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Tell Me Why…My Rheumatoid Arthritis Flares Up

Learn what causes RA symptoms to flare, and what you can do to help manage them.

Living with a chronic condition like rheumatoid arthritis (RA) has its own special challenges, as the approximate 1.5 million adults in the US with the autoimmune disease know. With RA, the body’s immune system turns on itself, attacking the joints, causing inflammation. Inflammation, in turn, causes the synovium—the tissue that lines the inside of the joint—to thicken. Normally the synovium produces a fluid that lubricates the joints, allowing them to move smoothly. But when the lining thickens, it causes swelling and pain in and around the joints¾typically the wrists, elbows, hands, feet, knees and ankles. It mainly affects women, with onset usually between the ages of 30 and 60.  Untreated inflammation can cause damage to the bones, as well as to the cartilage. A host of problems may follow, since loss of cartilage means there is no cushion between joint bones—creating pain from the bone-on-bone contact.  And because RA is a systemic disease, affecting the entire body, it can create medical conditions impacting the cardiovascular and respiratory systems.

RA is managed with two types of treatments: some medications are geared to reduce inflammation and relieve pain and other symptoms. Others aim to slow the progression of the disease. But even when well-managed, RA is a disease of ups and down. There may be days when you feel pretty good, but then things can take a turn and you experience a flare.

What is an RA flare-up?
A flare is a period of increased inflammation and pain, stiffness and tenderness in the affected joints. It can cause other symptoms as well, such as fatigue, fever and trouble sleeping due to pain. The symptoms may be so severe that they can disrupt your regular routine of work, taking care of family and other obligations.  Since the episodes can be so unpredictable and vary from person-to-person, it’s difficult for experts to come up with a single definition and course of treatment. A number of researchers have worked to better understand and identify flares. One prominent international study called OMERACT (Outcome Measures in Rheumatology) has conducted patient interviews, focus groups and surveys to better understand their range of symptoms.

What causes flares?
There are two types of flares: Predictable flares, which are caused by something that can be identified, and unpredictable flares, which can be more vexing, since there is no one event or activity to pin it on. Predictable flares include stress, poor sleep, an illness such as the flu, or overdoing physical activities, such as cleaning the house or raking leaves. Physical activity tends to be a common trigger.

While you’ll experience increased RA symptoms during a predictable flare, they may not last long and tend to resolve themselves. Unpredictable flares, on the other hand, may not improve on their own and could require an adjustment in your medication or some other type of therapy for relief. If you’re already taking oral steroids, your healthcare provider may increase the dosage. Steroid injections may also be used to calm the inflammation and reduce symptoms. During these episodes rest can be especially helpful.

How to avoid flares
It’s may not be possible to prevent flares entirely, given their erratic nature, but there are steps you can take to minimize known triggers:

  • Manage stress. Research suggests that stress and worrying can lead to a flare. Experiment with ways to calm down when you’re upset, whether it’s relaxing in a warm bath or doing deep-breathing exercises. These exercises are helpful since they shift your attention from whatever is bothering you to simply focusing on your breath—a calming exercise in itself. Pausing to take a few deep breaths during the day can also help dial down the tension and keep stress-induced RA pain away.
  • Stay active. Low impact activities, strengthening exercises and flexibility are important for combating joint stiffness and maintaining muscle tone. They can also help you control weight. When you have a flare-up, back off of your activities temporarily and get adequate rest.
  • Eat a Mediterranean diet. Research has shown that foods that are rich in omega-3 fatty acids, phytochemicals and antioxidants deliver potent anti-inflammatory nutrients.  Omega-3s are abundant in cold-water fish such as wild salmon, rainbow trout and black cod; moderate sources include canned albacore tuna, shrimp and halibut. Extra virgin olive oil is another dietary powerhouse for controlling inflammation: oleocanthal has a significant impact not only on inflammation, but helps reduce joint cartilage damage. Learn more about which foods to eat on a Mediterranean diet.  
  • Reduce inflammation with fiber. C-Reactive Protein (CRP) is a marker for inflammation that’s been linked to RA and other diseases. Some studies have found that people who eat lots of veggies, fruits and whole grains have lower CRP levels in their blood. The fiber may have less of an inflammation-fighting role than does the healthy plant chemicals called phytonutrients found in these foods.

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