoms. Flares can be triggered by various factors that vary from person to person, thought to promote inflammation in the body that leads to a worsening of symptoms. Two of the most commonly cited flare triggers include overuse of the affected joint/s and smoking. ^[2]

Common RA flare triggers include^[3]:

• Sudden weather changes, such as cold, rain, or humidity
• Environmental exposures, including asbestos, silica, sawdust and textile dust
• Cleaning detergents, pesticides, and similar chemical agents like paint thinners
• Switching medications or changing dosages
• Sleep deprivation or disruption
• Gum disease, especially gingivitis, a type of gum infection
• Hormonal changes or cycle fluctuations
• Stress, whether physical or emotional
• Infection or illness
• A lack of physical activity
• Allergens

Some flares are predictable with known triggers, while others are not and require careful attention^[4].

Can Exercise Cause a Rheumatoid Arthritis Flare-Up?

Moderate exercise may help prevent and manage RA flares by reducing inflammation, improving joint function, strengthening muscles, enhancing mood, and boosting energy levels. While exercise can be helpful, overexertion or inappropriate exercise can worsen symptoms and lead to a flare-up. It is important to follow an exercise program suited to your condition and fitness level.

Foods That Trigger Rheumatoid Arthritis

There are no foods known to trigger rheumatoid arthritis, although it is recommended to opt for foods that keep inflammation down and minimize the risk of flares. Foods that you might prefer to avoid include allergens, highly processed foods, red meat, dairy products, gluten, MSG (monosodium glutamate), sugar-rich foods, fried or excessively grilled foods, and foods high in trans fats.

How Long Does a Rheumatoid Arthritis Flare-Up Last?

The length of an RA flare-up can vary from a few hours to several weeks or months^[5]

. The average length of a flare-up is about 9 days.

The duration of a flare can be affected by the following factors:

• Inflammation extent and severity
• Type and dosage of medications you are taking
• The effectiveness of your treatment plan
• Complications or comorbidities
• Adherence to self-care practices
• Coping ability and support system

It is important to take note of when the symptoms start, to monitor their daily severity, and to take self-care measures to manage them. If you do not see an improvement after the first 4-5 days, you ought to consult with a healthcare professional about treatment options.

Rheumatoid Arthritis Self-Care for Managing Flares

Self-care is an important part of RA management. It entails looking after your physical, mental, emotional, and social needs. Self-care can help you cope with a flare-up by reducing pain, inflammation, stress, and negative emotions. Some of the practical tips for self-care during a flare-up are:

• Rest Well. Avoid overexertion or pushing yourself, and take breaks when needed. Listen to your body and respect your limits. You might benefit from taking short naps throughout the day, provided you get adequate sleep and without difficulties.
• Heat or Cold Therapy. While cold might assist numb pain and lessen swelling, heat can help relax muscles and promote blood flow. You can use hot or cold packs, heating pads, electric blankets, warm baths, or ice cubes.
• Assistive Devices. If you battle to get around, be gentle with your body and make use of splints, braces, canes, walkers, or grab bars to make it easier for yourself. Jar openers, button hooks, or voice-activated devices may also be helpful depending on where and how severe the flare is.
• Dental Hygiene. Oral health is very important for lessening the intensity of RA flare-ups. Those with severe RA are more likely to brush their teeth less often and have gum infections like gingivitis.^[6] Make sure to brush your teeth every day and consult with a dentist if you are battling with sore teeth, gums, cavities, or a dental infection.
• Over-The-Counter Pain Relievers. You can use acetaminophen, ibuprofen, naproxen, or aspirin to ease pain and inflammation. Consult with your doctor about using painkillers if you are on other medications, live with comorbidity, or are especially sensitive.
• Complementary and Alternative Therapies. Those with RA have found relief from massage, acupuncture, aromatherapy, meditation, yoga, tai chi, or music therapy.
• Emotional Support. Sharing your feelings, experiences, and concerns with people who understand and care about you. This helps you to feel calmer and allows for those you know to offer you practical help or useful advice.
• Psychotherapy for Depression. If you are facing anxiety, depression, or other mental health difficulties, seek professional assistance from a counselor or therapist. You can learn coping skills, stress management techniques, or cognitive-behavioral therapy to improve your mood and outlook.

Medical Treatment for RA Flare-Ups

In addition to self-care, you may need medical treatment to manage a severe flare-up or to prevent further damage to your joints and organs. It is best to consult with a doctor or rheumatologist to determine the best treatment plan for your condition.

Treatments for RA flare-ups include^[7]:

Corticosteroids

Steroids are powerful anti-inflammatory drugs that can quickly reduce inflammation and symptoms in a flare-up. They can be taken orally as pills (such as prednisone or prednisolone) or injected into the affected joints (such as cortisone). The effects may last for several months to a year. If RA flare symptoms do not go away after this time, it is important to remember that high-dose or long-term use of steroids can pose serious risks related to immune suppression. Instead of continuous steroid injections, it is best to speak to a specialist about other treatments for tackling severe RA.

Disease-modifying antirheumatic drugs (DMARDs)

DMARDs are drugs that slow down the progression of RA by modifying the immune system response that causes inflammation and RA-related damage. They can be taken orally as pills (such as methotrexate or sulfasalazine) or given by injection (such as leflunomide or hydroxychloroquine). DMARDs can help prevent future flares and reduce the need for steroids or biologic agents. Side effects of DMARDs include bone marrow suppression, liver toxicity, and respiratory issues.

Other Drugs for Rheumatoid Arthritis

There are other medications that can help treat RA flares. Referred to as biologic agents, these target specific molecules involved in the faulty immune system response in RA. They can be given as injections (such as etanercept or adalimumab) or infusions (such as infliximab or rituximab). Biologic agents can be very effective in controlling RA flares and preventing joint damage. However, they may come with side effects, such as an increased risk of infection, allergic reactions, or other complications.

Platelet-Rich Plasma Therapy^[8]

While not a standard treatment option for RA, PRP injections may help some patients to find relief. A tiny preliminary trial found that PRP therapy significantly reduced disease activity, discomfort, function, and quality of life in RA patients. The therapy was safe and well-tolerated by the patients, and the effects were sustained for up to 1 year. The long-term efficacy and safety of PRP therapy for RA, as well as the ideal dosage, still require further study.

Tips for Preventing Future Flare-Ups

While RA flares cannot entirely be avoided, there are several tactics that can help lower your risk of future flares and lessen the impact they have on your daily life. These include:

Dietary considerations. Eat a healthy, balanced diet that is high in antioxidants, lean proteins, whole grains, fruits, and vegetables. This can help reduce inflammation, boost immunity, and promote overall health. You should also avoid foods that may trigger inflammation, such as processed foods, red meat, dairy products, gluten, sugar-rich foods, and large amounts of salt.

Exercise and Physical Activity Recommendations. Regular physical activity can assist in improving cardiovascular health, mood, joint function, muscle strength, and flexibility. Physical activity should be appropriate for your situation. Set a weekly goal of two strength training sessions and at least 150 minutes of moderate-intensity aerobic activity. Pay attention to yourself, and do not overdo it. It is useful to stretch before and after exercise to help warm up and cool down. If required, consult with your doctor or a physical therapist to design an exercise program suitable for you.

Stress Reduction and Emotional Well-Being. Reduced inflammation, enhanced immunological response, and improved mood can all be a result of stress management and a positive mindset. Deep breathing, gradual muscle relaxation, guided imagery, and mindfulness meditation are a few examples of relaxation techniques you can practice. Besides, you can pursue hobbies, music, art, reading, or other happy-making pursuits. Do not hesitate to contact a counselor or therapist if you need additional assistance.

Medication Adherence. You can manage your RA symptoms and avoid flare-ups by taking your meds as directed by your doctor. You should also report any side effects or complications to your doctor as soon as possible.

Regular Check-Ups. Additionally, it's crucial to follow up with your physician or a rheumatologist frequently to monitor your symptoms and, if necessary, modify your treatment strategy. Your healthcare practitioner can better understand your requirements, preferences, and goals if you communicate with them honestly and freely. Feel free to ask questions, express concerns, or request information about your condition and treatment options. For better support and understanding, it might be helpful to involve your family members or caregivers in the communication process.

Conclusion

RA flare-ups are often challenging episodes of increased disease activity and symptoms that can affect your life quality and health outcomes. Understanding and managing RA flare-ups can lower their potential for joint damage and improve your overall well-being. It is important to recognize the signs of a flare-up, identify potential triggers, practice self-care, and seek medical treatment if symptoms do not quickly abate. Following a healthy lifestyle, taking anti-RA medications, and communicating with your healthcare provider can all help prevent future RA flares.

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