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Treating RA Flares and Exacerbations

Medically reviewed by Nancy Carteron, MD on January 26, 2017Written by Kimberly Holland

Dealing with RA flares

Rheumatoid arthritis (RA), the second most common form of arthritis, is a chronic inflammatory disease. RA causes the body’s immune system to mistakenly attack its own tissues and joints. Symptoms of RA include swelling, redness, stiffness, and possibly erosion and deformity 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 will flare and cause symptoms again. Read on to learn techniques and strategies for coping with RA flares.

What is a flare?

Mild cases of RA may disappear for good after only a brief period of disease activity, but often cases of RA are more severe and can cause symptoms for a lifetime.

People with RA can experience periods of increased activity, or flares (also called flare-ups). Flares can last several days or even months.

RA can also have times when it causes almost no symptoms, and inflammation is very low. These periods are called remissions. Most people with RA will alternate between low-activity and flares most of their lives. However, remission is possible with effective medications.

What causes flares?

Unfortunately, researchers don’t yet know what causes a flare to begin or end. In some cases, infections can cause RA to flare. In other words, being sick can make you sicker. A change in medication may also cause an RA flare. If you forget to take your medicine or stop taking it entirely, you likely will experience increased inflammation, which can lead to a flare.

No medicines can cure RA or always prevent RA flares. Instead, the goal of treatment is to ease symptoms, reduce inflammation, and prevent joint damage.

Medicines that treat RA flares

The medicines most often prescribed to treat RA can be divided into three groups:

  • Symptomatic treatments are designed to relieve acute pain and inflammation. The medicines in this group include steroids, nonsteroidal anti-inflammatory drugs (NSAIDs), and acetaminophen.
  • Disease-modifying treatments, also known as disease-modifying anti-rheumatic drugs, or DMARDs, are designed to slow the progression of the disease. DMARDs prevent the body’s inflammatory response, which eases symptoms, slows progression, and prevent joint damage.
  • Biologics are newer generation DMARDs, which mimic human immune molecules. They also inhibit the inflammatory response, but are more targeted.

Both DMARDs and biologics are immunosuppressants. RA is caused by a faulty response from your immune system leading to chronic inflammation. Immunosuppressants are designed to prevent this, and help reduce RA symptoms as a result.

Foods that may ease symptoms

There is research that suggests there may be a connection between what you eat and how you feel if you have RA. A balanced diet may help ease RA flare symptoms and prevent inflammation. These foods include:

  • omega-3-rich foods, such as salmon, tuna, walnuts, and flaxseed
  • antioxidant-rich foods, such as colorful vegetables and fruit, beans, nuts, red wine, dark chocolate, and cinnamon
  • extra-virgin olive oil, which has been shown to have anti-inflammatory benefits

Take care of yourself

One of the best and most important ways to treat RA flares is proper self-care. Flares make you feel tired, cause pain and stiffness in your joints, and can make it impossible to carry out normal everyday tasks. Some of the most important forms of self-care include:

  • frequent exercise and stretching
  • weight loss and management
  • eating a balanced diet
  • getting adequate rest

Discuss a diet and fitness regimen with your doctor. Keep in mind that your abilities may be different during a flare.

Alternative therapies that treat RA flares

Talk with your doctor before you begin using any alternative therapies. Some people will not be able to use some of these treatments because of possible interactions with prescription medications.

Some patients may benefit from alternative treatments, such as vitamins and supplements, herbs, or relaxation strategies. While research into the effectiveness of these treatments remains inconclusive, these treatments may benefit you.

Many RA patients will benefit from using heat and cold to help relax muscles, reduce swelling in joints, and dull pain. Alternate applying heating pads or ice packs to affected joints during a flare.

Be honest with others

When your RA is mid-flare, you may feel incapable of keeping up with your commitments, workload, and plans. 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.

Check up on your RA

Your healthcare provider will want to monitor you for signs of disease activity. Monitoring will likely include regular blood tests checking for indicators of inflammation. They may also request regular physical exams. These exams help them monitor how your body is handling the medicine you’re taking, how RA is affecting your joints and movements, and how you’re responding to your treatments. These check-ups provide benchmarks that your doctor can use to see how RA is affecting your body.

Get a grip on RA flares

You don’t have to suffer through a RA flare in silence. Talk with your doctor about what you’re experiencing and how your body is responding to treatment. Look into ways to help your body handle the additional stress caused by flares. Coping strategies may include traditional medicine or alternative therapies. These therapies may help your body handle the additional stress caused by the flare. Each person’s plan will be different. With the help of your doctor, you can find a plan that will work for you.

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