Understanding Rheumatoid Arthritis Flares

Rheumatoid arthritis (RA) is an autoimmune disease in which the immune system, which is supposed to protect the body, malfunctions and attacks its own healthy tissues. With RA, those attacks target the lining of the joints called the synovium. This leads to red, warm, inflamed, and painful joints.  

People with RA can experience flares, or flare-ups, periods in which inflammation and disease activity are high. RA flare-ups are caused by one or more triggers, including diet, stress, illness, weather changes, smoking, and overexertion.  

The most common signs of RA are joint pain and swelling, fatigue, and joint stiffness, especially in the morning and after sitting for long periods. RA affects the joints on both sides of the body, such as both hands or both knees. This symmetry helps distinguish RA from other types of inflammatory arthritis.

RA is a progressive condition, meaning it can lead to joint damage over time and affect additional body parts, including the eyes, heart, skin, lungs, and blood vessels.

This article will cover what an RA flare-up is, symptoms of a flare, common triggers, and how to cope.  

What Is an RA Flare-Up?

Flare-ups are episodes of increased disease activity in which the body is fighting itself. With RA flare-ups, inflammation increases.  

With a flare-up, you experience a short-term increase in RA symptoms. A flare-up can last a few days or persist for weeks or months.

Flare-ups typically involve joint stiffness and pain, but all RA symptoms can worsen, including fatigue. If a flare-up is especially severe, it can affect your ability to perform daily tasks.

Symptoms  

Each person with RA will experience flare-ups of their disease differently. For some people, symptoms come and go in waves, and for others, symptoms gradually worsen and then slowly improve.  

Symptoms of a flare-up include:

• An increase in joint pain
• Severe fatigue
• Swollen and tender joints
• Joint stiffness
• Depressed mood
• A general unwell feeling
• Night sweats
• Fever
• Appetite loss
• Weight loss

The symptoms of a flare-up can be overwhelming and frustrating. Symptoms can also affect your sleep quality and ability to perform daily tasks.  

Early flare-up symptoms are fatigue and a general unwell feeling (malaise). Flare symptoms will worsen until they reach a peak, and once that peak passes, symptoms will ease up and eventually disappear.  

Common RA Triggers  

Flare-ups can be triggered by many different factors, including stress, diet, sickness, weather, smoking, and overexertion. Disease flare-ups can sometimes happen randomly, without any known cause or trigger.  

A 2017 European Journal of Rheumatology study of 274 people with RA who attended a clinic in Turkey reported on specific triggers that worsened their symptoms. Triggers included emotional and physical stress, infection, trauma, fatigue, weather changes, diet, smoking, and long periods of standing or being active.

Stress  

Researchers know that stress can make RA worse, but they don't understand why. They suspect a link between inflammation and the body's stress response.

In the European Journal of Rheumatology study, researchers found psychological stress was most linked to RA flare-ups. More than 86.1% of the study participants reported stress as a trigger for flare-ups. 

Diet  

Some foods increase inflammation in the body, and reducing or eliminating these can potentially reduce the number of flares you experience.  

Foods that increase inflammation include:  

• Red meats
• Processed meat
• Foods with added sugars
• Refined grains, such as white flour
• Fried foods
• Margarine, shortening, and lard
• High-salt foods

Eliminating trigger foods from your diet can help reduce the number of flare-ups you experience or decrease the intensity of a flare when you do experience one.

Sickness

Getting sick with a cold, an infection, or other illness can make your immune system work harder. The more inflammation you have, the more likely you will experience an RA flare.

If you develop signs of an infection or severe illness, reach out to your healthcare provider right away to treat your symptoms before they worsen or lead to a flare-up.  

Weather  

Some studies have suggested weather or seasonal changes could impact RA symptoms. A 2019 BMC Musculoskeletal Disorders study of more than 12,000 people with RA found flare-ups of the joints of the hands and feet were highest in the spring months, followed by the winter months. Seasonal changes had less impact on larger joints.  

Smoking  

People with RA who smoke have higher inflammatory protein (cytokine) levels in their bodies. Smokers with RA also have more active disease processes than those who have never smoked or have quit smoking.

High disease activity and increased inflammation in RA mean more swollen, tender joints,  joint pain, and more frequent disease flare-ups. The more active your disease, the more likely you will experience joint damage or disability. You may even need surgery to repair or replace damaged joints.  

Overexertion  

Overexertion of your body and joints can cause RA to flare up. You should avoid pushing yourself, especially when symptoms start creeping up. Take the time to recognize when a flare is coming on. Knowing your limits will get easier the longer you live with RA.  

Trauma to a joint can also worsen RA symptoms. Take care to protect your joints, especially when exercising or doing a physical chore like gardening.  

But having RA doesn't mean you need to avoid physical activity. It means you should take care to protect your joints and slow down as needed.  

It is sometimes possible to avoid getting a flare or reduce the severity of RA flares. The best way to do this is by learning to avoid triggers. Another way is to stay on top of your treatment plan. Don't skip medicines or other treatments, and do what you can to manage stress, keep moving, and eat a healthy and balanced diet.  

How to Cope With RA Flares

An RA flare-up can last for days or even weeks. In that time, it is vital to do what you can to manage your symptoms and reduce inflammation and pain.  

Some ways to find relief during a flare-up are:  

• Exercise: Lack of activity can add more stiffness and pain to your joints during a flare-up. Low-intensity exercise can help you manage RA flares. Stretching and walking are exercises that are easy on the joints. If you feel severe pain or fatigue while exercising, listen to your body, stop, and rest. 
• Rest: While exercise can help manage a flare, sometimes it's just as important to allow your body to rest. Find a balance between activity and rest while you manage the flare. Additionally, if you feel like you need extra sleep or time to relax and do nothing during a flare, it is OK to do so. You should avoid pushing yourself during a flare to avoid injury and increased inflammation and pain.
• Manage stress: Managing stress can reduce the intensity and severity of a flare. Ways to manage stress and minimize flare pain are yoga, massage, and warm baths. Consider adding stress management techniques to your everyday routine for the most benefit. 
• Make healthy diet choices: Some foods can trigger or worsen a flare-up. Look out for inflammation-producing foods while making healthy choices. Add anti-inflammatory foods to your diet, including fish, lean protein, beans, whole grains, vitamin D–rich foods, and most fruits and vegetables. 
• Ask for help: Asking for help can be challenging, but your friends and family will want to help. Before a flare starts, let your loved ones know in advance how a flare-up might impact you and let them know what you might need help with when you experience a flare. This includes assisting with childcare or housework, or just providing a listening ear.
• Call your healthcare provider: If symptoms of a flare-up are mild, they will go away within a day or two. But if symptoms last longer than a few days or a mild flare becomes severe, reach out to your healthcare provider. They can prescribe a corticosteroid to help alleviate inflammation quickly or other treatments to manage flare symptoms, including pain.

Summary  

A rheumatoid arthritis flare-up is a short-term worsening of RA symptoms. A flare can last a few days or a few weeks and generally involves joint pain, joint stiffness, and fatigue. Sometimes, it is possible to prevent RA triggers with diet and by avoiding stress and illness.  

Flare-ups can be prevented by following your treatment plan and taking medications exactly as prescribed. Take the steps necessary to manage and reduce the severity of a flare, including resting, eating healthy, and managing stress.

A Word From Verywell

Dealing with a RA flare can affect your emotional health, making it harder to manage RA symptoms. There is also a link between RA and some mood disorders, especially depression.  

If you're concerned about your mental health's effect on managing RA, talk to your healthcare provider about helpful treatments and resources. Seeking treatment for issues with coping or mood disorders can help you manage your RA more effectively.