As a nurse practitioner living with rheumatoid arthritis (RA), I’ve had my share of RA flares. When I was first diagnosed, a friend who also had RA told me: “The only thing predictable about RA is the unpredictability.” Totally accurate.
An RA flare can be anything from struggling to brush your teeth to being completely bedbound. It can come on gradually, over hours or days, or even out of the blue after weeks of feeling great. It can last hours or seem to be never-ending. The symptoms can vary, too. Your flares may show up as a lot of joint pain, stiffness, and swelling (like mine do), or they may make you feel tired or even flu-like.
No matter the details of the flare, we all must find our own ways to get through it. Simply put, there is no other option. Finding ways to manage the symptoms that come with a flare is key to living your best life with RA, an another type of inflammatory condition like psoriatic arthritis or axial spondyloarthritis.
Managing RA Flares
Here are my go-to strategies for getting through a flare. Find out what works best for you.
Listen to Your Body
Fatigue can be an early warning sign that a flare is coming. Listen to your body. Rest is an investment in your health and needs to be budgeted into your life, even at inconvenient times.
Get Enough Sleep
According to a study in JAMA, sleep loss interferes with your immune system by actually increasing inflammatory cytokines, the cells that fight inflammation. Not getting enough sleep triggers the same signals to your immune system as being sick.
Always prioritize sleep. Treat sleep like money and don’t go into sleep debt. Making small changes in my sleep environment has had a huge impact on my sleep quality. I have a specific temperature I like the thermostat set to, blackout curtains, and electrical tape covering every small blue or green light on those electronic devices that never turn off.
Modify Your Exercise Routine
Movement is so important for people with RA — motion is lotion — but when you’re in a flare, you may need to modify your exercise regimen so that it makes you feel good.
In fact, the American College of Rheumatology (ACR) just released new guidelines at this beginning of this year that recommended regular exercise as one of the most important integrative interventions for rheumatoid arthritis. ACR did not, however, agree on the type of exercise.
It’s important to find what works for you. Choose low-impact, gentle exercises that don’t cause more joint pain or trigger your flares. Find the length of time and number of repetitions that works for you, too.
Ask for a referral to a physical therapist and occupational therapist. They can be very helpful in showing you ways to move, bend, and lift to avoid additional strain on your body and joints. They can also evaluate your current practices to find potential problematic movements and provide medical-grade splinting and braces specific to you and RA.
Use Assistive Devices
If you need to use a cane or walker to get around, just do it. These can provide independence and mobility during flares, which is very important for mental health. Tip: If you decide to purchase a cane, get the ones that have three feet and can stand up when you’re not using them. These are so helpful.
Meditation can alter nocioception, or the way your brain interprets things it senses, like pain. Mindfulness based meditation has a long history of helping to manage chronic pain. Keep in mind that there is no minimum or maximum time for meditation practices. Whatever you can fit into your daily routine will benefit you. Try one of these meditations from Global Healthy Living Foundation’s “Wellness Evolution” podcast.
Reach for the Ice
Ice packs can reduce pain and inflammation during a flare relatively quickly. There are many ice packs and frozen products on the market, but a bag of frozen peas is about $1 and easy to store and use.
Full disclosure: I’m always icing my hands with frozen vegetables. My kids now know there is a difference between the vegetables we eat and the ones I use for ice packs.
Heat Things Up
Heat can also help with pain and inflammation during flares. There are a lot of options when it comes to available products — from electric heating pads to ones that heat up in the microwave. If you don’t have one of these available, place dry, uncooked rice in a clean sock and heat it up in the microwave for about a minute. This makes a great impromptu heating pad. A hot bath or shower can also be helpful for painful, swollen joints.
Try stretching and doing gentle hand exercises while in the shower first thing in the morning. Sometimes this helps get your joints moving for the day and relieves that early morning stiffness and pain. Get tips on how to decide whether to use ice or heat.
Take Your Meds
Take your medications used to treat RA (i.e. your DMARDs or biologics) as prescribed. Don’t miss or skip doses unless instructed to do so. Staying on an appropriate treatment regimen is the best way to prevent your RA from flaring.
If you need it, take your pain medications. A great tip I got from RA warrior and disability advocate Lene Anderson to manage pain first thing in the morning: Set an alarm for about two hours before you need to get up for the day. Wake up, take your medications, and go back to sleep. By the time you wake up for your day, your medications will have taken effect. Lose the medication shame.
Get Relief at Hand (and Foot)
Compression gloves can be helpful for hand pain. Sometimes inflamed and swollen joints need a little extra support. Some people with RA wear compression gloves to prevent swelling and pain, while others wear them when their pain and swelling gets bad. There are many styles of compression gloves, and it’s important to find ones that work for you.
Compression socks can also be helpful for foot pain by helping to improve circulation and preventing swelling. These are especially helpful if you spend long hours on your feet either standing or walking. If you have other foot problems, like plantar fasciitis, compression is also beneficial. (Because who has only RA in their feet?!)
Reconsider Your Footwear
Wear high-quality footwear every day, but especially during a flare. If you’re flaring, now is not the time to wear those heels you’ve been hanging onto since high school. Supportive shoes can be a game changer. High-quality shoes can reduce the burden that joints carry and even may help avoid rheumatic related surgeries.
Evaluate Your Mindset
When you’re in a flare, the most important thing you can do is to stay in control of your mindset and emotions. Yes, that’s easier said than done. Flares are frustrating to say the least. But remember, while you can’t control all the circumstances that trigger flares, you can control your thoughts. Do your best to say in control of what you can control.
When my emotions start spinning, I make a list of things I can (and can’t) control in the notes app. Then, I consciously and intentionally let go of the ones I can’t control (even when this is very hard to do!) and list actions to change the things I can control. I start checking these off one by one. This helps my emotions get back on track and not derail my entire day.
Know When to Call the Doctor
Especially if you’re experiencing more (or more severe) flares than normal, you shouldn’t stay silent. Talk to your medical provider ASAP, so together you can discuss whether it’s time to re-evaluate your medical treatments.
Be a More Proactive Patient with ArthritisPower
ArthritisPower is a patient-led, patient-centered research registry for joint, bone, and inflammatory skin conditions. You can participate in voluntary research studies about your health conditions and use the app to track your symptoms, disease activity, and medications — and share with your doctor. Learn more and sign up here.
Watch: Redefining Your Goals with Rheumatoid Arthritis
This video is part of an educational project from researchers at Yale University, Berkshire Medical Center, Carnegie Mellon University, Hospital for Special Surgery, CreakyJoints and the Global Healthy Living Foundation, and ArthritisPower. It was made possible with support from the Rheumatology Research Foundation. Watch more videos from this series here.
Brandel MG, et al. Mindfulness Meditation in the Treatment of Chronic Pain. Neurosurg Clin N Am. 2022. doi: https://doi.org/10.1016/j.nec.2022.02.005.
Riskowski J, et al. Arthritis, foot pain and shoe wear: current musculoskeletal research on feet. Curr Opin Rheumatol. March 2011. doi: https://doi.org/10.1097/BOR.0b013e3283422cf5.
Zeidan F, et al. Mindfulness meditation-based pain relief: a mechanistic account. Ann N Y Acad Sci. 2016. doi: https://doi.org/10.1111/nyas.13153.