How to Manage a Flare of Inflammatory Arthritis

How to Manage a Flare of Inflammatory Arthritis

What is a flare?

When a person has an inflammatory arthritis they can have periods where their symptoms worsen, this is a ‘flare’. The unpredictability of a ‘flare’ can make living with an inflammatory arthritis difficult. It may start slowly or suddenly. It can last for hours, days or weeks. How it affects the individual can vary. Sometimes a flare may be triggered by an infection or stress and sometimes there is no identifiable trigger.

If you think you have an infection, please consult your GP, you may need to temporarily stop some of your arthritis medication.  

The symptoms of a flare include some of the following:

• increase of swelling and/or stiffness in the joints
• worsening pain in the joints
• increased tiredness and fatigue
• general feeling unwell

Medications can help prevent flares and stop symptoms from becoming severe. Medical treatment and home remedies can also help manage symptoms during a flare.

How do I recognise the early signs of a Flare?

Understanding and knowing what to look for in a flare of your arthritis can sometimes prevent the flare becoming more severe.

The cause of a flare is not always clear but you can begin to recognise some triggers. For example, having a really stressful time at work, a full day in the garden or doing housework, an infection etc.

Early action can help to alleviate symptoms more quickly, such as, making time for extra rest and taking pain killers or anti-inflammatory tablets.

How do I manage a flare?

Balance Rest and Activity

• Pace activities – sometimes complete rest is required
• Take short rests between activity
• Keep your joints moving
• Use your energy efficiently

Once you feel a bit better

• Gently increase activity, take breaks when you get tired

You may need to cut back on work, exercise and social activities during a flare, but do not stop them altogether.

• Improve sleep quality and establish a good bedtime routine

For example, same bedtime every night, avoiding screen time and stimulating TV before bed. Your bedroom should be tidy, dark and quiet. Your bed and bedding should be comfortable. Have a hot/cool shower before going to bed

• Gentle exercise can help reduce stiffness

For example, stretching and taking your joints through a range of motion whilst sat in a chair

Splints

Wrist splints will allow you to use your hands without putting too much pressure on your wrists. These can be very helpful when you have a flare up of your wrists.

Medication

• Continue to take your usual medications
• If you take steroids, do not alter the dose without first discussing with your GP or the Rheumatology Team
• If you are prescribed painkillers or anti-inflammatory tablets/gels, these should help with pain. DO NOT EXCEED THE RECOMMENDED DOSE

Adjust and ask for help

Have a plan in place for dealing with the unpredictable nature of a flare.

• Firstly, adjust your expectations of yourself
• Discuss working arrangements with your employer for flexible working in the event of a flare or possibly working from home at last minute.
• Put together an action plan with family/friends so that they can be ready to help support you in the event of a flare
• Ensure sufficient food and medical supplies stocked up at home

Hot and Cold Therapies

Heat and/or cold can reduce pain and inflammation when applied to a joint.

• Heat increases blood flow and can ease aches, stiffness and relax tight muscles. You can use warm baths, microwaveable wheat bag, hot water bottle, heat pad or hot compress
• Cold is often best for acute pain and swelling and can slow down the production of joint fluid that exacerbates joint swelling. You can use a bag of ice cubes or frozen peas or gel pack

These treatments may be applied for up to 15 minutes. Always place a towel between the skin and heat/cold source to prevent burning or skin damage.

Reduce Stress and Anxiety

Feelings of stress and anxiety can release stress hormones which can cause an increase in inflammation. Resulting muscle tension can also increase pain. Relaxation can reduce stress and reduce pain by decreasing muscle tension and release endorphins, the body’s natural pain killer. Relaxation techniques include;

• Meditation, yoga
• Mindfulness
• Deep breathing exercises
• Massage

You should decline any activities that will increase stress and anxiety such as additional assignments at work and social invitations.

Try to resist negative thoughts about your arthritis. Try to think about the positives and what you can do rather than what you cannot. Remember that inflammatory arthritis has its ups and downs.

When should I contact the Rheumatology Department?

In time, you will be able to recognise what you can manage at home and when you need extra support and guidance.

If you cannot manage your flare and it is not settling within 7 days contact the Rheumatology Clinical Nurse Specialist Advice Line on 01905 760461 or your GP.

The Rheumatology Advice Line is available Monday to Friday between 08:30 and 15:30 hours. It is an answer phone service. We ask that you leave your name, hospital/NHS number, contact number and a brief summary of your problem and we hope to respond to you call within 24hrs. At times, the advice line needs to be turned off either due to a high volume of calls or limited staff availability. If this is the case, we will leave a message indicating when it will be available again. If there is no message to listen to, then call back again later as there may be a problem with the service.

Looking after yourself brings a lot of health benefits not only for your arthritis. Having a healthy balanced diet and being a healthy weight, ensuring adequate sleep, taking regular exercise and reducing stress should all help to reduce the frequency of arthritis flares.

It’s important to inform your rheumatologist of recurrent flares when you are seen in the rheumatology clinic for your appointment. Recurrent flares can be an indicator that a modification to your treatment is required to better control your arthritis.

If your symptoms or condition worsens, or if you are concerned about anything, please call your GP, 111, or 999.

Patient Experience

We know that being admitted to hospital can bea difficult and unsettling time for you and your loved ones. If you have any questions or concerns, please do speak with a member of staff on the ward or in the relevant department who will do their best to answer your questions and reassure you. 

Feedback

Feedback is really important and useful to us – it can tell us where we are working well and where improvements can be made. There are lots of ways you can share your experience with us including completing our Friends and Family Test – cards are available and can be posted on all wards, departments and clinics at our hospitals. We value your comments and feedback and thank you for taking the time to share this with us.

Patient Advice and Liaison Service (PALS)

If you have any concerns or questions about your care, we advise you to talk with the nurse in charge or the department manager in the first instance as they are best placed to answer any questions or resolve concerns quickly. If the relevant member of staff is unable to help resolve your concern, you can contact the PALS Team. We offer informal help, advice or support about any aspect of hospital services & experiences.

Our PALS team will liaise with the various departments in our hospitals on your behalf, if you feel unable to do so, to resolve your problems and where appropriate refer to outside help.

If you are still unhappy you can contact the Complaints Department, who can investigate your concerns. You can make a complaint orally, electronically or in writing and we can advise and guide you through the complaints procedure.

How to contact PALS:

Telephone Patient Services: 0300 123 1732 or via email at: wah-tr.PALS@nhs.net

Opening times:

The PALS telephone lines are open Monday to Friday from 8.30am to 4.00pm. Please be aware that you may need to leave a voicemail message, but we aim to return your call within one working day.

If you are unable to understand this leaflet, please communicate with a member of staff.

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