Though the length and severity of a flare can vary greatly from person to person, it typically involves joint pain, swelling, and stiffness, along with overall fatigue. “These symptoms can make activities of daily living quite difficult — getting dressed, preparing food, doing chores around the house, using your hands to grasp objects, and shopping,” says Howard Smith, MD, a rheumatologist at the Cleveland Clinic in Ohio. Flares may be brought on by external factors such as stress, infection, or simply not getting enough sleep, according to Dr. Smith. It’s also thought that there may be an internal cause, but the process by which it happens isn’t well understood, he adds. RA symptoms tend to “wax and wane,” Smith explains. “At times, the immune system becomes overactive and that leads to increasing joint pain and swelling.” The joints you use most frequently are typically the ones affected during a flare. These include the joints in your hands and wrists; weight-bearing joints such as your knees, ankles, and feet; and those in your neck. Smith adds that a flare may affect more joints on your dominant side.
1. Follow your treatment plan.
Work with your rheumatologist on an action plan that you can initiate in the event of a flare, says Smith, and follow it to a T when a flare kicks in. Everyone experiences RA and flares differently, so management strategies differ too, adds Michelle J. Ormseth, MD, a rheumatologist at Vanderbilt University Medical Center in Nashville. In most cases, a regimen of nonsteroidal anti-inflammatory drugs (NSAIDs) and a corticosteroid can bring minor flares under control. More severe flares may call for an immunosuppressant drug or, if you’re already on one, a change in that drug, along with a corticosteroid to help tame inflammation and other symptoms.
2. Try hot and cold packs.
A heating pad or an ice pack can increase your pain threshold wherever you apply it, which helps decrease the sensation of pain, Dr. Ormseth says. Use cold therapy if joints are swollen, as heat can worsen swelling. Apply a cold pack, like a bag of frozen vegetables, to swollen joints two to four times a day for 15 minutes each time. Use heat if joints are painful but not swollen during your flare. Try applying a heating pad, warm compress, or heat patch to the affected joints two or three times a day for 15 minutes at a time, or soak in a warm bath. Just make sure you don’t overdo either hot or cold treatment.
3. Soothe your body and mind.
Give yourself some extra TLC to help your body recover from a flare. Practice relaxation techniques to help your mind and body calm down and recover. Engage in practices like deep breathing, meditation, and visualization. Try a little pampering — soaking in a warm bath, listening to soothing music, enjoying quiet time, or sipping on a steaming mug of tea. Where possible, adds Smith, do your best to avoid physically and emotionally stressful situations.
4. Call for backup.
The world doesn’t stop when your RA flares, and neither do your responsibilities. When RA knocks you down, put a second action plan in place to address the essentials — work, family, and household chores. Designate responsibilities to each member of your household so that they know how and when to help when a flare strikes. Delay or reschedule anything that’s not urgent. If you need additional resources, try reaching out to your place of worship or a volunteer group in your neighborhood that can pitch in when you need help.
5. Balance rest with activity.
Rest is important. However, sticking with your regular exercise program, or a modified version of it, may actually help you feel better. Try alternating rest with light activity, which could even be something as simple as slowly raising and lowering your legs while seated. But don’t overdo it, and if it hurts, stop. Talk to your doctor or physical therapist about the type of exercises that are easiest on your joints, and whether practicing gentle stretching in the morning might help relieve stiffness.
6. Prioritize your response.
It’s important to take action against an RA flare, but there’s no exact order in which you should tackle these steps, Ormseth says. If possible, try to do all of them together to bring symptoms under control quickly. “Since it’s an immune-mediated attack on the joints, particularly for a severe flare,” Ormseth explains, “it isn’t good for people to just wait it out with rest, because the joints may get damaged.” Work with your rheumatologist to manage flares appropriately and to get your RA under control — don’t just deal with your symptoms. “It’s very important to treat the disease itself and not just mask the pain with pain medications,” adds Ormseth. It’s crucial to tame your flare as quickly as possible, adds Smith, because “the longer the flare goes on, the harder it may be to get it under control.”
