Fighting Flares

Get tips on how to anticipate flare-ups and techniques for handling them.

When you have rheumatoid arthritis (RA), you know how unpredictable disease flare-ups can be. They can happen frequently, or you may have long periods of remission with only occasional bouts of swollen joints, pain and fatigue. Flares can occur in just a few joints or involve your whole body, and they can last from days to weeks.

What fires a flare?

Unfortunately, we don’t really know what triggers flares—or prevents them—although we do have some tantalizing clues. Sometimes, they’re triggered by certain foods or stress. Or your hormones may play a role. Pregnancy seems to help prevent flares in about 75% of women with RA; although in 90% of these cases, flares begin to recur within six months of giving birth.

Even such seemingly unrelated factors as where you live, whether you smoke, your mood, the weather and your level of formal education have been implicated in RA’s ups and downs.

Like everyday aches and pains, RA symptoms can wax and wane, so it’s important to know how to distinguish a real flare in order to treat it quickly.

Here are a few tips for coping with a flare:

1. First steps. You can start with nondrug treatments. Physical therapy, splints, moist heat or cold packs can help. If it’s one joint, like a knee, finger or shoulder, doctors recommend trying to rest it and applying ice for 20 minutes on and 20 minutes off for up to two hours.

2. Keep moving. Although rest is important, so is exercise. Doing nothing can leave you with stiff joints. Avoid strength and endurance exercises during flares. Instead, concentrate on gentle stretching movements that maintain your range of motion.

3. Watch your diet. Eating foods rich in fish and plant oils, and avoiding red meat, can help reduce inflammation. If you take omega-3 anti-inflammatory supplements, try boosting your intake to 3,000 mg a day. If you take fish oil capsules, don’t go by the number on the front of the bottle. Check the total amount of docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) listed on the back label. Added together, they’ll tell you how much omega-3 you’re getting in each two-capsule dose.

4. Try alternatives. Although most alternative approaches haven’t been well researched, some people with RA report that they get relief with relaxation, meditation, hypnosis, acupressure, acupuncture and yoga.

5. Call your doctor. Your physician can raise the dosage of your RA medication and prescribe other drugs to relieve pain and reduce inflammation and tissue damage. If your flare is severe, you may temporarily need corticosteroids, the most powerful anti-inflammatory medications.

Don’t try to tough out a flare on your own. Working with your doctor, you can devise a plan that will help you bounce back quickly, strongly and with a minimum of discomfort. Your doctor can also determine if your flare is because your medicine isn't working well and a new treatment is needed.


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