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 flares or disease flare-ups. Any time your RA is exacerbated, it can interrupt your life. Flare-ups can interrupt a person’s life 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 of record of your flare experiences, so that you can recognize later signs.

Most people who have 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 in response to 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 overproduction of pro-inflammatory cytokines. In 2017, the European Journal of Rheumatology reported on study aimed to identify factors associated with disease flare-ups and remission. What they found was that psychological stress and mood status are independent triggers for flareups. They concluded this might offer an explanation as to 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. As well, the medications you take to treat RA—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 all types of arthritis often state their joints hurt more during both extreme cold and hot temperatures. One 2016 review of 12 studies reports there is little evidence supporting the notion that cold climate worsens arthritis symptoms, although 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. Adults should aim to get a minimum of seven hours of sleep every night. this according to the Centers for Disease Control and Prevention. 

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


There are no medications that can prevent flares. But there 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 and relaxation—like deep breathing and meditation—to help you to handle the emotional effects of a flare.

Distract yourself: Distraction, in the form of listening to music, watching a favorite television show, or surfing the internet are all good ways to help take focus off 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 to feel better both physically and mentally. Ask your doctor 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 doctor about whether it is safe to take these medications, as they may counteract 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 doctor. However, if a flare continues, contact your doctor about prescribing a corticosteroid in the short-term. A corticosteroid can reduce inflammation and pain, and potentially shorten the duration of your flare. Your doctor can also help you to find better ways to manage your disease and any potential flare triggers. 

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

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

  3. Deall C and Majeed H. Effect of cold weather on the symptoms of arthritic disease: A review of the literature. J Gen Pract (Los Angel) 2016, 4:5. doi:10.4172/2329-9126.1000275

  4. Centers for Disease Control and Prevention. How Much Sleep Do I Need? Updated March 2, 2017.