Recognizing and Coping With Rheumatoid Arthritis Exacerbations

Rheumatoid arthritis (RA) is often a disease of ups and downs. One day, your joints feel fine, and the next, swelling and pain keep you up at night. The exacerbation periods where RA is more active are called flare-ups or flares, which can cause increased pain, stiffness, and fatigue for days or even weeks.


An Overview of Rheumatoid Arthritis

Preventing exacerbations of your disease is much easier than treating them. To do this, you will need to recognize signs that a flare might be coming and take action to prevent it and keep it from disrupting your life.

Early Recognition

Prevention starts with being aware of your body and how RA affects it. Early on, it may help to keep a record of your flare experiences so that you can recognize later signs.

Most people who have had RA for a long time know flares start when morning stiffness increases. This means you will wake up in the morning feeling like your joints are stiffer than they usually are, and it takes longer for them to loosen up and for you to get moving in the morning. If a flare is bad, morning stiffness may last all day. 

In addition to morning stiffness, you may also experience some or all the following symptoms with a flare:

  • Pain
  • Inflammation and swelling
  • Extreme fatigue and sleepiness
  • Tender joints
  • Dry skin or eyes
  • Fever

These symptoms may make it hard to function and may interfere with your mood, sleep, and ability to perform everyday tasks. Symptoms will worsen until they reach a peak. As your flare ends, your symptoms will lessen and eventually be gone.

shoulder joint pain
Anupong Thongchan / EyeEm / Getty Images

Causes of Exacerbations

Your flares will either be predictable or unpredictable. Predictable flares are caused by one or more triggers, while unpredictable ones do not seem to have an apparent cause. Unpredictable flares are more challenging to prevent and treat.

Predictable flares usually are the result of specific triggers. Triggers may include:

Stress—emotional or physical: Although researchers don’t know why, stress can induce flares. This likely has to do with the idea that stress may lead to the overproduction of pro-inflammatory cytokines. In 2017, the European Journal of Rheumatology reported one study that identified factors associated with disease flare-ups and remission.

What they found was that psychological stress and mood status are independent triggers for flare-ups. They concluded this might explain why some people are resistant to certain treatments and are prone to unpredictable flare-ups of their disease.

Sickness: Illnesses, especially viral infections, can lead to flares because they affect your immune system. Some medications that are used to treat RA—like corticosteroids and biologics, for example—make you more vulnerable to infection.

Overexertion: When people with RA are feeling well, they tend to overdo things, and the result is often a flare-up of their symptoms.

Diet: There has been no specific evidence linking RA flares to certain foods. However, plenty of people living with RA have reported certain foods—including red meat, refined carbohydrates, sugar, alcohol, and caffeine—have made their symptoms worse.

Further, eating certain foods can help control inflammation. Researchers have pointed out the Mediterranean diet—which includes lots of fruits and vegetables, whole grains, and healthy fats—is a good diet option for people living with RA.

Weather: Although researchers disagree, many people with RA report pressure changes and humidity exacerbate their joint symptoms. People with RA and arthritis often state their joints hurt more during extreme cold and hot temperatures.

One 2016 review of 12 studies reported that there is little evidence supporting the notion that cold climate worsens arthritis symptoms. However, some studies have shown patients do report worsening pain and stiffness when the weather is cold and damp.

Poor sleep: Lack of refreshing sleep can make RA symptoms worse and lead to flare-ups. According to the Centers for Disease Control and Prevention, adults should aim to get a minimum of seven hours of sleep every night.

Knowing which triggers might affect you can help you to work towards avoiding a flare or reducing the severity of predictable flares.


There are no medications that can prevent flares. But there are some things you can do to relieve symptoms and avoid disease exacerbation when you feel a flare coming on.

Rest: If you feel like you cannot get anything done, don’t. Rest is important, and it is the best way to manage and get through a flare.

Manage stress: Stress can cause RA flares, and flares can cause stress. If you are flaring, try stress-reduction techniques like deep breathing and meditation to help you handle the emotional effects of a flare.

Distract yourself: Distraction, such as in the form of listening to music, watching a favorite television show, or surfing the internet, are all good ways to help take the focus off of the pain. 

Try heat and cold: Ice packs, warm baths or showers, heating pads, electric blankets, and hot tubs are effective ways to manage pain and promote relaxation during a flare. 

Gentle activity: If you can handle it, light movement can help you feel better physically and mentally. Ask your healthcare provider about whether low-impact exercises—­such as yoga or tai-chi—are right for you.

Take an over-the-counter (OTC) pain relieverOTC pain relievers—including acetaminophen, ibuprofen, or naproxen sodium—can ease pain caused by flares. Talk to your healthcare provider about whether it is safe to take these medications, as they may interact negatively with prescription treatments. Topical pain relievers containing salicylates, capsaicin, menthol, or camphor, can also help.

A Word From Verywell

You don’t have to suffer in silence during flares, especially if flares seem to occur frequently. If your symptoms are mild and go away quickly, you probably don’t need to get in touch with your healthcare provider. However, if your flare-ups are too bothersome, contact your healthcare provider so that they can help you find better ways to manage your disease and any potential flare triggers. 

Remember, each person’s experience with RA is different. With your healthcare provider’s help, you can find ways to reduce the number of flares you experience and/or the duration of flares you do experience. 

4 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Yilmaz V, Umay E, Gündoğdu I, et al. Rheumatoid arthritis: Are psychological factors effective in disease flare? Eur J Rheumatol. 2017;4(2):127–132. doi:10.5152/eurjrheum.2017.16100

  2. Khanna S, Jaiswal KS, Gupta B. Managing rheumatoid arthritis with dietary interventionsFront Nutr. 2017;4:52. doi:10.3389/fnut.2017.00052

  3. Deall C, Majeed H. Effect of cold weather on the symptoms of arthritic disease: A review of the literature. J Gen Pract (Los Angel) 2016;4:275. doi:10.4172/2329-9126.1000275

  4. Centers for Disease Control and Prevention. How much sleep do I need

By Lana Barhum
Lana Barhum has been a freelance medical writer since 2009. She shares advice on living well with chronic disease.