Rheumatoid arthritis (RA) is a chronic inflammatory disease caused by an overactive immune system that mistakenly attacks tissues and joints. The most common form of autoimmune arthritis, RA affects more than 1.3 million Americans. The symptoms of RA typically include swelling, redness, stiffness, and sometimes erosion and abnormality in the affected joints.
For some people, RA is a cyclical disease: Symptoms can disappear for several weeks, months, or even years. Then the disease flares up and causes symptoms again. Read on to learn techniques and strategies for coping with RA flares.
In the same way that RA symptoms and triggers can vary, the amount of time a flare lasts can fluctuate. Sometimes a flare can last a day, sometimes a few days, sometimes a week, and even possibly years if a flare goes untreated.
Most flares are unpredictable and can start suddenly.
RA flares can start suddenly and unexpectedly. In some instances, there is no definable cause. In other cases, an RA flare can be triggered by mental stress, physical overexertion, or an infection.
Signs you may have an RA flare include:
- joints feeling stiffer than usual in the morning, and not loosening up as easily throughout the day
- increased fatigue
- night sweats or fever
- a general “unwell” feeling that persists
Typically, flares can be suppressed with medication, and at times, eased with home remedies.
Even if you’re using medication for your RA, certain home remedies may aid in calming flares.
- Hot and cold therapies. Heating pads and hot baths can help soothe stiff joints. Ice packs can help with dulling acute pain and easing swollen joints.
- Massage. Massages can help with relaxing stiff muscles and easing stress
- Acupuncture. Acupuncture is the practice of inserting tiny needles into the skin.
Research suggeststhis alternative therapy can help improve function and quality of life in people living with RA.
- Daily movement. Staying active when possible can help prevent stiffness and maintain muscle.
- Rest. You may not be able to complete as many activities or errands when you’re dealing with an RA flare. Giving yourself time to rest in between activities can help keep stress levels lower.
- Meditation. Stress can trigger an RA flare, so it’s important to find ways to attempt to lower your stress levels via activities like meditation. There is some clinical evidence to support mindfulness meditation as a productive alternative therapy for easing RA symptoms.
Studies showthat fish oil supplements, which contain omega-3 fatty acids, can help reduce the number of swollen and tender joints. Curcumin, a main ingredient in turmeric, has also been shown in studiesto help ease arthritis symptoms. However, talk with your doctor before starting any supplements. Not all supplements are created equal, and the FDA doesn’t regulate fish oil or curcumin dosage.
- Diet. While there is no specific diet that can cure arthritis, there are foods that may help your RA symptoms by helping to lower inflammation in your body, such as fatty fish, peas and beans, fruits and veggies, and olive oil.
While there is no cure, those with RA can help treat and suppress flares by taking certain medications. The medications most often prescribed to treat RA can be divided into three groups.
Nonsteroidal anti-inflammatory drugs (NSAIDs) are designed to relieve acute pain and inflammation. These are often the first type of drugs prescribed for people dealing with RA.
Ibuprofen and naproxen are two examples of over-the-counter NSAIDs, although they can also be prescribed by a doctor at higher dosages.
When taken at the correct dose, side effects of NSAIDs are typically mild, but more severe side effects include gastrointestinal issues, bruising, a greater risk of heart attack and stroke, and possible allergic complications.
Disease-modifying anti-rheumatic drugs, or DMARDs, are designed to slow the progression of the disease while also helping to reduce inflammation. These can only be prescribed by your doctor or specialist.
Currently, there are three types of DMARDS:
- conventional DMARDs, which broadly suppress your immune system in order to ease inflammation
- targeted DMARDs, which block precise pathways inside cells
- biologic DMARDs, which focus on individual immune proteins known as cytokines
Common DMARDs include methotrexate, leflunomide (Arava), and hydroxychloroquine (Plaquenil).
Because all DMARDs suppress your immune system, they can increase your risk of infection. They can also make getting vaccines more dangerous. Make sure to talk with your doctor about the side effects of any specific DMARD they are prescribing to you.
The American College of Rheumatology (ACR) classifies JAK inhibitors as targeted synthetic DMARDs.
Your doctor may prescribe JAK inhibitors if DMARDs or biologics aren’t treating your RA as well. These medications affect genes and the activity of immune cells, which can help prevent inflammation and stop damage to joints and tissues.
JAK inhibitors include:
- baricitinib (Olumiant)
- tofacitinib (Xeljanz, Xeljanz XR)
- upadacitinib (Rinvoq)
Before starting a JAK inhibitor, talk with your doctor to weigh the benefits and risks.
Biologics are a specialized type of DMARD usually prescribed when traditional DMARDs don’t seem to be working. Biologics are usually administered via a shot or through an IV, and work by blocking certain immune system signals that can create inflammation.
Common biologics include adalimumab (Humira), certolizumab (Cimzia), and etanercept (Enbrel).
Like traditional DMARDs, biologics can increase your risk of infection. There are many types of biologics, so talk with your doctor to find out what other possible side effects your medication might have.
In addition to incorporating both home remedies and medication to help suppress your RA flares, finding a rheumatologist (a doctor who specializes in diseases of the joints, bones, and muscles) you like and can trust, and keeping an open line of communication with them, may make it easier to navigate flares when they do arise.
If your RA has made movement difficult, routine visits to a physical therapist, if possible, can help restore some flexibility.
You may feel incapable of keeping up with your commitments, workload, and plans when an RA flare catches you off guard. 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.
Like many other autoimmune diseases, RA can feel frustrating at times due to the unpredictability of flare-ups. However, medication interventions have made treating flare-ups easier, and may even help to lessen the number of flares you do experience.
Home remedies like maintaining a nutrient-dense, inflammation-lowering diet, exercising, and practicing meditation can also help to ease the difficulties that come with RA flares.
And while RA flares may knock you down temporarily, having a doctor you trust and a flare-up plan in place can help you get back up — just as strong as before.