Symptoms of Rheumatoid Arthritis Flares

Rheumatoid arthritis (RA) is a form of arthritis and an autoimmune disease. An RA flare, also known as an exacerbation, is when a person experiences transient worsening of their RA symptoms—such as joint pain and swelling—which indicates increased inflammation and disease activity. RA flares vary widely in frequency, duration, and severity.

Flares can be predictable (triggered by something) or unpredictable. Self-care measures like rest and anti-inflammatory medicines may be able to help with flares, but when they don't, it's time to see a doctor. Repeated or consistent flares may signal the need for a medication adjustment or other change in treatment. Research has also found that RA flares may contribute substantially to worsening cardiovascular comorbidity, joint damage, and other long-term outcomes.

man experiencing sharp pain in elbow

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Frequent Symptoms

Symptoms of an RA flare are the same as those of RA, but they are more severe:

  • Joint stiffness, especially morning stiffness
  • Intense, consistent, and persistent joint pain
  • Swelling in the joints
  • Intense fatigue
  • Sleep disturbance
  • Night and day sweats
  • Pallor
  • Feeling generally ill (flu-like)
  • Profoundly compromised mobility and ability
  • Sensitivity to noise and light
  • Cognitive shutdown (such as trouble concentrating)
  • Social withdrawal
  • Emotional distress
  • Weight loss
  • Tremor
  • Weakness

People with RA often experience a cluster of these symptoms. It's important to note that not all patients will experience all of the above symptoms during an RA flare.

Types of Flares

There are two types of RA flares: predictable and unpredictable.

Predictable Flares

This type of flare is caused by one or more known triggers. Overexertion, poor sleep, stress, or an infection like the flu can all set off RA symptoms. With a predictable flare, you’ll temporarily feel worse, but your symptoms will resolve in time.

Unpredictable Flares

On the other hand, unpredictable flares don't have an obvious trigger. These flares might not get better on their own. This type of flare is more challenging to prevent and treat.

Flares occur frequently in RA patients with low disease activity, and are associated with worse disease activity, a lower quality of life, and more radiographic progression. 

What Does an RA Flare Feel Like?

Someone with RA may usually be able to do household chores, but a flare can interfere with their ability to perform these tasks. Even simple things like using the bathroom and combing one's hair can become extremely difficult and tiring to complete. Some people have said that their joint stiffness was so severe that it felt like their limbs were stuck together with superglue.

Those experiencing a flare are likely feeling symptoms from head to toe. Fatigue can be debilitating, so much so that people experiencing an RA flare don't feel refreshed even if they sleep for long periods of time. It may also keep someone in bed for hours or days.

The symptoms of an RA flare can be so bad that a person experiencing one feels like their thoughts are all scattered and will hide away from others. They can also result in significant distress, including tearfulness, irritability, and frustration, and lead to depression, which can lead to suicide ideation.

How Long a Flare Lasts

The length of a flare varies, and can be different for different people. Some may experience it for a year, months, or days. A flare can last as long as there isn't a change in treatment. In one study, flares lasted longer than two weeks in 30% of participants, one to two weeks in 13%, and less than one week in 57%. Longer duration of a flare was associated with changes in disease-modifying therapy.

It's essential to work with your doctor to monitor your symptoms and tweak your treatment plan accordingly when you experience RA flares.

Patients with RA experience flares more often when noted to be in higher disease activity states than when in remission. 

Complications

Much remains unknown about RA flares, and scientists are still trying to find out how flares affect people with this condition. Fewer than half of patients in one study were able to sustain full remission beyond one year, and radiographic progression was observed more often in people who did not remain in sustained remission. This study suggests that periodic worsening of disease occurs and raises the question as to whether flares can contribute to suboptimal outcomes in RA.

However, the medications used to treat RA can lead to complications in the stomach, lungs, eyes, and more. Be sure to see your doctor when any new or worsening symptoms arise.

When to Talk to Your Doctor

If you are experiencing worsening symptoms of RA, you should see your doctor for an evaluation of your symptoms and current medications. Flares may require a change in your treatment plan to resolve.

A Word From Verywell

The symptoms of RA can negatively impact a person's mental health and prevent them from living their life to the fullest. Thankfully, there are ways to take care of yourself to recover from a flare when it does occur. Coping with RA is possible by working with your healthcare providers to monitor your disease and practicing self-care to minimize the impact of flares on your health and well-being.

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