What Is an Arthritis Flare Up?

Is It a Flare or Worsening Disease?

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An arthritis flare up is technically defined as an episode of increased disease activity or worsening arthritis symptoms. People with arthritis 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 which are associated with a flare.

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

At the onset of a flare, most people 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. In other words, they self-treat the flare.

A flare can involve a single joint. Increased symptoms:

  • can occur with normal activity
  • may follow physical exertion
  • may develop after a prolonged period of stress
  • may occur without any obvious provocation

Regardless of what causes the flare, it is distressing.

It makes 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 people consult their doctor.

Of course, initially, the hope is that the flare will be short-lived. 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 (i.e., disease progression)? 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.

The Bottom Line

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. Reasonably, though, be honest with yourself and admit if you have had a recent period when you were overactive. Adjusting your activity level may be the best course. But, there will be times when a flare seems to come out of nowhere. 

Source:

Hewlett S. et al.  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. May 12, 2011.

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