9 Strategies for Surviving Your Next RA Flare
Even if you’re staying on top of your treatment and following your doctor’s lifestyle recommendations, RA symptoms can still stop you in your tracks. An RA "flare" is when your symptoms—pain, fatigue, stiffness—worsen to the point that they interfere with your daily activities, like getting dressed or preparing food. Or when you're in so much pain that all you want to do is lie in bed. We don't want to sugarcoat it: Flares are really, really hard. But there are ways to lessen your discomfort, win back a bit of energy, and get through this tough time.
Don't Take It Personally
You didn't do anything to cause your flare. You're not weak or lazy or unhealthy for getting one. Everyone with RA, in remission or not, experiences flares. In fact, over the course of any given six months, nearly three quarters of RA patients are likely to experience at least one flare, according to a study in The Journal of Rheumatology. Blaming yourself only makes them harder. Instead of focusing on how or why, focus on getting through the flare and remembering that it will end and you'll be able to get on with your life.
Evaluate Your Medications
Some of the most important research examining RA pain and flares comes from the Brigham and Women's Rheumatoid Arthritis Sequential Study (BRASS), a prospective observational study following 1,500 people with RA over the course of 15 years. One key finding: For fighting flares, making a medication change was the number-one intervention. Talk to your rheumatologist about increasing your current dosage, starting a new disease-modifying antirheumatic drug (DMARD), trying a short-term corticosteroid, or adding a nonsteroidal anti-inflammatory drug (NSAID) to your regimen.
Clear Your Calendar
During a flare, make things as easy as possible on yourself so that your body can focus on healing, says Kevin Deane, M.D., Ph.D., a professor of rheumatology and rheumatologist at UCHealth at the University of Colorado in Aurora, CO. Cancel plans if you have to, without guilt. Take a sick day. Order takeout. Don't make your bed or the cookies you promised your neighbor. Spend the energy you do have on self-care instead: a hot bath, a massage, or a This Is Us marathon.
Conserve Your Energy
An occupational therapist can help you develop an energy-conservation plan: strategies that take some of the effort out of everyday activities so you don't tire out as quickly. For example, push or pull or slide items rather than lifting. If you have to lift something, scoop it with both hands. Use a shower seat to save yourself standing time. Get what you need for the day—clothes, handbag, shoes—all at once to save yourself multiple trips to the closet. These may seem like tiny adjustments, but they can add up to make your day that much easier.
Heat Things Up
“Heat can be an effective tool in relieving the intense joint pain associated with RA flares,” says Howard R. Smith, M.D. director of the Lupus Clinic, Department of Rheumatic and Immunologic Diseases, at the Cleveland Clinic in Ohio. Drape moist hot packs over your inflamed joints, lay on a heating pad, wrap your hands in electric mittens, or soak in a long, hot shower (use that shower seat!) or bath. Hot tip: You can make your own heating pad by putting a wet washcloth inside a freezer bag and nuking it in the microwave for a minute.
Go Deep With the Heat
Ask your doctor about diathermy, a therapeutic treatment that uses a high-frequency electric current—typically ultrasound with RA patients—to generate heat within body tissues. The deep heat increases blood flow to the area and can speed up healing. After a (painless!) diathermy treatment, your joint should feel less stiff and more relaxed, making it easier to go about your day. Diathermy can be provided by an occupational or physical therapist, your primary care doc, or via referral to an ultrasound technician. If you've got a pacemaker, prosthesis, or intrauterine device (IUD), though, this therapy is not for you.
Or Cool Things Down
For very sharp, acute joint pain, Dr. Smith recommends ice instead of heat. Cold temperatures more quickly ease the swelling involved in inflammation and numb pain for fast and easy flare relief. Wrap ice packs or frozen pea bags in a thin towel and apply directly to the area for about 15 to 20 minutes. Let your skin return to normal temperature before applying ice again. If your gym or local spa has a cryotherapy plunge pool—and if you can make it there without worsening your flare—a short dip in it might be a quick fix for flare discomfort.
Treat Your Feet
For almost everyone with RA, foot and hand pain is a top complaint. Since we use our feet to, you know, walk, they can become especially inflamed. Orthopedic footwear—deep and wide soft-leather shoes—can alleviate pressure on your joints. Wear them whenever you can, even just putzing around at home. If you can't bear to leave the house in these not-so-stylish loafers, put on supportive running shoes instead. Ask your doctor or podiatrist about shoes with rocker soles, too; depending on the type, they can alleviate the load on your forefoot or reduce ankle motion.
Lie Down and Breathe
Myriad studies have shown that meditation and mindfulness can lessen pain and boost mood. But one study found that mindfulness strategies worked better than cognitive behavioral therapy for pain (CBT-P) and arthritis education in reducing morning disability, stress, and fatigue—in both the short and long term for people with RA! The mindfulness techniques included breathing meditations, present-moment awareness, and reminders to savor positive experiences. You don't have to sit in an uncomfortable position to meditate: Just lay down on your bed and focus on your breaths. It's totally OK if you fall asleep!
Flare Basics: Journal of Rheumatology. (2009.) "Developing a Standardized Definition for Disease “Flare” in Rheumatoid Arthritis (OMERACT 9 Special Interest Group)." https://www.jrheum.org/content/36/10/2335?ijkey=6457026174b5a33da7bb014932a315fef1bf3848&keytype2=tf_ipsecsha
BRASS Study: Brigham & Women's Hospital. (2021.) "Brigham and Women's Rheumatoid Arthritis Sequential Study (BRASS)." https://www.brassstudy.org/
Flare Frequency and Duration: Journal of Rheumatology. (2014.) "Flares in Rheumatoid Arthritis: Frequency and Management. A Report from the BRASS Registry." https://www.jrheum.org/content/41/2/227#ref-5
Medication Changes: Journal of Rheumatology. (2019.) "Correlates of Successful Rheumatoid Arthritis Flare Management: Clinician-driven Treatment, Home-based Strategies, & Medication Change."https://www.jrheum.org/content/early/2019/06/11/jrheum.181160
Energy Conservation: Cornell Agricultural Safety and Health Program. (n.d.) "Energy Conservation for a Person with Rheumatoid Arthritis." https://nasdonline.org/1870/d001812/energy-conservation-for-a-person-with-rheumatoid-arthritis.html
Footwear: Current Opinion in Rheumatology. (2011.) "Arthritis, Foot Pain & Shoe Wear: Current Musculoskeletal Research on Feet." https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3132870/