What Is an Arthritis Flare?

Is It a Flare or Worsening Disease?

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An arthritis flare is technically defined as an episode of increased disease activity or worsening arthritis symptoms. Patients typically realize they are in a flare when certain changes occur. There is usually intense pain which may be described as constant or persistent. Systemic characteristics become more pronounced, such as fatigue, malaise, or fever. Swelling may or may not be included among the increased symptoms associated with a flare.

There does seem to be a significant increase in stiffness, especially morning stiffness. With regard to fatigue, patients usually describe fatigue that is associated with a flare as severe and intense compared to usual fatigue associated with the disease. It is often described as feeling wiped out or having no energy or strength. Even after a period of sleep, the patient in a flare still feels unrefreshed.

At the onset of a flare, most patients increase their effort to manage the increased symptoms, without seeking medical advice. They lie down to get more rest, use a heating pad or cold pack on an affected joint, or increase their medications.

A flare can involve a single joint; increased symptoms can occur with normal activity; increased symptoms may follow physical exertion; increased symptoms may develop after a prolonged period of stress; and increased symptoms may occur without any obvious provocation.

Regardless of what causes the flare, it is distressing. You feel physically worse, it disrupts your routine and ability to function normally, it is disruptive to sleep -- and then emotions get involved.

If the flare is particularly intense, becomes disruptive, and feels uncontrollable despite self-management, that's when most patients consult their doctor.

Of course, initially, patients hope the flare will be of short duration. When it turns into a prolonged episode that seems unshakeable, one begins to wonder if it is really a flare. Instead, might it be a worsening of the disease? To differentiate a flare from worsening of the disease, your doctor may order blood tests, such as the sedimentation rate and CRP (C-reactive protein). If these tests, which are indicative of nonspecific inflammation, are higher than usual, plus there is no sign of infection, the results would suggest that a flare was underway.

Treatment of a flare may require a short course of corticosteroids, such as prednisone or a Medrol dosepack. If the flare persists, your doctor may adjust the dose of your regular medications, or may ultimately decide to add another medication or switch one drug for another. It could be that your arthritis treatment has stopped working and it is simply time for a change.

Don't wait too long before you seek your doctor's advice. Your doctor has the expertise that is needed to get you back on the right track.


I'm hurting. I want to kill myself: rheumatoid arthritis flare is more than a high joint count;an international patient perspective on flare where medical help is sought. Rheumatology. Hewlett S. et al. May 12, 2011.

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