Coping With an Arthritis Flare
What to do if your symptoms of pain, stiffness and fatigue suddenly get worse.
By Michele Cohen Marill
Having an arthritis flare can feel like hitting a wall. Your arthritis has been manageable, then suddenly swollen joints, pain, fatigue and mental fogginess derail your day-to-day activities.
For some people, flares are an inevitable part of the arthritis journey. They are often temporary, but it can be difficult to tell whether this sudden escalation in symptoms will pass or whether it’s a signal that you need to make changes to your treatment plan to prevent progression of your disease. Depending on the situation and your medical history, your doctor may determine that it indicates a worsening of your disease and adjust your treatment.
How you experience a flare may vary depending on the type of arthritis you have and the trigger. Some triggers may be obvious. For example, if you over-exerted yourself while working in the yard or exercised more intensely than usual, or if you experienced a stressful event such as moving or changing jobs, you may have a temporary recurrence of symptoms. For some people, eating particular foods or even having their teeth cleaned can trigger a flare or temporary worsening of symptoms.
In other cases a flare may come on suddenly, with no apparent cause. That might indicate that your medication is no longer working as well and needs to be adjusted or changed.
As troubling as a flare can be, “you’re not alone in this,” says Victoria Ruffing, director of nursing and patient education at the Johns Hopkins Arthritis Center. Your health care team can help you get through it, and you can find support in the Arthritis Foundation’s online community and Connect Groups from others living with arthritis who know what you’re going through.
How Serious is Your Flare?
A flare can be as mild as a recurrence of morning stiffness, but don’t dismiss it. Even if the symptoms resolve quickly, make a note of when they occurred, how long they lasted and how you felt so you can share that information at your next medical visit, Ruffing says.
If your symptoms are severe or last more than a few days, contact your rheumatologist right away, says Ruffing. Your doctor may prescribe an additional drug, like prednisone, or adjust your regular meds until the flare subsides.
If the pain continues getting worse or the symptoms don’t respond to your efforts to relieve them with ice, heat or a nonsteroidal anti-inflammatory drug (NSAID) like ibuprofen, that’s a red flag that your disease may be worsening and you and your doctor may need to adjust your treatment plan and medication, she says.
Symptoms aren’t always due to a flare. For example, if you take regular injections and you begin experiencing symptoms before it’s time for the next shot, the medication may not be working as expected. A blood test can detect markers of inflammation, which will help determine whether you need a change in your treatment regimen.
What a Flare Feels Like With…
Rheumatoid Arthritis: You may have some version of the original symptoms you felt when your rheumatoid arthritis (RA) was diagnosed, including joint pain and swelling, morning stiffness, redness, fatigue and mental fogginess. If pain reoccurs in the same joint, your doctor may want to have imaging of your joint, with ultrasound or MRI, for example, or check your bloodwork to measure inflammation markers.
Psoriatic Arthritis: You may have an increase in psoriatic plaques and pain and swelling in one or several joints, which could be accompanied by fatigue. Like RA, psoriatic arthritis can affect organs as well, so be alert to other symptoms. For example, if you develop eye pain or blurry vision, you should be evaluated by an ophthalmologist.
Ankylosing Spondylitis: Ankylosing spondylitis flares often involve fatigue and back pain, but the pain can occur in other joints, such as the shoulders, hips, hands and feet. Don’t ignore eye problems or other symptoms that could indicate systemic effects of the disease.
Lupus: A lupus flare can cause fever, rash, joint pain, fatigue, sores in the mouth or nose, numbness or tingling or headache. Because active lupus disease involves inflammation of organs, it’s important to contact your rheumatologist to evaluate your symptoms and head off any disease progression.
Gout: A gout flare is often called an “attack” because it causes sudden pain and swelling in a joint — often the big toe. In some cases, a flare is the first sign that someone has gout, which is caused by the build-up of uric acid in the body. If you have a prescription medicine for gout, take it. If not, take ibuprofen or naproxen (not aspirin, which can raise uric acid levels), and call your doctor. Ice the painful joint, drink plenty of fluids and avoid alcoholic and sugary beverages and purine-rich foods, such as red meat and certain seafoods.
Osteoarthritis: Unlike other forms of arthritis, osteoarthritis is not a systemic disease. It affects specific joints rather than the entire body. However, you still might have a sudden increase in pain or swelling in a joint, particularly after over-use. If you have repeated painful episodes, you should contact your health provider, who might refer you to an orthopedist or physical therapist.
How Can I Relieve My Flare?
If your flare is severe, your doctor may determine that your disease is worsening and may alter your treatment plan and medication. But whether it’s mild or severe, you can take some steps to ease the joint pain and swelling by resting it, applying an ice or heat pack and taking an over-the-counter analgesic, like acetaminophen (Tylenol), or NSAID, like ibuprofen or naproxen. If you have morning stiffness, a hot shower or gentle stretching may help.
Meanwhile, double-down on healthy habits, such as getting enough sleep, eating healthy foods and relaxing with deep-breathing exercises or meditation. And don’t be too hard on yourself. “No one leads a totally stress-free life. There are going to be things that come up in life that could trigger a flare,” says Ruffing.
Last reviewed 4/21/2021
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