An illustration of a man with rheumatoid arthritis, as evident by red pain spots on his arms and legs. the man is sitting in a purple chair in a living room, hunched over and texting on his phone.
Credit: Tatiana Ayazo

You know what you should do to help keep your rheumatoid arthritis under control — and you’re probably good about it most of the time. You never miss an appointment with your rheumatologist and refill your prescriptions on time. You rest your joints when they are inflamed and you’ve even bought some arthritis-friendly household gadgets to make it easier to get dressed, cook dinner, and do other daily chores. But despite your best efforts, you may have some unintentional habits that could make your rheumatoid arthritis symptoms worse — things you might not even realize are thwarting your good efforts.

Sometimes, the choices you make every day, like what to eat for dinner or what time to go to bed, may exacerbate RA symptoms.

Fortunately, you can take back control by becoming aware of the all the factors that can make your rheumatoid arthritis worse. With that knowledge, you can adjust your routine, avoid potential rheumatoid arthritis triggers, or take extra steps to help ease symptoms and protect your joint health.

That said, if you make adjustments and worsening RA symptoms persist, talk to your doctor right away, says Elizabeth Schulman, MD, a rheumatologist at Hospital for Special Surgery in New York City. They can help determine if the uptick in symptoms is related to a flare due to a trigger, or if you need to make a change to your treatment plan.

If you’ve been experiencing extra pain or stiffness, here are 14 things you may not realize are making your rheumatoid arthritis symptoms worse.

Trigger: You’ve stopped exercising

When you have joint pain, you may be inclined to skip your usual evening walk or sit on the side of the pool instead of swimming laps. After all, being active when you’re already in pain can only make your joints hurt more and worsen your symptoms, right? Wrong. Staying active is a key part of an effective rheumatoid arthritis treatment plan. When paired with pharmacological (medication) and physical therapies, exercise has been shown to alleviate RA symptoms by helping to ease inflammation, improve physical function, and reduce joint damage, according to research published in the journal Expert Review of Clinical Immunology.

Regular exercise can help boost your strength and flexibility. Stronger muscles help support your joints, and improved flexibility can lead to better day-to-day function.

Another benefit: Weight-bearing exercise (like walking) can help prevent osteoporosis, or a loss of bone density, which can result from rheumatoid arthritis, according to the Mayo Clinic. Plus, people with arthritis who exercise regularly also have more energy, improved mood, and better sleep.

Range-of-motion, strength-training, and low-impact aerobic exercises can all have a positive effect on reducing arthritis-related pain and disability, according to the American College of Rheumatology (ACR). Talk to your doctor before starting a new exercise plan to determine if there are any exercises you should focus on in particular or avoid all together. Similarly, you may want to consider working with a physical therapist or a personal trainer who has experience working with people with arthritis or chronic pain, as they can help you find which types of activities are best for you and at what level or pace you should do them.

Trigger: You overdid a workout

When you’re feeling well, you may be tempted to go full throttle during your workout. But if you haven’t been active for a while, you shouldn’t push too hard, too fast. Otherwise, you might overwork your muscles and worsen joint pain, according to the Mayo Clinic. To ease your joints back into exercise, start slowly, keep the impact low, and take a break if your joints start to hurt.

If your RA does start to flare, scale back, but don’t stop all activity. Gentle range-of-motion exercises can help you work through a flare, as they will help keep your joints flexible, and “aim to get the normal amount of movement you should have within a joint,” Chris Gagliardi, an American Council of Exercise (ACE) certified personal trainer and ACE Resource Center manager, previously told CreakyJoints. Here are some range-of-motion exercises you can do every day.

Trigger: You’re under the weather

We’ve been so worried about COVID-19 that we may not realize that a less-threatening cold, sore throat, other infection could lead to an uptick in RA symptoms. “Infections, including both viruses and bacteria, can trigger activation of your immune system,” explains Dr. Shulman, which can cause a disease flare. In addition to prompt treatment of any underlying infection, Dr. Shulman says to let your rheumatologist know if you’re experiencing symptoms of an infection to determine if your medications need to be adjusted or held. Sometimes, your doctor may recommend temporarily stopping certain medications that affect immune system function, such as disease-modifying antirheumatic drugs (DMARDs), while your body is dealing with an infection in order to help it recover.

Trigger: You eat a lot of red meat

There’s nothing wrong with enjoying the occasional good rib eye, hamburger, or veal chop. But animal products, such as red meat and dairy-based foods, contain a lot of saturated fat, which is associated with an increase in inflammatory blood markers and a decrease in anti-inflammatory blood markers. Several studies have shown diets heavy in red meat can exacerbate rheumatoid arthritis symptoms, likely due to their pro-inflammatory effects, according to a review of research published in the journal Frontiers in Nutrition. On the flip side, the same study found that diets rich in fruits, vegetables, whole grains, and beans have anti-inflammatory properties that may help reduce pain and inflammation in people with RA.

Does that mean you can’t eat red meat if you have RA? Not at all. You can still enjoy a steak now and then — but don’t make it a daily thing. And when you do eat meat, choose a lean cut. Drain the fat from cooked ground meat. Cut back on processed meats that are high in saturated fat, such as bacon, hot dogs, and salami.

Trigger: You don’t eat a lot of fish

Cold water fish like salmon, mackerel, and tuna are high in omega-3 fatty acids, which were found to significantly improve RA disease activity, according to an analysis of research published in the journal Nutrition. Other studies, including one published in the Global Journal of Health Science, have shown people with RA who take omega-3 supplements may need less pain relief medication.

If fish isn’t your favorite, you can get omega-3s from walnuts, chia seeds, and flaxseed. Some brands of eggs, yogurt, or soy drinks are also fortified with omega-3s. Ask your doctor whether you should take omega-3 supplements.

Trigger: You don’t take medication as prescribed

Maybe your symptoms have subsided and you figured it was fine to stop taking some or all of your medications. Or maybe you simply forget to take a dose now and then. Whatever your reason, the result is the same: poor adherence to your regimen may lead an increased risk of worsening symptoms or disease activity. With some medications, it can take time to see these effects, so if you stopped medication a few weeks or months ago, you may only be starting to see the impact now. If your treatment isn’t working for you or you have a hard time sticking to your regimen, talk to your rheumatologist about other options and ideas to help you stay on track.

Trigger: You’ve gained some weight

We know excess body weight isn’t healthy for us, and we know it’s not easy or simple to lose weight —especially when you have a disease like RA that can make it challenging to exercise or have the energy to prepare healthy meals. But it’s important to know about this connection between weight and RA. Multiple studies, including a 2019 study published in the journal Advances in Rheumatology, have found that RA patients who are overweight have worse outcomes than those with a healthy body mass index, and are less likely to achieve sustained remission. “Fat tissue releases proteins called cytokines, which cause inflammation in the body,” Caroline A. Andrews, MD, medical weight management specialist at Hospital for Special Surgery in New York City previously told CreakyJoints. Extra body weight can also put extra stress on weight-bearing joints, which can also exacerbate inflammation.

The good news is that you don’t have to lose a ton of weight to see a difference in your RA symptoms. A 2018 study published in the International Journal of Clinical Rheumatology evaluated the association between weight loss and RA disease activity. Researchers found that overweight people who lost 11 pounds were three times as likely to see disease activity improvement compared to those who lost less. Here are some weight loss tips that may be especially helpful to people with inflammatory arthritis like RA.

Trigger: You drink a lot of soda

Get this: A 16-ounce bottle of regular cola contains about 49 grams of sugar — that’s a little more than 12 teaspoons of added sugar, plus more than 200 empty calories, in just one not-very-big bottle. Consuming too much added sugar causes the body to release pro-inflammatory cytokines, Jen Bruning, MS, RD, registered dietitian nutritionist and spokesperson for the Academy of Nutrition & Dietetics previously told CreakyJoints. Cytokine levels are already high when you have inflammatory arthritis; producing more only results in more inflammation, which is what causes pain, swelling, and stiffness in your joints.

And research has shown regularly drinking sugar-sweetened drinks is linked to greater weight gain and obesity which, as mentioned, can make RA symptoms worse. One 2017 study that surveyed 217 people with rheumatoid arthritis noted that among 20 foods, sugar-sweetened soda was the most frequently reported to worsen RA symptoms, followed by desserts. (And if you’re curious, blueberries and spinach were most often reported to improve RA symptoms.)

The healthiest drink for you is water, of course. But making the switch may not be so easy at first. If it’s the bubbles you love, try sparkling water. To pump up the flavor, add a splash of juice, sliced lemon or lime, or even some fresh herbs.

Trigger: You smoke

This may be a more obvious RA trigger, but we’d be remiss not to include it here. Smoking harms your heart and lungs, increases the risk for many types of cancer and diabetes, and decreases immune function. And if those aren’t enough reasons to kick a smoking habit, people with RA who smoke have an increased risk of more severe disease, and may be less likely to experience remission, according to the Mayo Clinic. Smoking may decrease the effectiveness of some RA medications.

Quitting smoking is not easy, but if you have RA, it’s critical. Talk to your doctor about strategies to help you quit once and for all.

Trigger: You have another chronic condition

When you have another health condition in addition to rheumatoid arthritis, it can impact several aspects of your arthritis and treatment course, says Dr. Shulman. If you have an underlying liver disease, for example, you can’t take certain medications, such as methotrexate, as it can affect the liver.

Some chronic conditions have symptoms that can overlap symptoms of RA. “For instance, osteoarthritis and fibromyalgia are two different illnesses that can cause pain, and it’s important for your rheumatologist to help tease out those differences,” says Dr. Shulman. Pain from fibromyalgia or osteoarthritis needs to be treated differently than pain from RA — and RA treatments that focus on reducing inflammation won’t necessarily help improve pain from these other conditions. Many other chronic illnesses such as cancers, cardiovascular disease, kidney diseases may also impact RA overall. Keep your rheumatologist up to date on all your medical issues, so they can determine a treatment plan that is individualized for you.

Trigger: You have gum disease

Neglect your oral health, and your joints may feel the effects. As strange a link as it may seem, research published in the journal Arthritis Research and Therapy found that RA patients were significantly more likely to have gum disease than people without RA, and that the severity of their gum disease tended to increase along with RA disease activity. The exact connection between gum disease and RA still needs more research; one study suggests a specific bacterium that causes gum disease might also trigger the inflammatory autoimmune response in the joints of people with RA. Maintaining good oral health is important for everyone, but with RA, it stands to be extra vigilant. Brush twice a day, floss at night, and ask your dentist and rheumatologist how often you should get dental cleanings and checkups.

Trigger: You’ve been in a negative mood lately

When you’re in pain, it can be tough to stay optimistic. But it’s crucial to try. Robert Kerns, PhD, Professor of Psychiatry, Neurology, and Psychology at Yale University previously told CreakyJoints that a negative mindset may actually intensify pain and extend its duration. Caring for your mental health is crucial, especially when coping with a chronic illness. Make sure to discuss any mental or emotional issues with your doctor, as they may be able to provide coping strategies or refer you to someone who can help.

Trigger: You text all the time

Not only does the repetitive motion put extra stress on the joints in your fingers (the same joints RA tends to affect first), but it can also impact your wrists, elbows, and even your neck. Just think about your texting position: phone down, head bent forward. That position puts extra stress on the joints and muscles in your neck, which may translate to more stiffness and pain. Your neck muscles, in their proper position, are designed to support the weight of your head. For every inch you drop your head forward, you double the load on those muscles, according to experts at the Cleveland Clinic. Looking down at your phone, with your chin to your chest, can put about 60 pounds of force on your neck. Hold or prop up your phone, if possible, so the device is at eye level. Here are more ways to text and type with less pain when you have arthritis.

Trigger: You’re not sleeping well

The link is well-established: poor sleep is associated with more pain and fatigue, as well as higher levels of depression and greater functional disability in people with RA. There’s an unfortunate catch-22 here as well, as RA pain can cause difficulty sleeping — a phenomenon many patients have coined as ‘painsomnia.’ There are no magical solutions for a better night’s sleep, but improving your shut-eye starts with recognizing its importance in your overall RA management. To help you get the rest your body needs, here are some sleeping tips that people with arthritis swear by.

What to Do if Your Symptoms Are Getting Worse

“Rheumatologists rely on your symptoms to help guide treatment decisions and determine if your medications are working for you,” says Dr. Shulman.

Tell your doctor immediately about changes in joint pain, stiffness, and swelling, as well as any other concerns. They can help determine if worsening symptoms were brought on by an illness or stressor, or if it means that your medications need to be adjusted or even changed entirely.

Track Your Symptoms with ArthritisPower

Join CreakyJoints’ patient-centered research registry and track symptoms like fatigue and pain. Read more and sign up here.

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