Understanding Rheumatoid Arthritis Flare-Ups: Symptoms, Triggers, and Management Techniques

More than just a condition that causes achy joints, rheumatoid arthritis (RA) is a chronic inflammatory disorder that can affect a person’s life in profound ways.

A flare-up is a period of increased disease activity during which your RA symptoms worsen beyond the usual day-to-day levels. Unlike the baseline discomfort or joint pain of RA, flares often hit hard, causing joint pain and stiffness that can leave you feeling immobilized, despite treatment.

Predictable flares are caused by known triggers, such as poor sleep, stress, and infections like the flu. These flares usually resolve over time on their own, especially if you address the trigger, such as by improving your sleep or managing your stress better.

Unpredictable flares, as their name implies, pop up without a known trigger. These flares might not get better over time, requiring instead changes to your medication to get your disease back under control.

Flares don’t always arrive with a warning, so tuning into your body is essential. Keep track of your usual symptoms, including what they are, how severe they are, and how long they last. You can do this by simply writing it down in a notebook or journal, or by using one of various apps and digital tools available. By keeping a symptom journal, you can spot when things change and know when you might be heading into a flare-up.

• Fatigue and decreased energy
• Increased joint pain, tenderness, and swelling
• Joint stiffness, especially in the morning upon first waking up
• Reduced range of joint motion
• Changes in mood, including irritability, aggression, and depression

  [5]

• Mental fogginess

  [6]

• Low-grade fever

  [7]

• Loss of appetite or weight

  [3]

Pinpointing what sets off a flare can be tricky, as triggers can differ from person to person and range from environmental and lifestyle factors, to biological causes, to behavioral and dietary issues. Common culprits include:

• Cold, damp weather, which tends to exacerbate joint pain and stiffness
• Stress, which can lead to a chain reaction in the body, worsening inflammation
• Poor sleep
• Infections or illness, such as the common cold and flu, which can provoke the immune system
• Hormonal changes, such as during menstruation or menopause
• Smoking

  [3]

• Overexertion from physical activity
• Exposure to environmental pollutants, toxins, or chemical agents, such as asbestos, sawdust, pesticides, and cleaning detergents

  [3]

Your symptom diary should be as detailed as possible and may include information such as:

• How severe your RA pain is according to a scale of your choosing (such as 0 to 10)
• How your symptoms are affecting your activities, such as causing you to skip work, school, or social activities
• How your symptoms change as you move and what factors increase or decrease your symptoms
• How your symptoms respond to over-the-counter medications for pain or inflammation, such acetaminophen, ibuprofen, and naproxen

  [10]

• How your symptoms are affecting you emotionally
• What you were doing when your symptoms first starting getting worse

When a flare hits, taking action early can make a big difference.

Immediate Steps

Some steps you can take immediately and on your own to soothe or manage your symptoms include:

• Resting up and engaging in relaxation techniques, such as deep breathing and guided imagery, to release both physical tension and emotional stress
• Using heat or cold therapy — heat to relax stiff muscles or cold to reduce swelling
• Taking a hot shower or gently stretching to relieve morning stiffness
• Using assistive devices such as splints and braces, walking canes, and button hooks, as needed

  [3]

• Distracting yourself from the pain by engaging in an activity you enjoy (that doesn’t heavily rely on your problematic joints) and keeping your mind busy while doing other activities

Also remember to lean on your support system. While your loved ones may not be able to take away your pain or other symptoms, they can help you with day-to-day activities, especially those that could make your symptoms worse.

Pharmaceutical Interventions

Various medications can also help to reduce symptoms. Always consult with your healthcare provider before starting new medications or changing your dosages of current medications.

Over-the-counter or prescription-strength pain relievers and nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, naproxen, acetaminophen, and aspirin, can help provide quick relief for mild pain and inflammation during an RA flare.

Biologics are a more advanced type of DMARDs that target specific biological processes or molecules that cause RA-related inflammation. If you’re experiencing an RA flare with significant symptoms or one that’s not adequately controlled by other medications, your provider may start you on a biologic along with or instead of other drug therapies.

Holistic and Lifestyle Approaches

Other holistic and lifestyle approaches to treat your RA flare include:

• Improving your sleep hygiene for better sleep, such as by establishing set sleep and wake times, creating a comfortable sleep environment that’s dark and cool, and avoiding heavy meals before bed

  [13]

• Eating anti-inflammatory foods, such as those rich in omega-3 fatty and antioxidants, and avoiding those that promote inflammation

  [14]

• Engaging in gentle physical activity, such as hand exercises, swimming, and low-impact tai chi or yoga
• Adjusting your overall response to pain through mindfulness practices, deep breathing exercises, and counseling or psychotherapy

While flares can’t always be avoided, adopting proactive habits can reduce their frequency and impact. These include:

• Regular checkups with your care team to monitor disease activity and adjust treatment as needed
• Prioritizing rest and stress reduction or management
• Following a healthy, anti-inflammatory diet, such as the Mediterranean diet

  [14]

• Creating a personalized action plan with your care team so you know what steps to take when a flare strikes

  [15]

• Maintaining exercise and physical activity, but listen to your body and rest when needed
• Building a strong support system of family, friends, or RA support groups

• Managing rheumatoid arthritis flare-ups involves recognizing symptoms, identifying triggers, and employing effective management strategies.
• Immediate actions like resting and using heat or cold therapy can provide some relief during flares.
• Persistent or severe symptoms may require a reevaluation of medication by a healthcare professional.
• Using a comprehensive approach that includes lifestyle adjustments and medication can help minimize the impact of future flare-ups.