How to Avoid Rheumatoid Arthritis Flare-Ups 

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

An exercising woman stops to rub where an RA flare up occurred. What causes rheumatoid arthritis flare ups?

Updated on July 20, 2022

Approximately 1.4 million adults in the United States are living with rheumatoid arthritis (RA). When you have this autoimmune disease, your body’s immune system sees your own cells as foreign and targets them, causing inflammation in various tissues, particularly in your joints.    

Increased inflammation causes the synovium—the tissue that lines the inside of your joints—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 joints.

What are the risks of RA?

RA typically affects the wrists, elbows, hands, feet, knees, and ankles. Women are about two to three times more likely to develop RA than men and most people are diagnosed when they’re in their sixties.  

If you have RA, untreated inflammation can affect your cartilage as well, leading to damage and loss of cushioning between the bones in your joints. Extensive damage or loss of cartilage can create bone-on-bone contact, which can cause pain and lead to destruction of the bone.

Because RA is a systemic disease—meaning it affects the entire body—it can increase your risk for other medical conditions, especially conditions that affect the heart, blood vessels, and lungs. 

What is an RA flare-up? 

An RA flare-up is a period of increased inflammation and worsening symptoms, such as 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. Sometimes, RA flare-up symptoms can be so severe that they disrupt your regular routines, like working, taking care of loved ones, and other obligations.

There are two types of flares: predictable flare-ups, which are caused by something that can be identified, and unpredictable flare-ups, which have causes that may be difficult to identify.

Predictable flare-ups can be triggered by many things. Common triggers include stress, poor sleep, skipping or stopping medication doses, an illness such as the flu, or overdoing physical activities

Unpredictable flare-ups 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 (HCP) 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. 

Because flare-ups vary from person to person, treatment may need to be tailored to each individual.

Understanding treatments for RA

RA is managed with two types of treatments. Some medications are geared toward reducing inflammation and relieving pain and other symptoms. Others aim to slow the progression of the disease. As a group, these are called disease-modifying antirheumatic drugs (DMARDS).

The most commonly prescribed DMARD is methotrexate. While it may take time to feel the full effect of DMARDs, it’s important to take them as prescribed. Especially when started early in the course of the disease, DMARDs can slow down the progression of RA, delay or prevent joint damage, and decrease the likelihood of having a flare. 

One study showed that people with RA who took methotrexate as prescribed less than 80 percent of the time developed significantly worse RA and worse physical functioning over the course of four years. The study was published in the journal Clinical and Experimental Rheumatology in 2022.

How to avoid RA flare-ups 

If you have RA, there may be days when you feel good, while other days can be more challenging, especially if you’re experiencing a flare-up. It may not be possible to prevent flares entirely given their unpredictable nature, but there are several steps you can take.

In addition to following your treatment plan as prescribed, work with your HCP on understanding and developing ways to minimize known triggers. Strategies may include the following: 

Manage stress. Experiment with calming techniques, whether it’s relaxing in a warm bath, doing deep-breathing exercises, or practicing meditation. These activities can shift your attention away from stressful thoughts. Pausing to take a few deep breaths during the day can also help dial down tension. 

Stay active. Low-impact activities, strengthening exercises, and stretching are important for relieving joint stiffness and maintaining muscle tone. They can also help you control weight and relieve stress on your joints. Talk with your HCP about whether you could benefit from a physical activity program, what types of exercises are safe for you, and what activities to avoid if you should have a flare-up.

Eat healthfully. Consider following an anti-inflammatory eating pattern like the Mediterranean diet, which is high in fruits, veggies, lean protein, whole grains, fiber, and healthy fats like omega-3 fatty acids. Research has shown that foods that are rich in omega-3 fatty acids and plant chemicals like antioxidants can deliver potent anti-inflammatory nutrients.

Good sources of omega-3 fatty acids include fish like salmon, nuts, and flax seeds. Extra virgin olive oil is another dietary powerhouse that may help control inflammation, in combination with an overall healthy diet. 

If you smoke, quit. Smoking can worsen RA, lead to other medical problems, and make it harder to stay physically active. You can ask your HCP about ways to quit successfully, like smoking cessation medications and joining a smoking cessation program. It’s one of the best things you can do for your RA and your health.

Join an RA self-management education class. Learning more about your condition can help you better understand your symptoms and triggers and how to manage them. Your HCP can help you find a class, or you can find programs online recommended by reputable sources like the CDC. 

Article sources open article sources

Hunter TM, Boytsov NN, Zhang X, et al. Prevalence of rheumatoid arthritis in the United States adult population in healthcare claims databases, 2004-2014. Rheumatol Int. 2017 Sep;37(9):1551-1557.
National Institutes of Arthritis and Musckuloskeletal and Skin Diseases. Rheumatoid Arthritis. Last reviewed September 2019.
Centers for Disease Control and Prevention. Rheumatoid Arthritis. Last reviewed April 7, 2022.
National Library of Medicine. MedlinePlus. Rheumatoid Arthritis. Accessed July 15 2022.
Fraenkel L, Bathon JM, England BR, et al. 2021 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis. Arthritis Care Res (Hoboken). 2021 Jul;73(7):924-939. doi: 10.1002/acr.24596.
Kang JH, Choi SE, Xu H, et al. Non-adherence to methotrexate was associated with high disease activity and poor health-related outcomes during a 4-year follow-up of rheumatoid arthritis patients. Clin Exp Rheumatol. 2022 Feb 17.
Raad T, Griffin A, George ES, et al. Dietary Interventions with or without Omega-3 Supplementation for the Management of Rheumatoid Arthritis: A Systematic Review. Nutrients. 2021 Oct 4;13(10):3506.
Philippou E, Petersson SD, Rodomar C, et al. Rheumatoid arthritis and dietary interventions: systematic review of clinical trials. Nutr Rev. 2021 Mar 9;79(4):410-428.
Arthritis. Self-Management Education Workshops. Last reviewed June 25, 2020.
Arthritis Foundation. Understanding Rheumatoid Arthritis Flares. Accessed July 20, 2022.
Arthritis Foundation. Tips for Managing an Arthritis Flare. Accessed July 20, 2022.

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