I have RA and taking Methatrexate, Voltaren and Plaquenal. I also am prescribed Ultram for pain when needed, but I prefer to take Tylenol instead. I am also considering the option of Enbrel of which I haven't made up my mind about yet. However, I find that my flare ups mostly start in the early evening and go throughout the night, especially in the early hours when I wake up all achy, with chills and in alot of pain. The only comfort I find is in taking Tylenol, which helps relieve the achiness and relieves the pain. Any other suggestions? Will a heating pad help? I live in a warm climate so an electric blanket is not an option this time of year, but I used it quite frequently in the winter months.