Managing your rheumatoid arthritis (RA) is an ongoing balancing act. Even people with well-controlled RA symptoms can be surprised by sudden flare ups.
Rheumatoid arthritis flare ups are a well-known symptom of rheumatoid arthritis, and when you’re in the middle of a flare, it can feel as though nothing can help. We’ve created this article to hopefully help ease your pain.
What Causes Rheumatoid Arthritis?
Rheumatoid Arthritis is caused by inflammation of a joint’s synovial membrane. Any joints with such a membrane can experience RA, including the facet joints in the spine.
What Is a Rheumatoid Arthritis Flare Up?
A rheumatoid arthritis flare up describes a short-term escalation of your RA symptoms. A flare up can subside within a day or two, or it can persist for several weeks or months.
An RA flare up generally involves joint stiffness and pain, although it can manifest itself as a worsening of any symptom. If the flare up is especially severe, it can affect your ability to perform your everyday activities.
What Does a Rheumatoid Arthritis Flare Up Feel Like?
Rheumatoid Arthritis flare ups can cause varied symptoms, and not every person experiences the same ones. However, many people describe their flare up symptoms in a similar way, as a sudden increase in pain, stiffness, and swelling of the joints of the body.
Other common RA flare up symptoms include limited joint mobility along with severe fatigue and symptoms that mimic the flu. Note that your symptoms’ frequency and severity may vary. Because there is no standard list of Rheumatoid Arthritis flare up symptoms, physicians may find it difficult to design standard treatment options.
Rheumatoid Arthritis Flare Up Triggers
Potential RA flare up triggers include:
- Stress
- Injury
- Overuse
- Spinal infections
- Poor sleep
- Smoking
- Medication changes
Many flare ups occur without an identifiable trigger. Certain foods are thought to increase inflammation and could contribute to an RA flare up, including:
- Processed meats
- Red meat
- Dairy products
- Added sugar
- High-sodium foods
- High-MSG foods
- Gluten
- Alcohol
By avoiding these foods and sticking to a rheumatoid arthritis diet, you’ll likely reduce your RA symptoms’ severity.
Excessive physical activity can also trigger an RA flare up. If you participate in exercise or sports that could result in an injury, follow protective guidelines to keep yourself safe. By learning to identify the start of an RA flare up, you can moderate your activity accordingly.
Finally, airborne toxins can trigger an RA flare up. Besides cigarette smoke, these harmful substances include chemicals such as household cleaners. Switching to environmentally safe cleaners may help. Airborne toxins are a particular cause for concern in densely populated cities and other areas that experience air pollution and smog. To minimize your risks, stay indoors during periods of poor air quality.
When managing any chronic medical condition, it’s difficult to predict when a flare up will occur. As a result, there isn’t a foolproof strategy for preventing a flare up.
To stand the best chance of avoiding a Rheumatoid Arthritis flare up, it is important to follow a healthy lifestyle including proper nutrition (some people are proponents of eating whole unprocessed foods and avoiding pro-inflammatory foods like trans fats and high fructose corn syrup). Getting good sleep (practicing good sleep hygiene), reducing stress (meditation, regular light impact exercise), and not smoking – can all help to reduce risk of RA flareups.
Treatments for Rheumatoid Arthritis
There is no cure for RA, but many treatments are available.
Medications
The types of medications recommended by your doctor will depend on the severity of your symptoms and how long you’ve had rheumatoid arthritis.
- NSAIDs. Nonsteroidal anti-inflammatory drugs (NSAIDs) can relieve pain and reduce inflammation. Over-the-counter NSAIDs include ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve). Stronger NSAIDs are available by prescription. Side effects may include stomach irritation, heart problems and kidney damage.
- Steroids. Corticosteroid medications, such as prednisone, reduce inflammation and pain and slow joint damage. Side effects may include thinning of bones, weight gain and diabetes. Doctors often prescribe a corticosteroid to relieve symptoms quickly, with the goal of gradually tapering off the medication.
- Conventional DMARDs. These drugs can slow the progression of rheumatoid arthritis and save the joints and other tissues from permanent damage. Common DMARDs include methotrexate (Trexall, Otrexup, others), leflunomide (Arava), hydroxychloroquine (Plaquenil) and sulfasalazine (Azulfidine). Side effects vary but may include liver damage and severe lung infections.
- Biologic agents. Also known as biologic response modifiers, this newer class of DMARDs includes abatacept (Orencia), adalimumab (Humira), anakinra (Kineret), certolizumab (Cimzia), etanercept (Enbrel), golimumab (Simponi), infliximab (Remicade), rituximab (Rituxan), sarilumab (Kevzara) and tocilizumab (Actemra). Biologic DMARDs are usually most effective when paired with a conventional DMARD, such as methotrexate. This type of drug also increases the risk of infections.
- Targeted synthetic DMARDs. Baricitinib (Olumiant), tofacitinib (Xeljanz) and upadacitinib (Rinvoq) may be used if conventional DMARDs and biologics haven’t been effective. Higher doses of tofacitinib can increase the risk of blood clots in the lungs, serious heart-related events and cancer.
Therapy
Your doctor may refer you to a physical or occupational therapist who can teach you exercises to help keep your joints flexible. The therapist may also suggest new ways to do daily tasks that will be easier on your joints. For example, you may want to pick up an object using your forearms.
Assistive devices can make it easier to avoid stressing your painful joints. For instance, a kitchen knife equipped with a hand grip helps protect your finger and wrist joints. Certain tools, such as buttonhooks, can make it easier to get dressed. Catalogs and medical supply stores are good places to look for ideas.
Surgery
If medications fail to prevent or slow joint damage, you and your doctor may consider surgery to repair damaged joints. Surgery may help restore your ability to use your joint. It can also reduce pain and improve function.
Rheumatoid arthritis surgery may involve one or more of the following procedures:
- Synovectomy. Surgery to remove the inflamed lining of the joint (synovium) can help reduce pain and improve the joint’s flexibility.
- Tendon repair. Inflammation and joint damage may cause tendons around your joint to loosen or rupture. Your surgeon may be able to repair the tendons around your joint.
- Joint fusion. Surgically fusing a joint may be recommended to stabilize or realign a joint and for pain relief when a joint replacement isn’t an option.
- Total joint replacement. During joint replacement surgery, your surgeon removes the damaged parts of your joint and inserts a prosthesis made of metal and plastic.
Surgery carries a risk of bleeding, infection and pain. Discuss the benefits and risks with your doctor.