My rheumatoid arthritis is flaring
very badly at the moment.
What can I do to help myself?
Taken from NRAS magazine, Autumn 2011
Unfortunately it is not yet possible to eliminate the unpredictable nature of rheumatoid arthritis and a flare of pain or more stiffness in the joints can occur from time to time. This may also be accompanied by feeling tired and somewhat unwell, often resembling the start of ‘flu-like symptoms.
Everyone’s arthritis is unique to them; signs and symptoms will vary as well as responses to treatment. Similarly, the degree and severity of a flare will vary from one person to another. The more you understand about your arthritis and the relationships you have been able to build with your GP, practice nurse and hospital team, the happier you will feel asking for advice and help if you need it. Before contacting a health professional just run through in your mind what information they will need in order to advise you about a flare up:
- How long have the symptoms been troubling you?
- On a scale of 0 -10 (10 = very bad) how bad is your pain?
- Which joints are swollen?
- Are your joints stiff, for how long and what time of day is the worst?
- What medications are you taking?
- Have you taken more pain-killers or anti-inflammatories or both?
- Have you had a blood test recently?
- Have you had an infection (even a mild cold) during the last 2-3 weeks?
- Have you been able to continue with normal activities?
- If only 1 joint has flared up, eg a knee or shoulder, has this joint been troublesome previously and if so have you had a joint injection and how long ago was this done?
If a flare-up is mild
If a flare is mild you may be able to manage it very well with a few changes to your routine. There is good evidence that simple pain killers (eg. paracetamol, co-codamol, co-dydramol) when taken regularly, will keep the level of pain relief ‘topped up’ in your body.
However, it is important not to exceed the stated dose. If you have been prescribed anti-inflammatory medication it helps to continue this as prescribed, remembering to take it with or after food.
Try to stop and rest as much as possible between your essential activities. Try not to feel guilty about leaving non-essential tasks!
A warm shower or bath in the morning will ease stiffness. A warm or cold compress on a single joint (eg swollen knee) for up to 10 minutes at a time can give temporary relief. It is important to protect your skin from the ice compress with a damp tea towel or similar. Hand joints may feel more comfortable after immersion in alternate hot and cold bowls of water, moving from one to the other a few times.
Try to maintain gentle movement in a swollen joint as complete immobility can lead to worsening stiffness.
If a flare-up is persistent
If your flare is persistent and does not respond to these simple measures you may need to speak to a health care professional for additional help. If you have an infection, this may need treatment but a viral infection will not respond to antibiotics and therefore needs to run its course. Advice from your doctor will be important as some medications may need to be stopped until an infection settles (eg biologic treatments).
Lastly, and uncommonly, if flares become more frequent and troubling a review by the rheumatologist would be recommended to assess your treatment regime and consider any possible changes.