cartoon shows a woman with tattoos holding a mug. She has red spots on her wrists and elbows indicating joint pain
Credit: Tatiana Ayazo

Going through life wondering when the next time your rheumatoid arthritis is going to flare is a normal anxiety for many of us living with rheumatoid arthritis (RA) or another type of inflammatory arthritis. When our RA is bad, it can be very debilitating with an assortment of fatigue, pain, insomnia, brain fog, and more. It’s only natural that we want to take steps to ensure these disruptive symptoms don’t reoccur.  

But for many people with RA, flares can be the rule rather than the exception. RA can come out of nowhere or be triggered. The diagnosis period can take years; the treatment journey is long; and the disease is progressive. 

There is a series of question I ask myself to prompt myself to determine why I’m flaring and how to feel better.  Many times this helps the flares go away with some self-management, but when they don’t and they begin to impede my daily life, I know it’s time to collaborate with my rheumatologist. 

1. Have I Been Tracking My Symptoms?

As a first step, I start tracking my symptoms so I can have clear communication with my rheumatologist or family physician if I need to see them. Tracking your symptoms can help you determine how long-lasting your symptoms have been and how they are impacting your everyday life.  

Find the way you prefer to track your symptoms. Personally, I partnered with Arthritis Research Canada for their OPERAS program, an app designed to track  physical activity and symptoms in RA patients. Keeping tabs on my symptoms has  taught me so much about my health and how to tackle flares.  

There is no right or wrong method to track your symptoms, it’s just a matter of finding which way gives you the best understanding of your arthritis. You can use ArthritisPower, OPERAS paired with a Fitbit, or you can use pen and paper — whatever works best for you and your disease journey.

2. Am I Doing Too Much?

Stress has a profound impact on my RA, sleep, mental health, and self-care. Simply put: When I’m stressed, I’m doing worse. For this reason, it’s important for me to examine my stress levels and what is happening in my life so I can begin to alleviate some of the stress. At the very least, doing so can help ease my debilitating symptoms. 

If I feel my emotions are currently too much of a challenge for me to deal with on my own, I know there is no shame in seeking professional help from a mental health clinician — whether that means participating in talk therapy or taking medications.  

3. Do I Need to Move More — or Less?

Am I getting too little physical activity? For me, physical activity is a double-edged sword — the right amount can help but overdoing can make me feel worse. If I am doing too little physical activity, I start gently moving to see if it helps reduce my symptoms. For example, I’ll go for a 30-minute walk, try some yoga, or body weight exercises, or I’ll get into the pool and sauna. When I aim for 7,000 to 10,000 steps each day, I tend to feel my best. And yet, when I can’t handle doing too much movement, I have to ask myself why. The important thing is to keep moving throughout the day, pace yourself, and meet yourself where you are. 

It can be easy to overdo with rheumatoid arthritis, especially when life events get in the way. When I moved from my apartment to a house, for example, I knew I would put myself into a flare because moving is a strenuous activity. Luckily, moving doesn’t happen too often.  

4. Am I Engaging in Too Many of My Triggers?

Do I need to examine what I have been eating or drinking lately? I have a sweet tooth and love Sauvignon Blanc, but my autoimmune disease rather dislikes dessert and wine — and it lets me know when I have overindulged in either.  

Food and alcohol aren’t my only triggers; prolonged sitting or standing can also cause a disruption in my body.  

5. Have I Been Diligent with My Meds?

If I have skipped taking my medications once or twice it can increase my symptoms. I’ve learned to be as diligent with my medications as best as I can to avoid an increase in disease activity.  

6. Have I Had a Recent Infection?

When I am dealing with an infection of any kind, I notice my RA gets worse. This was a big lesson for me in my early years with RA when a pelvic infection threw me into a huge flare. I didn’t know my medications were making me even sicker at that point because of the infection.  

7. Am I Practicing Good Sleep Hygiene?

Have I been waking up frequently during the night? Have I been needing multiple naps a day? Are there improvements I can make with how I am sleeping? For example, can I try napping less or stay up later at night instead of going to bed too early? Navigating good sleep habits with RA can be tricky, and it takes time to know what works for you and a good night’s sleep.  

8. How Is the Weather?

I always do better in the beginning of summer until the heat waves pop up, and I fare worse in the winter as the weather cools. Making sure I keep up with movement in a comfortable way is crucial for me, which is why I favor having an at-home gym for the days it’s frightful outside.  In the winter, the sauna is my favorite activity to combat those achy winter blues.  

9. Is It That Time of the Month?

How close is it to my menstrual cycle or to an infusion? My symptoms of fatigue, inflammation, and pain typically rise around both times of the month. This also impacts my mental health.  

10. How Long Are My Symptoms Lasting?

If my symptoms are temporary, it’s more than likely I overexerted myself. However, if my pain or fatigue is lingering for more than three weeks and nothing I do to relieve symptoms is helping, I know it is time to make an appointment with my rheumatologist or family physician to get my blood work done.  

11. Is Self-Care Helping?

Before I reach out for help, I try the following self-management strategies:   

  • Stretch 
  • Walk or swim for 30 minutes 
  • Take a sauna, hot shower, or bath 
  • Ice inflamed areas 
  • Hydrate and nourish my body with a nutrient-dense meal

Once I get a little bit more pep in my step after practicing these healthy habits for one to two days, I add in strength training with resistance bands or my body weight. It generally takes me three to four days to really start to feel the true benefits of regular exercise, however often after just one workout I feel a difference from when I’ve been sedentary.  

If my self-management toolkit does not alleviate any of my symptoms or I start to feel worse, I know this is a warning sign that I need to see my doctor.  

Be a More Proactive Patient with ArthritisPower

Join CreakyJoints’ patient-centered research registry to track your symptoms, disease activity, and medications — and share with your doctor. Sign up.