Arthritis Flares Are Normal but Still Difficult

A sudden increase in symptoms can hit at any time.


You’ve been managing your arthritis symptoms well and doing all the right things to stay healthy, but one day you wake up and feel like it was all for naught. Your joints ache like crazy, the worst you can remember in a long time. It could be an arthritis flare.

Is your arthritis getting worse despite all your efforts? Are you going to feel like this from now on?

Probably not. Although arthritis is a chronic disease, you can have acute episodes of pain and inflammation, known as flares. While troublesome and unpredictable, flares are temporary. They do not signal a failure in your efforts to control arthritis symptoms.

Flares may be seen after infections or after highly stressful situations. Often, however, it isn’t clear what triggers a flare. You may have long periods of time when your arthritis is quiet, or in remission. Then, suddenly, the inflammation becomes more active and you have an arthritis flare.

Flares can be alarming, not only because of the pain, but because of their unpredictability. You may feel discouraged or afraid of further damage to your joints. You sometimes wonder whether something you did may have caused the flare.

What can you do to combat these feelings? Remember that you have a range of tools in your arsenal to address pain, from asking your doctor to increase your pain medications, to applying cold packs or practicing deep breathing techniques.

Also, remember that flares do calm down. You may want to think about how you handle the inevitable “bad days” and flares before you experience them. Just as regular fire drills help people deal with real emergencies, preparing for a flare can help you jump into action when it happens.

Discuss a plan of action with your doctor. One possible approach would be to adjust your medications temporarily while the disease is unusually active. This will not only relieve some of the pain associated with a flare; it will also help minimize any damage that may occur from unchecked inflammation.  

Be aware that your medications may not control the flare right away, even if your doctor increases the dosage. Or they may only have a limited effect on your flare. Of course you and your doctors should be in agreement about possible increases in your medications, or even new medications at the time of a flare. Many doctors will review such a plan for a flare that can be implemented when needed without permission from the doctor.

How much a flare affects your everyday life will depend on its severity and how often it occurs, says David Pisetsky, MD, a rheumatologist at Duke University Medical Center in Durham, NC. If they occur only occasionally and with minimal pain and fatigue, you may be possible to work during a flare and keep up other activities. A good measure, Pisetsky says, is how you feel after work and the next day.

If you hurt or feel very tired after work, a period of rest and time away from the job is likely a good idea, the doctor says.

The following is a list of some other steps you might want to incorporate in your plan of action. Remember, some techniques work better for some people than for others. Try a few of these, and if they don’t work for you, discard them and try others.

  • Balance periods of activity with periods of rest. Although more rest can help during a flare, you probably don’t need to abandon your regular activities, work or exercise program. Spending long periods of time in bed is counterproductive; it usually will prolong your pain. Instead, try to intersperse periods of rest with some light activity.
  • Have a plan to deal with your obligations. Plan ahead so that you can still get things done. At work, try to arrange for coverage, work fewer hours per week, or bring work home. Discuss your plan with your supervisors and co-workers ahead of time and assure them of your commitment. At home plan to apportion a few extra jobs among family members, and make sure everyone knows what they are expected to do to keep things running smoothly.
  • Communicate with your family and friends. The time to let your family and friends know that you may need more help is when things are going well, not when the flare hits. They will understand better what is needed and how they can help when you call to say that you’re having a particularly bad day. If someone volunteers to help you through a flare, give them a specific job to do or else their assistance may go unused.
  • Apply a hot or cold pack to inflamed joints. Different people prefer one or the other. Some people even prefer warm packs for certain joints and cold packs for other joints. You will learn your own preferences through trial and error.
  • Practice relaxation or mind-diversion techniques. These techniques work best when you practice them on a regular basis. Even though relaxation may not directly reduce your pain, it can minimize stress, which is a factor shown to amplify pain.

Learn more about pain and ways to manage it in our Pain Toolkit.

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