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Patients with rheumatoid arthritis often develop flares, which is a period of time in which symptoms of the disease intensify. This article outlines the top 5 reasons that contribute to the development of flares in patients with rheumatoid arthritis.

Rheumatoid arthritis, a common form of arthritis, is an autoimmune disease that develops when the immune system starts to attack our own healthy tissue. Rheumatoid arthritis, a type of inflammatory arthritis, is one of the most common forms of arthritis. In fact, rheumatoid arthritis, which is a type of inflammatory arthritis, affects up to one percent of the world’s population.

Rheumatoid arthritis is not always an active disease, and actually surfaces in a sudden surge of inflammation called a flare. A flare is characterized by an increase in symptoms of rheumatoid arthritis such as joint pain and swelling, and fatigue.

While there is no consensus on the definition of a flare, most doctors agree that, if you have rheumatoid arthritis and your normal health changes over the course of three days, then you are experiencing a rheumatoid arthritis flare.

There are two types of flares:

  1. Predictable flares. These develop due to exposure to a known trigger. As an example, a patient with rheumatoid arthritis who spends all day cleaning the house from top to bottom over the course of one day will have swollen and stiff joints the next day, leading to a flare up. This a predictable flare because it is well known that overexertion can lead to this situation. The good thing about predictable flares is that while you may feel bad temporarily, the symptoms will go away with time.
  2. Unpredictable flares. These develop for unknown reasons and patients are often unable to identify any possible trigger. These flares often lead to higher intensity of symptoms compared to predictable flares and might not get better on their own.
Often, patients will try to resolve these flares by self-care measures, such as rest and anti-inflammatory medicines. However, these are often not enough and you will need to see your doctor for a medication adjustment or other changes in treatment that can help treat the pain.

With regards to what causes these flares, although there are some things that commonly trigger a rheumatoid arthritis flare, these can differ from person to person. Furthermore, triggers are not always clear as a flare could be the cause of something that happened a few days ago or it can be the result of a number of things that accumulate over time.

Exposure to these five triggers can often lead to a flare:

  1. Fatigue. As mentioned above, overexertion or overdoing an activity can trigger inflammation in patients with rheumatoid arthritis, leading to an increase in fatigue and the development of a rheumatoid arthritis flare. Scientific evidence shows that chemicals called cytokines play a role in inflammation and promotion of fatigue in patients with rheumatoid arthritis. Fortunately, there are new drugs that can actually help prevent the release of cytokines, thus preventing the development of flares.
  2. Stress. Patients with rheumatoid arthritis find that when they go through periods of high stress, they often develop a flare during or right after. In fact, one study showed that there is significant evidence that points to stress as a trigger for flares.
  3. Pregnancy. During pregnancy, the body partially "turns off" the immune system in order to prevent any harm to the fetus. As rheumatoid arthritis develops due to an impairment in the immune system, turning this often causes patients to go into remission. However, the months right after giving birth can frequently trigger a flare as the immune system is just being turned back on. In fact, approximately 75 percent of women with rheumatoid arthritis go into remission when they are pregnant but up to 90 percent experience a flare in the first year after giving birth.
  4. Infection. Medications that are used to treat rheumatoid arthritis work by suppressing the immune system. However, as the immune system serves to protect us from foreign pathogens, that leads to a higher risk of infections. One study shows that almost half of the patients with rheumatoid arthritis that were part of the study had more than one infection that was serious enough that the patient had to be hospitalized or given intravenous antibiotics. These infections themselves, including the common cold or the flu, can trigger a flare.
  5. Foods. Many patients with rheumatoid arthritis, as well as their doctors, agree that specific types of foods can trigger the development of a flare. However, the exact food types that cause this can be difficult to pinpoint as not all foods that cause a flare-up in some individuals will cause it in others. This phenomenon varies from person to person. The best approach to this problem is to keep track of foods that lead to the development of a flare and avoid these in the future.

Managing rheumatoid arthritis flares

There are ways to manage rheumatoid arthritis flares. These include:

  1. Avoid triggers you know cause flares, such as certain foods or overexertion.
  2. Manage stress. As stress is a major contributor to these flares, utilize strategies to manage stress. These can include deep breathing, meditation, or mind-body exercises such as yoga.
  3. Rest. Make sure to not overexert yourself and give yourself enough time to rest between periods of activity.
  4. Be aware of the early symptoms of a flare. In this way, you can go to your doctor right away and activate a management plan for the flare. It is best a keep diary of your triggers and symptoms.
  5. During a flare, make sure to balance your day with rest and activity. Total rest can actually worsen a flare, so some gentle activity like range-of-motion exercise can help prevent joint pain and stiffness.
  6. Use medicines or products that can help treat the flare. In the case of a minor flare, non-steroidal anti-inflammatory drug (NSAIDs), such as aspirin, can help relieve pain and reduce inflammation. Other products such as hot or cold packs can also be applied to the joint. In the case of serious flares, a stronger medication such as prescription steroids may be needed.

  • Wiener, Carolyn L. "The burden of rheumatoid arthritis: tolerating the uncertainty." Deciphering Sociological Research. Palgrave, London, 1982. 286-297.
  • Myasoedova, Elena, et al. "The role of rheumatoid arthritis (RA) flare and cumulative burden of RA severity in the risk of cardiovascular disease." Annals of the rheumatic diseases 75.3 (2016): 560-565.
  • Hewlett, Sarah, et al. "‘I’m hurting, I want to kill myself’: rheumatoid arthritis flare is more than a high joint count—an international patient perspective on flare where medical help is sought." Rheumatology 51.1 (2011): 69-76.
  • Photo courtesy of SteadyHealth.com

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