A flare up of inflammatory arthritis (such as rheumatoid arthritis and psoriatic arthritis) happens when you develop worsening inflammation in your joints. Sometimes simple self-management techniques over a few days will be enough to settle the flare. However, if your symptoms are severe, not improving, or you are getting frequent flares then it is important that you seek medical help, as uncontrolled inflammation can lead to damage of your joints.
How will I know if I am having a flare of my arthritis?
You may notice the following symptoms:
Worsening joint pain: typically the pain is worse in the morning and improves with exercise
Stiffness of your joints: again this is usually worse in the morning
Swelling of your joints
What can I do to improve my symptoms?
Self management advice:
Try using cool packs on affected joints. Taking a hot bath or shower can help relieve morning stiffness and pain.
Ensure that you are wearing comfortable foot wear
If you have ongoing pain in your feet you may also benefit from a review by a podiatrist.
Take regular pain relief
e.g. paracetamol and ibuprofen (providing you have no contraindications to taking these medications)
Rest and relaxation
Pain can result in physical muscle tension as well as emotional stress. Physical tension and emotional stress can in turn lead to worsening pain. As a result you can end up entering in a ‘pain cycle’. Rest and relaxation can help break this pain cycle and improve symptoms.
Do gentle exercises
Gentle exercises can help relieve your pain. Exercises will also keep your muscles strong to help support your joints. The following link will take you to the versus arthritis ‘Keep moving’ booklet which contains simple physiotherapy exercises that you can practice at home: https://www.versusarthritis.org/media/3097/keep-moving-poster.pdf
For further information please see page on Exercise.
Speak to those closest to you so they can understand why you might be struggling to do certain activities. They may be able to help you with daily activities if you are struggling, as well as providing emotional support.
Look after your mental health
Emotional stress alone can sometimes trigger a flare of your arthritis and can worsen pain. For more advice on looking after your mental health, visit the ‘mood cafe’ website by clicking on the following link: https://www.moodcafe.co.uk/
Smoking reduces the chance of you responding to the treatments that we have available. People with inflammatory arthritis who smoke are at increased risk of severe disease and have worse long term outcomes. Nicotine replacement therapy has been proven to increase your chances of stopping smoking. You can speak to your pharmacist, GP or rheumatology doctor for advice on nicotine replacement therapy. For further information please see page on Smoking.
If you are overweight, weight loss may improve your inflammatory arthritis and increase your chance of responding to treatment. This may be more challenging during an acute flare but is important to consider in the long term.
I have tried the above self-management measures but I have ongoing symptoms, what do I do know?
If you have ongoing symptoms despite the above measures you should seek medical help by either:
Your healthcare provider will review your symptoms and discuss treatment options. If your symptoms and examination findings are suggestive of active inflammation of your joints, they may suggest treatment with one or more of the following options:
Non-steroidal anti-inflammatory medication (NSAIDS): Examples of NSAIDS include ibuprofen and naproxen.
Steroid treatment: Steroids are usually very effective in treating an acute flare of inflammatory arthritis. However, they can result in many side effects when taken regularly or long term. They are therefore reserved for treating an acute flare but are not usually a long-term treatment option. Steroid can be administered in different ways
Intra-muscular steroid injection
Intra-articular steroid injection – a steroid injection directly into the affected joint
Disease Modifying Anti-inflammatory treatment (DMARD): If you are having flares of your arthritis it may be a sign that your long term treatment for your inflammatory arthritis needs to be altered. This may involve increasing the dose of your existing medication, adding in a new medication or switching to an alternative treatment. Examples of long term treatments for inflammatory arthritis includes: DMARDs such as methotrexate, sulfasalazine, hydroxychloroquine and leflunomide as well as Biologic treatment.