Flaring and rheumatoid arthritis (RA) — they go together like summer and sticky popsicles, except for being much less wonderful. The last few weeks, I’ve taken a closer look at this part of living with RA. If you missed my articles on what an RA flare is and what it’s like to flare with RA, make sure to hop on over to check them out.
How you deal with an RA flare depends on how severe it is. Flares exist on a continuum from mild to severe and require different types of intervention depending on how bad they are. Some of you can deal with it yourself, others will need help from their rheumatologist.
Prepare for the flare
Having a plan is key to coping with a flare. When you’re in the middle of increased pain, swelling, fatigue, and running a fever, it’s hard to think. Putting together a Flare Kit ahead of time means you just have to reach out for a solution. It doesn’t matter if your Flare Kit is in a nifty box or a list posted on your fridge, as long as you have easy access to it.
A Flare Kit is inspired by Britt’s practical tips for pain management. It contains the essentials for getting you through a period when your RA is in the driver’s seat. What’s in your Kit depends on what works for you. The basics could include heat and cold packs, splints and braces to support aching joints, topical anti-inflammatories and other pain relieving creams, lots of sleep, and pain meds. If you have small children, it’s important to keep the medication where little hands can’t get to them. If your doctor has prescribed opioids, make sure you keep them in a place where only you can access them.
In addition to the basics, spoil yourself a little when you feel like crap. Tuck a few treats into your Flare Kit — a good book, a sinful box of chocolate, and a movie you’ve always wanted to see. Being in the middle of a flare can test your emotions. Being extra good to yourself takes the sting off.
When to call your doctor
Flares that originate in overdoing it are often on the mild or moderate end of the continuum. Taking some time for a few days or a week to rest and be good to yourself may be enough for your body to start simmering down again. But sometimes, the flare continues or gets more intense. Those are the kinds that may need extra help.
The extra help often involves a steroid burst, a prescription of a fairly high dose of prednisone that is tapered off within a week or two, or a systemic steroid shot. If the flare shows no signs of abating, your doctor may prescribe a lower dose of daily prednisone to take until you start bouncing back.
Another approach is to start tinkering with the medication you take for RA. This happens especially when the flare starts looking less like a flare and more like RA getting the upper hand. Sometimes, an increased dose of your DMARD medication will do the trick, at other times adding an additional medication, or switching altogether may be required.
If you haven’t already discussed flares with your rheumatologist, make sure to bring it up in your next appointment. Knowing when to ask for your doctor’s help can make a flare less scary.
Dealing with the fear
In addition to having a plan to deal with the physical aspects of a flare, you may also want to prepare yourself for the fear that can accompany it. If your RA has been under control, a flare can send you spiraling into panic that the disease is coming back. Will it damage your joints? Will you be able to continue to work? What about the plans you had with friends on Sunday? It’s amazing how quickly fear can take over.
Just as you prepared a practical Flare Kit, prepare how to cope emotionally. I suggest writing it down — once you start panicking, rational thought goes out the window. Remember that you’ve been here before and have the skills to cope with it. Think about what you’ve done in the past to deal with hard situations. The basics in the emotional Kit include talking with friends, readjusting your expectations of yourself (none of us are perfect), reading inspirational books, and meditating. If the fear is taking over, you may also want to try to talk yourself down using techniques from cognitive behavioural therapy.
Living with RA means facing many things we’d rather not. One of these is that flaring is inevitable. Accepting that this is part of your reality and making sure you have a plan to deal with it when it comes can make coping with the flare much easier.
How do you deal with flares?
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Lene writes the award-winning blog The Seated View. She’s the author of Your Life with Rheumatoid Arthritis: Tools for Managing Treatment, Side Effects and Pain and 7 Facets: A Meditation on Pain.
Lene Andersen is the Community Leader for HealthCentral’s RA Community. Lene (pronounced Lena) is an award-winning writer, health and disability advocate, and photographer living in Toronto. She’s written several books, including Your Life with Rheumatoid Arthritis: Tools for Managing Treatment, Side Effects and Pain, and 7 Facets: A Meditation on Pain, as well as the award-winning blog, The Seated View. Follow Lene on Twitter @TheSeatedView and on Facebook. Watch her story on HealthCentral.