Table of ContentsView AllTable of ContentsRA Flare-upsSymptomsTriggersManagementOutlook

Table of ContentsView All

View All

Table of Contents

RA Flare-ups

Symptoms

Triggers

Management

Outlook

Rheumatoid arthritis(RA) is anautoimmune diseasein which the immune system attacks the joint linings. Aprogressive condition, RA can be managed with medication, but symptom exacerbations, also known as RAflare-ups, can occur.

This article discusses RA flare-ups. It explains what an RA flare-up feels like, common triggers, and how to manage joint pain and inflammation.

seksan Mongkhonkhamsao / Getty Images

woman with elbow pain at doctor’s visit.

What Is an RA Flare-Up?

Flare-ups are episodes of increased disease activity in which the body is fighting itself.With RA flare-ups, inflammation increases.

With a flare-up, you experience a short-term increase in RA symptoms. A flare-up can last a few days or persist for weeks or months.

Flare-ups typically involve joint stiffness and pain, but all RA symptoms can worsen, including fatigue. If a flare-up is especially severe, it can affect your ability to perform daily tasks.

Some people experience multiple RA flare-ups yearly, while others experience long periods of remission when they experience no disease symptoms for some time.

Symptoms of an RA Flare-Up

An RA flare-up can cause intense joint pain along with whole-body symptoms like fatigue or a general feeling of illness.

Each person with RA will experience flare-ups of their disease differently. For some people, symptoms come and go in waves, and for others, symptoms gradually worsen and then slowly improve.

Symptoms of a flare-up include:

The symptoms of a flare-up can be overwhelming and frustrating. Symptoms can also affect your sleep quality and ability to perform daily tasks.

Early flare-up symptoms are fatigue and a general unwell feeling (malaise).Flare symptoms will worsen until they reach a peak, and once that peak passes, symptoms will ease up and eventually disappear.

Common RA Triggers

A 2017European Journal of Rheumatologystudy of 274 people with RA who attended a clinic in Turkey reported on specific triggers that worsened their symptoms.Triggers included emotional and physical stress,infection, trauma, fatigue, weather changes, diet, smoking, and long periods of standing or being active.

Stress

Researchers know that stress can make RA worse, but they don’t understand why. They suspect a link between inflammation and the body’s stress response.

In theEuropean Journal of Rheumatologystudy, researchers found psychological stress was most linked to RA flare-ups.More than 86.1% of the study participants reported stress as a trigger for flare-ups.

Diet

Some foods increase inflammation in the body, and reducing or eliminating these can potentially reduce the number of flares you experience.

Foods that increase inflammation include:

Eliminating trigger foods from your diet can help reduce the number of flare-ups you experience or decrease the intensity of a flare when you do experience one.

Foods to Avoid With Rheumatoid Arthritis

Sickness

Getting sick with a cold, an infection, or other illness can make your immune system work harder. The more inflammation you have, the more likely you will experience an RA flare.

If you develop signs of an infection or severe illness, reach out to your healthcare provider right away to treat your symptoms before they worsen or lead to a flare-up.

Weather

Smoking

People with RA who smoke have higher inflammatory protein (cytokine) levels in their bodies. Smokers with RA also have more active disease processes than those who have never smoked or have quit smoking.

High disease activity and increased inflammation in RA mean more swollen, tender joints,  joint pain, and more frequent disease flare-ups. The more active your disease, the more likely you will experience joint damage or disability. You may even need surgery to repair or replace damaged joints.

Overexertion

Overexertion of your body and joints can cause RA to flare up. You should avoid pushing yourself, especially when symptoms start creeping up. Take the time to recognize when a flare is coming on. Knowing your limits will get easier the longer you live with RA.

Trauma to a joint can also worsen RA symptoms. Take care to protect your joints, especially when exercising or doing a physical chore like gardening.

But having RA doesn’t mean you need to avoid physical activity. It means you should protect your joints and slow down as needed.

Managing RA Flare-Ups

An RA flare-up can last for days or even weeks. In that time, it is vital to do what you can to manage your symptoms and reduce inflammation and pain. Here are some ways to find relief during a flare-up.

Heat or Cold Therapy

For an acute flare-up of RA joint pain involving swelling, ice (also known as cryotherapy) is usually the better option. Wrap an icepack in a light towel and apply to the painful area for up to 20 minutes.

Heat therapy may or may not be helpful during an acute flare, so use your judgment. Moist heat, such as a damp heating pad, hot water bottle, hot shower, or bath, is helpful for reducing morning stiffness and increasing your range of motion.

However, heat can sometimes increase pain, particularly when swelling is involved.If heat doesn’t help or makes your symptoms worse, apply ice instead. Some people also find it helpful to alternate between ice and heat.

Exercise

Lack of activity can add more stiffness and pain to your joints during a flare-up. Low-intensity exercise can help you manage RA flares. Stretching and walking are exercises that are easy on the joints. If you feel severe pain or fatigue while exercising, listen to your body, stop, and rest.

Rest

While exercise can help manage a flare, sometimes it’s just as important to allow your body to rest. Find a balance between activity and rest while you manage the flare. Additionally, if you feel like you need extra sleep or time to relax and do nothing during a flare, it is OK to do so. You should avoid pushing yourself during a flare to prevent injury and increased inflammation and pain.

Reduce Stress

Managing stress can reduce the intensity and severity of a flare. Ways to manage stress and minimize flare pain are yoga, massage, and warm baths. Consider adding stress management techniques to your everyday routine for the most benefit.

Monitor What You Eat

Some foods can trigger or worsen a flare-up. Look out for inflammation-producing foods while making healthy choices. Addanti-inflammatory foodsto your diet, including fish, lean protein, beans, whole grains, vitamin D–rich foods, and most fruits and vegetables.

Find Support

Asking for help can be challenging, but your friends and family will want to help. Let your loved ones know in advance how a flare-up might impact you and what you might need help with when you experience a flare. This includes assisting with childcare or housework or just providing a listening ear.

Call Your Healthcare Provider

RA is a lifelong condition without a cure. Symptoms will come and go, alternating between periods of flare-ups and periods of remission, when the disease is inactive.

Conventional DMARDs include methotrexate, leflunomide, hydroxychloroquine, and sulfasalazine. Biologic DMARDs come in five different classes and include:

If your current treatment plan is not effective, one or more of these medications can help to improve your outlook and quality of life.

Summary

11 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.McWilliams DF, Rahman S, James RJE, et al.Disease activity flares and pain flares in an early rheumatoid arthritis inception cohort; characteristics, antecedents and sequelae.BMC Rheumatol.2019;3:49. doi:10.1186/s41927-019-0100-9InformedHealth.org.Rheumatoid arthritis: Living and dealing with fatigue.Yılmaz V, Umay E, Gündoğdu İ, Karaahmet ZÖ, Öztürk AE.Rheumatoid arthritis: Are psychological factors effective in disease flare?.Eur J Rheumatol. 2017;4(2):127-132. doi:10.5152/eurjrheum.2017.16100Harvard Health.Foods that fight inflammation.Zhu H, Pollock NK, Kotak I, et al.Dietary sodium, adiposity, and inflammation in healthy adolescents.Pediatrics. 2014;133(3):e635-e642. doi:10.1542/peds.2013-1794Mori H, Sawada T, Nishiyama S, et al.Influence of seasonal changes on disease activity and distribution of affected joints in rheumatoid arthritis.BMC Musculoskelet Disord. 2019;20(1):30. Published 2019 Jan 18. doi:10.1186/s12891-019-2418-2Roelsgaard IK, Thomsen T, Østergaard M, Semb AG, Andersen L, Esbensen BA.How do people with rheumatoid arthritis experience participation in a smoking cessation trial: A qualitative study.Int J Qual Stud Health Well-being. 2020;15(1):1725997. doi:10.1080/17482631.2020.1725997Arthritis Foundation.Treatments for rheumatoid arthritis.Johns Hopkins Medicine.Cryotherapy cold therapy for pain management.Arthritis Foundation.Heat therapy helps relax stiff joints.Arthritis Foundation.Biologics.

11 Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.McWilliams DF, Rahman S, James RJE, et al.Disease activity flares and pain flares in an early rheumatoid arthritis inception cohort; characteristics, antecedents and sequelae.BMC Rheumatol.2019;3:49. doi:10.1186/s41927-019-0100-9InformedHealth.org.Rheumatoid arthritis: Living and dealing with fatigue.Yılmaz V, Umay E, Gündoğdu İ, Karaahmet ZÖ, Öztürk AE.Rheumatoid arthritis: Are psychological factors effective in disease flare?.Eur J Rheumatol. 2017;4(2):127-132. doi:10.5152/eurjrheum.2017.16100Harvard Health.Foods that fight inflammation.Zhu H, Pollock NK, Kotak I, et al.Dietary sodium, adiposity, and inflammation in healthy adolescents.Pediatrics. 2014;133(3):e635-e642. doi:10.1542/peds.2013-1794Mori H, Sawada T, Nishiyama S, et al.Influence of seasonal changes on disease activity and distribution of affected joints in rheumatoid arthritis.BMC Musculoskelet Disord. 2019;20(1):30. Published 2019 Jan 18. doi:10.1186/s12891-019-2418-2Roelsgaard IK, Thomsen T, Østergaard M, Semb AG, Andersen L, Esbensen BA.How do people with rheumatoid arthritis experience participation in a smoking cessation trial: A qualitative study.Int J Qual Stud Health Well-being. 2020;15(1):1725997. doi:10.1080/17482631.2020.1725997Arthritis Foundation.Treatments for rheumatoid arthritis.Johns Hopkins Medicine.Cryotherapy cold therapy for pain management.Arthritis Foundation.Heat therapy helps relax stiff joints.Arthritis Foundation.Biologics.

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

McWilliams DF, Rahman S, James RJE, et al.Disease activity flares and pain flares in an early rheumatoid arthritis inception cohort; characteristics, antecedents and sequelae.BMC Rheumatol.2019;3:49. doi:10.1186/s41927-019-0100-9InformedHealth.org.Rheumatoid arthritis: Living and dealing with fatigue.Yılmaz V, Umay E, Gündoğdu İ, Karaahmet ZÖ, Öztürk AE.Rheumatoid arthritis: Are psychological factors effective in disease flare?.Eur J Rheumatol. 2017;4(2):127-132. doi:10.5152/eurjrheum.2017.16100Harvard Health.Foods that fight inflammation.Zhu H, Pollock NK, Kotak I, et al.Dietary sodium, adiposity, and inflammation in healthy adolescents.Pediatrics. 2014;133(3):e635-e642. doi:10.1542/peds.2013-1794Mori H, Sawada T, Nishiyama S, et al.Influence of seasonal changes on disease activity and distribution of affected joints in rheumatoid arthritis.BMC Musculoskelet Disord. 2019;20(1):30. Published 2019 Jan 18. doi:10.1186/s12891-019-2418-2Roelsgaard IK, Thomsen T, Østergaard M, Semb AG, Andersen L, Esbensen BA.How do people with rheumatoid arthritis experience participation in a smoking cessation trial: A qualitative study.Int J Qual Stud Health Well-being. 2020;15(1):1725997. doi:10.1080/17482631.2020.1725997Arthritis Foundation.Treatments for rheumatoid arthritis.Johns Hopkins Medicine.Cryotherapy cold therapy for pain management.Arthritis Foundation.Heat therapy helps relax stiff joints.Arthritis Foundation.Biologics.

McWilliams DF, Rahman S, James RJE, et al.Disease activity flares and pain flares in an early rheumatoid arthritis inception cohort; characteristics, antecedents and sequelae.BMC Rheumatol.2019;3:49. doi:10.1186/s41927-019-0100-9

InformedHealth.org.Rheumatoid arthritis: Living and dealing with fatigue.

Yılmaz V, Umay E, Gündoğdu İ, Karaahmet ZÖ, Öztürk AE.Rheumatoid arthritis: Are psychological factors effective in disease flare?.Eur J Rheumatol. 2017;4(2):127-132. doi:10.5152/eurjrheum.2017.16100

Harvard Health.Foods that fight inflammation.

Zhu H, Pollock NK, Kotak I, et al.Dietary sodium, adiposity, and inflammation in healthy adolescents.Pediatrics. 2014;133(3):e635-e642. doi:10.1542/peds.2013-1794

Mori H, Sawada T, Nishiyama S, et al.Influence of seasonal changes on disease activity and distribution of affected joints in rheumatoid arthritis.BMC Musculoskelet Disord. 2019;20(1):30. Published 2019 Jan 18. doi:10.1186/s12891-019-2418-2

Roelsgaard IK, Thomsen T, Østergaard M, Semb AG, Andersen L, Esbensen BA.How do people with rheumatoid arthritis experience participation in a smoking cessation trial: A qualitative study.Int J Qual Stud Health Well-being. 2020;15(1):1725997. doi:10.1080/17482631.2020.1725997

Arthritis Foundation.Treatments for rheumatoid arthritis.

Johns Hopkins Medicine.Cryotherapy cold therapy for pain management.

Arthritis Foundation.Heat therapy helps relax stiff joints.

Arthritis Foundation.Biologics.

Meet Our Medical Expert Board

Share Feedback

Was this page helpful?Thanks for your feedback!What is your feedback?OtherHelpfulReport an ErrorSubmit

Was this page helpful?

Thanks for your feedback!

What is your feedback?OtherHelpfulReport an ErrorSubmit

What is your feedback?