Managing a flare of inflammatory arthritis

At other times a 'flare' of arthritis may result in some of the following symptoms:

• increase of swelling and/or stiffness in the joints
• worsening pain in the joints
• increased tiredness
• general 'unwell' feeling
• night sweats / fever / weight loss.

A flare is unpredictable and may start suddenly. It can last for hours, days or weeks.

Some flare triggers include infection, such as a chest or urinary infection, or physical or mental stress. In some cases there is no identifiable trigger.

If you have an infection, it is best to consult your GP, as you may require treatment.

Medication

Taking your painkillers and/or anti-inflammatory tablets regularly should help to control the pain. Never exceed the maximum recommended dose.

You should continue to take your other usual medication. If you are taking steroid tablets, it is important that you do not alter the dose without consulting your GP or a member of the Rheumatology team.

Anti-inflammatory gels may be applied locally to swollen and inflamed joints following the manufacturer's instructions.

Heat or cold

Heat or cold applied to joints may reduce pain and inflammation.

• Heat: wheat bag, hot water bottle, heat pad.
• Cold: bag of ice cubes or frozen peas, wheat bag 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.

Rest and exercise

During a flare it is important to 'pace' your activities. You will need to plan your day taking into consideration your increased tiredness.

Short rests in between activities may be needed but it is advisable to keep your joints moving. This will help prevent stiffness and maintain muscle tone.

If a flare does not settle

If your flare has not responded to these treatments after seven days and you need further help, you should contact your GP for advice and/or treatment.

To supplement the advice from your GP you can email us:

Email: rheumatologyadviceline@ouh.nhs.uk

Steroids (such as an intramuscular depomedrone injection) can be very effective in treating flares of rheumatoid arthritis that have not responded to the above measures; however, they can also have significant side-effects in the long-term and can also mask or aggravate infections.

We suggest discussing a personalised plan for your flares with the Rheumatology team, which will then be documented for your GP in your clinic letter.