Rheumatoid ArthritisFinding Strength: Life With RA

12 Things That Can Make Rheumatoid Arthritis Worse

While you likely know your main RA triggers, you may be surprised by some of these other factors.
12 Things That Can Make Rheumatoid Arthritis Worse
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Updated on November 13, 2023
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While it’s important to understand treatment options for rheumatoid arthritis (RA) to help manage RA symptoms and disease progression, it is equally important to be aware of what can make RA worse. You need to know what you shouldn’t be doing, just as much as what you should be doing.

RELATED: Rheumatoid Arthritis Treatment and Therapies

Things to Avoid When You Have RA

Below are a dozen things that can make you feel worse when you have rheumatoid arthritis, cause your symptoms to flare, or cause your disease to progress.

1. Not Sticking to Your RA Treatment

After you are diagnosed with RA, your doctor will recommend a course of treatment to help manage RA symptoms and disease activity. If you fail to follow the treatment regimen — by not filling prescriptions, not taking medication as directed, not exercising, or skipping appointments — there is an increased risk of worsening symptoms and disease activity. That’s the case even when it’s unintentional, such as when you forget.

While your reasons for not following your treatment plan may be entirely valid, it is your responsibility to discuss those reasons with your doctor before you make changes to the prescribed regimen. You could benefit from a medication change or the addition of a treatment. Be sure to have that conversation with your doctor and decide on your next move together.

RELATED: Rheumatoid Arthritis Disease Progression and Symptoms: An Overview

2. Leading a Sedentary Lifestyle

Regular physical activity is necessary for everyone, including people with RA, and there are numerous health benefits associated with it. Improved muscle strength, as well as better bone and joint health, is essential for people with RA. Rest is also needed to restore the body from the episodes of intense pain and fatigue that are characteristic of RA. But rest can’t become a way of life; striking a balance between rest and activity is optimal. A sedentary lifestyle actually does the opposite of what you want, leading to increased pain, fatigue, and weakness.

RELATED: Best and Worst Exercise Trends for Rheumatoid Arthritis

3. Eating a Pro-Inflammatory Diet

Certain foods and additives are believed to increase inflammation in the body, such as sugar, saturated fats, trans fats, omega-6 fatty acids, refined carbohydrates, monosodium glutamate (MSG), gluten, aspartame, and alcohol. Check out Dr. Andrew Weil’s Anti-Inflammatory Food Pyramid for some ideas and guidance.

RELATED: A Comprehensive Guide to an Anti-Inflammatory Diet

QUESTION OF THE DAY:

What are your best flare-prevention tips?

4. Overdoing Activities

Despite the importance of regular physical activity, there is a limit. It’s imperative to respect pain signals and to recognize your physical limit and stop just before you reach it. If you overdo it, you risk a flare of symptoms.

RELATED: Planning Ahead or Being Spontaneous: Which Approach Works Better for People With Rheumatoid Arthritis?

5. Smoking

One study found that smoking was associated with higher levels of disease activity in RA, including more swollen joints. In addition, smoking can reduce bone mass, making you more susceptible to osteoporosis, according to the Arthritis Foundation. Quitting is a surefire way to improve your RA, lung health, bone health, and overall health.

RELATED: 7 Joint Pain Triggers That Can Make RA Worse

6. Stressing Out

If you have RA, you don’t need to be told that stress makes it worse. You know because you live it. Interestingly, many people with RA are able to point to a stressful or traumatic event that occurred just before the onset of a flare. Research has found that women who had recently been diagnosed with RA reported more stressful life events in the year prior to the onset of symptoms compared with those who didn’t have RA.

RELATED: How the Stress Response Affects Rheumatoid Arthritis

7. Focusing on Negativity and Pessimism

Simply put, it takes a positive attitude, rather than a negative or pessimistic one, to achieve positive results. It is logical that you need a positive approach to stay on track with your treatment regimen, exercise routine, diet, and more. You must believe in the goal. In one study, researchers found that optimism and mental resilience were associated with less pain severity in people with or at risk for knee osteoarthritis.

RELATED: Catastrophizing About Rheumatoid Arthritis Pain Can Make It Worse

8. Becoming Dehydrated

We are often reminded to drink water and stay well hydrated, but for some reason don’t always follow through. Dehydration is linked to fatigue, a slower metabolism, worse cognitive functioning, and the formation of kidney stones. You may be surprised to learn that lack of hydration is also tied to increased joint pain.

RELATED: 6 Tips to Help You Stay Hydrated

9. Forgetting to Protect Your Joints

Joint protection is an important part of any treatment program for RA. The goal is to reduce pain, prevent deformity, stabilize the joints, and reduce stress on the joints. This is accomplished through the use of splints, braces, or assistive devices; exercise; proper body mechanics; pacing your activities; and modifying your environment if necessary. Failure to protect your joints can make RA worse.

RELATED: 8 Ways to Prevent Rheumatoid Arthritis Joint Damage

10. Neglecting Your Oral Health

Research suggests that tooth loss may predict RA and its severity. Researchers who have studied the connection between RA and periodontal disease discovered similarities in the joint and oral tissues, and in the inflammatory processes that affect them. The types of cells that infiltrate both tissues of the joints in RA and of the mouth in periodontitis — a progressive form of gum disease — are similar. Also, the levels of pro-inflammatory proteins, such as tumor necrosis factor (TNF), interleukin-1, and interleukin-6, are also similar in both RA and periodontitis. There are potential consequences when oral health is neglected.

RELATED: What You Need to Know About Gum Disease

11. Investing in Quack Cures

A quack cure is essentially “hope in a bottle,” an unproven remedy that is ineffective at best and potentially harmful at worst. It is a waste of time and money, especially if you abandon the prescribed treatment from your rheumatologist in favor of the unproven remedy that is cloaked in deception. You risk making your RA worse.

RELATED: Complementary Therapies and At-Home Practices to Help Soothe Rheumatoid Arthritis

12. Ignoring RA Symptoms 

When you experience the first symptoms of RA, it’s not unusual to assume you injured yourself. You hope it will go away in time, and when it doesn’t, you find yourself self-treating with over-the-counter pain relief products. How long you spend in this phase of waiting and self-treating is crucial because, with RA, early diagnosis and early treatment is imperative in slowing disease progression and preventing joint deformity. Waiting too long can make your RA worse.

The same rule applies once you’ve been diagnosed with RA. Any new or worsening symptoms that were previously well managed can be a sign RA is progressing. Be sure to reach out to your doctor to talk about the next steps, which may involve a change in treatment.

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David Alboukrek, MD

Medical Reviewer
Castle Connolly Top Doctor

David Alboukrek, MD, is board-certified in internal medicine and rheumatology. He is an affiliate clinical professor at Florida Atlantic University's Charles E. Schmidt College of Medicine, where he has been a preceptor for first and second year medical students, and participates in clinical activities such as elective rotations with the third and fourth year medical students and second and third year internal medicine residents. He is currently chairperson of the Medical Staff Excellence Committee (peer review) at Boca Raton Regional Hospital, where he previously served as chief of medicine from 2011 to 2013. He maintains privileges at Boca Raton Regional Hospital and Delray Medical Center.

Dr. Alboukrek was born in Mexico City and grew up in Guatemala, where he attended medical school. He went on to complete a family medicine residency program in Guatemala City before moving to the United States. He did a one-year fellowship in child psychiatry at the Children's Hospital in Philadelphia, followed by a residency in internal medicine at Berkshire Medical Center in Pittsfield, Massachusetts. He then completed a fellowship in rheumatology at the University of Texas Health Science Center in San Antonio, Texas. Before moving to Boca Raton in 1995, he was in practice with Berkshire Orthopedic Associates in Massachusetts.

Alboukrek has been a member of multiple medical societies in the USA and abroad. He is a fellow of the American College of Rheumatology. He is a member of the Florida Medical Association, Florida Society of Rheumatology, and the Palm Beach County Medical Society. He has had active roles in the Osteoporosis Diagnostic and Treatment Center of South Florida and the RASF–Clinical Research Center, and has provided care to indigent patients at the Whelton Virshup Creaky Joints Arthritis Clinic for many years.

When not at work he is most likely playing pickleball or ping pong somewhere.

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CarolEustice

Carol Eustice

Author

Carol Eustice was diagnosed with rheumatoid arthritis (RA) at age 19. Having lived her entire adult life with RA, Carol brings first-hand experience of the condition, along with a medical background, to her writing. She attended Cleveland State University in Cleveland, Ohio, earning a Bachelor of Science degree in biology. She is also a registered medical technologist (MT), certified by the American Society for Clinical Pathology.

Carol worked in a hospital laboratory for 16 years, then made a career switch in 1997 to become a writer for The Mining Company, which became About.com and is now VerywellHealth.com. She wrote for the site for 20 years, primarily about arthritis-related diseases. She has also authored two books about arthritis, The Everything Health Guide to Arthritis (2007), and Natural Arthritis Treatment (2012). She is a member of the Association of Rheumatology Health Professionals (ARHP) and the Arthritis Foundation.

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EDITORIAL SOURCES
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
Additional Sources
  • Dr. Weil’s Anti-Inflammatory Food Pyramid. Weil.
  • Gianfrancesco MA et al. Smoking Is Associated With Higher Disease Activity in Rheumatoid Arthritis: A Longitudinal Study Controlling for Time-Varying Covariates. The Journal of Rheumatology. April 2019.
  • 16 Joint-Protection Tips. Arthritis Foundation.
  • Germain V et al. Role of Stress in the Development of Rheumatoid Arthritis: A Case-Control Study. Rheumatology. February 1, 2021.
  • Thompson KA et al. Optimism and Psychological Resilience Are Beneficially Associated With Measures of Clinical and Experimental Pain in Adults With or At Risk for Knee Osteoarthritis. The Clinical Journal of Pain. December 2018.