Treating RA Flares and Exacerbations
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Treating RA Flares and Exacerbations

Dealing with RA Flares

Rheumatoid arthritis (RA), the second most common form of arthritis, is a chronic inflammatory disease. RA causes the body’s immune system to mistakenly attack its own tissues and joints. Symptoms of RA include swelling, redness, stiffness, and possibly erosion and deformity in affected joints.

For many people, RA is a cyclical disease: symptoms can disappear for several weeks, months, or even years. Then, the disease will flare and cause symptoms again. Read on to learn techniques and strategies for coping with RA flares.

What Is a Flare?

Mild cases of RA may disappear for good after only a brief period of disease activity, but some cases of RA are more severe and can cause symptoms for a lifetime.

People with severe RA will experience periods of increased activity, or flares (also called flare-ups). Flares can last several days or even months.

RA can also have times when it causes almost no symptoms, and inflammation is very low or nonexistent. These periods are called remissions. People with severe forms of RA will alternate between remission and flare most of their lives.

What Causes Flares?

Unfortunately, researchers don’t yet know what causes a flare to begin or end. In some cases, illness can cause dormant RA to flare. In other words, being sick makes you sicker. A change in medication may also cause an RA flare. If you forget to take your medicine or stop taking it entirely, you may experience increased inflammation, which can lead to a flare.

No medicines can cure RA or prevent RA flares. Instead, the goal of treatment is to ease symptoms, reduce inflammation, and return the body to remission.

Medicines That Treat RA Flares

The medicines most often prescribed to treat RA can be divided into three groups:

  • Symptomatic treatments are designed to relieve acute pain and inflammation. The medicines in this group include steroids, nonsteroidal anti-inflammatory drugs (NSAIDs), and acetaminophen.
  • Disease-modifying treatments, also known as disease-modifying anti-rheumatic drugs, or DMARDs, are designed to slow the progression of the disease. DMARDs prevent the body’s inflammatory response, which eases symptoms and slows progression.
  • Immunosuppressants. RA is caused by a faulty response from your immune system. Immunosuppressants are designed to prevent this, and help reduce RA symptoms as a result.

Foods That May Ease Symptoms

There is research that suggests there may be a connection between what you eat and how you feel if you have RA. A balanced diet may help ease RA flare symptoms and prevent inflammation. These foods include:

  • omega-3-rich foods, such as salmon, tuna, walnuts, flaxseed, and soy
  • antioxidant-rich foods, such as colorful vegetables and fruit, beans, nuts, red wine, dark chocolate, and cinnamon
  • extra-virgin olive oil, which has been shown to have anti-inflammatory benefits

Take Care of Yourself

From our Healthline community
Stress can bring on the pain, just as pain can bring on stress. Focusing on a movie or reading helps me. For some, soft music helps.
– Ronnie, living with RA

One of the best and most important ways to treat RA flares is proper self-care. Flares make you feel tired, cause pain and stiffness in your joints, and can make it impossible to carry out normal everyday tasks. Some of the most important forms of self-care include:

  • frequent exercise and stretching
  • weight loss and management
  • eating a balanced diet
  • getting adequate rest

Discuss a diet and fitness regimen with your doctor. Keep in mind that your abilities may be different during a flare.

Alternative Therapies That Treat RA Flares

Before you begin using any alternative therapies, talk with your doctor. Some people will not be able to use some these treatments because of possible interactions with prescription medications.

Some patients may benefit from alternative treatments, such as vitamins and supplements, herbs, or relaxation strategies. While research into the effectiveness of these treatments remains inconclusive, these treatments may benefit you.

Many RA patients will benefit from using heat and cold to help relax muscles, reduce swelling in joints, and dull pain. Alternate applying heating pads or ice packs to affected joints during a flare.

Be Honest with Others

When your RA is mid-flare, you may feel incapable of keeping up with your commitments, workload, and plans. Communicate what you’re experiencing with your friends, family members, and colleagues. Open communication helps them understand what you’re experiencing and helps you find people who may be willing to help when your symptoms are particularly problematic.

Don’t be afraid to admit when you can’t do something. Stressing your body beyond what it can handle may actually make your flare worse.

Check Up on Your RA

Your healthcare provider will want to monitor you for signs of disease activity. Monitoring will likely include regular blood tests checking for indicators of inflammation. They may also request regular physical exams. These exams help them monitor how your body is handling the medicine you’re taking, how RA is affecting your joints and movements, and how you’re responding to your treatments. These check-ups provide benchmarks that your doctor can use to see how RA is affecting your body.

Get a Grip on RA Flares

You don’t have to suffer through an RA flare in silence. Talk with your doctor about what you’re experiencing and how your body is responding to treatment. Look into ways to help your body handle the additional stress caused by flares. Coping strategies may include traditional medicine or alternative therapies. These therapies may help your body handle the additional stress caused by the flare. Each person’s plan will be different. With the help of your doctor, you can find a plan that will work for you.

Read Video Transcript »

Rheumatoid arthritis is an autoimmune inflammatory arthritis. The word "auto" means self, so these are diseases in which the immune system attacks itself. Normally your immune system is not supposed to do that. It's supposed to attack viruses, bacteria, fight off infections, but in some people for whatever reason their immune system gets confused and attacks its own tissues. In the case of rheumatoid arthritis the immune system makes inflammation, the inflammation runs through the body and settles into certain areas, especially into the joints, and if it settles into those joints it can cause pain, swelling, stiffness, and over time that swelling has chemicals, which can cause destruction of bone underneath it, leading to deformity and disability.

Once a diagnosis of rheumatoid arthritis is made, depending on the severity we decide on the treatment path. Traditionally we use two groups of medications, the disease modifying medications referred to as DMARDS, and the biologic medications. Traditionally we start with a DMARD if the symptoms are relatively mild. If on the other hand the symptoms are more severe, we may start with a biologic medication. Oftentimes we find ourselves combining various combinations of these medications to get adequate control of the disease.

Disease modifying medications or DMARDS have been on the market for many years. They're oral medications that act on the immune system in a more general way. They act on overactive immune processes, whereas biologic medications, this newer group of medications, is much more specific targeted therapy.

One of the most important properties of our immune system is to make inflammation. Say for example you get a cut or a wound. It's your immune system that detects the danger and makes inflammation. Inflammation is made by a group of proteins referred to as cytokines. These are signaling proteins.They tell cells to make inflammation.

Some of the newer treatments referred to as biologic medications target specific pro-inflammatory cytokines. By preventing or inhibiting these inflammatory cytokines, inflammation is prevented from being made.

The majority of our patients actually are on various combinations of medications and to adequately control our patients oftentimes we combine these medications. Occasionally we get lucky. We find a patient that may be in the early stages or has very mild disease or has a great response to just an oral disease modifying medication. This happens in about a third of our patients, however two-thirds of our patients require various combinations of disease modifying medications or disease modifying medications plus a biologic.

Oftentimes we will often cycle through various biologics. If one biologic doesn't work, we may swap it out for another one to achieve better control of the disease.

If a patient has persistent joint pain, stiffness, or swelling, then they are most likely failing their current therapy. On the other hand, at times patients feel that their symptoms are adequately controlled, however there are certain objective measures that the rheumatologist monitors, and if those objective measures such as blood work, ultrasound, x-rays are showing persistent disease activity, then also we consider that the patient is failing current therapy. In either situation we try to dose adjust these patients or change medications to get better control of their disease process.

More Resources

Video: Get the Facts About Medications for Advancing RA
Understanding Biologic Treatments for RA
Severe RA Doctor Discussion Guide
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