Resource Managing RA symptoms and flares Managing pain and fatigue alongside your everyday responsibilities can be challenging. Balancing this with the unpredictability of flare-ups makes it even harder. This can be one of the most challenging aspects of supported self-management. Print At a glance Managing flares What is a flare? – When your RA symptoms become a lot worse and harder to control. This can affect the whole body or specific joints. Causes – Sometimes flares occur after periods of stress or illness or after ‘overdoing’ things. At times, they may not have an obvious cause. Speak to your rheumatology team if you are getting regular flares or have a flare that isn’t going down with self-management. How to self-manage flares Rest and relaxation a Taking pain medication regularly and at the right dose Hot baths or showers Use of cool packs Aids Gentle exercises Comfortable, supportive shoes Managing pain Pain is personal and specific to you. The best way to ease the pain of RA is to aim for effective and continuing control of the disease process. Pain-management techniques Pain medication – taking painkillers on a regular basis, as prescribed can help to reduce pain. Especially useful for long-term pain. Exercise – to strengthen joints, keep your heart healthy and help manage pain. Heat therapy – relieve pain and stiffness in muscles and joints. Cold therapy – Relieve swelling in joints. TENS machines – relieve pain. Relaxation techniques – Make you less tense, helping to relieve pain. Sleep – Improving the quality and quantity of sleep can help relieve pain. It can also improve how well you cope with pain. Positive thinking – Can help you to cope better with pain. Distraction – Can help you to take your mind off the pain you are experiencing, which can reduce pain levels. Complementary therapies – Make sure any complementary therapies you try will not interfere with your medication. Some people find some complementary therapies help to relieve symptoms including pain. Managing fatigue Fatigue isn’t just tiredness. It is a more extreme level of tiredness that isn’t always relieved by sleep. People with long-term conditions such as RA can feel a level of fatigue much of the time. Get a good night’s sleep Self-management of fatigue rest and relaxation Pace your activities and plan ahead Follow a healthy diet and make sure you drink enough fluids Find easy-to-use gadgets (such as electric tin-openers or a long-handled hairbrush etc). Connect with other people who have RA, e.g. through our online forum: healthunlocked.com/nras Did you find this article helpful? Total likes: 12 Managing flares Your RA is always with you, so you may experience some level of symptoms from it all the time. Medication and supported self-management techniques can help to control these symptoms. You may experience times when the symptoms become a lot worse and harder to control. This is called a ‘flare-up’ or ‘flare’. This may be more generalised, with increased pain and stiffness throughout your body. It may affect a particular joint or joints, making them become swollen or tender. Sometimes flares occur after periods of stress or illness or after ‘overdoing’ things. At times, they may not have an obvious cause. Flare-ups can range from manageable and short-lived to ongoing and so severe you can hardly get out of bed. It can be frustrating, bewildering and painful and can make everyday life much harder. Along with the joint pain you may also experience a worsening of symptoms such as fatigue and stiffness. You may also notice changes in your mood and have difficulty sleeping. You may get better at identifying early signs of a flare. This may help you to start self-management techniques before symptoms get worse. You may notice that your fatigue feels worse just before the start of a flare, but in some cases you may not get any warning signs at all. Sometimes, rest and simple self-management techniques are enough to control a flare. If symptoms do not improve, you may need to see one of your healthcare team to discuss treatment options. If you are having regular flares it may be time to review your RA treatment. Your symptoms and blood tests will help the team to assess your disease. This will help them to determine whether the flares are a sign that your RA is becoming less controlled. Some general methods for managing a flare include: Rest and relaxation at the first signs of a flare Taking pain medication regularly and at the right dose Hot baths or showers to relieve early morning stiffness and pain Use of cool packs Aids, for example a stick if your knee is a problem Gentle exercises, to help relieve stiffness, which can make pain feel worse Making those closest to you aware, so they can understand why you’re not coping as you usually do and help if needed Wearing comfortable, supportive shoes Over time, you will learn to develop coping strategies that work for you, to manage your flares. When a flare does not respond to these strategies, you may need to seek help from your rheumatology team. They may recommend having a steroid injection, to get the flare under quick control. This injection may go into muscle, to reduce pain and swelling throughout the body. If a specific joint is very swollen, it may be given directly into the joint. Managing pain and fatigue Managing pain Pain is personal and specific to you. The best way to ease the pain of RA is to aim for effective and continuing control of the disease process. You can do this through a combination of medication and self-management techniques. There are various medications that can help relieve pain. Your RA medication, in controlling your disease, will also help to relieve pain. There may be times when you also need painkillers or non-steroidal anti-inflammatories (NSAIDs). These medicines can offer fast relief from pain. If these do not help, steroids may be an option, given as a course of tablets or a one-off injection or infusion. Using painkillers effectively If you have pain every day, taking painkillers on a regular basis, as prescribed can help. You may be able to reduce the dose or frequency when your RA is under better control. Many people try to minimise the amount of pain medication they take, by only taking it when the pain is hard to bear. This level of pain may be too much for the painkillers to control. Taking daily pain medication early, at the first signs of a flare is often more effective. “I went on a course about using painkillers, and it’s made a real difference. The main message was about taking regular medication; don’t wait.” Pain medication options include: Simple pain medication (e.g. Paracetamol) Compound pain medication (pain medication with a mild opioid drug). such as Co-codamol Opioids, such as Tramadol Anti-inflammatories such as Ibuprofen or Voltarol gels or tablets. These are sometimes called NSAIDs and COX-2s Steroids given either by mouth, injection or infusion These options are not all suitable for everyone. Speak to a member of your healthcare team if you feel your medication is not controlling your pain. This can be your GP, nurse specialist or rheumatologist. Pain-management techniques Exercise It helps to keep as active as you can. Maintaining full range of movement and strength in your joints helps reduce stiffness. Exercise is also good for your heart, which is especially important for people with RA. When you exercise, your body releases chemicals called endorphins. These act as the body’s natural painkillers and they also improve your mood. There’s more about exercise on our website at: Article Exercise for rheumatoid arthritis Exercise is important because it helps reduce the risk of further joint damage. It also helps by reducing pain and the risk of heart disease and by improving muscle strength and mental wellbeing. There are exercises for people at all stages of their RA journey. Heat therapy Either dry or moist heat can help if a muscle is painful or a joint is sore. Protect your skin from direct dry heat with a towel – you can use: a hot water bottle, electric heat pad or gel pad. Moist heat can be: a hot shower or bath, a basin or bowl of hot water, or a damp towel heated in a microwave. Cold therapy You can get relief from an inflamed (red, hot, swollen) joint, by using almost any clean, cold item. For example: A bowl of cold water with ice cubes added for hands or feet A bag of frozen peas as a mouldable ice pack (wrap it in a towel) A gel pack; or a damp towel, kept in the fridge TENS Some people use a TENS machine (Transcutaneous Electrical Nerve Stimulators) to relieve pain. A physiotherapist can give you more information about TENS. Relaxation When you’re in pain over a long time, you can become tense without realising it. Tensing your muscles like this can also affect you mentally and emotionally. It can make you feel anxious and on edge. Finding ways to relax both body and mind and making this part of a daily routine can help. It takes practice, but once you’ve learned the technique you can use it anywhere. Different types of relaxation include deep breathing and guided imagery relaxation. There is no evidence to suggest that any technique is better than others. Find the one that feels comfortable to you and that suits your lifestyle. You will find many helpful videos about relaxation online. Sleep When something disrupts your sleep, this can leave you feeling tired and demotivated. It can also increase pain. Given that it is often pain that disrupts your sleep in the first place, this becomes a vicious circle. A good sleep routine can help. This includes: Keeping to fixed times for going to bed and waking up Creating a relaxing bedtime routine. If possible, this includes avoiding looking at a TV or mobile phone screen for around 1 hour before bed Only going to bed when you feel tired Maintaining a comfortable sleeping environment that’s not too hot, cold, noisy or bright Not napping during the day Avoiding caffeine, nicotine and alcohol late at night Avoiding eating a heavy meal late at night Talk to your GP or specialist nurse if you continue to have poor sleep as they will be able to help. For more information and tips on sleep, go to: Article Sleep Getting a good night’s sleep can be tough, especially when you are suffering from the symptoms of RA. We hope that this article will help to give you some tips for getting a good night’s sleep. Positive thinking Some people find ‘positive thinking’ helps them to cope better. If you want to give it a go, try focusing on the things you can do, rather than those you can’t. Try not to avoid doing things because of your pain, so that it doesn’t dominate your life. Sometimes, small changes to your way of thinking can help. For example, you may lay awake in bed thinking, ‘I’ll never get to sleep’. Instead, try telling yourself: ‘At least I’m resting my body’. Distraction Doing activities that distract you, taking your mind off your pain can lessen the level of pain you feel. You can distract yourself from pain by doing an activity or hobby that interests you. When you are in pain, you may not feel like socialising, but this can actually help. You are more likely to laugh while in the company of others and laughter can help relieve pain. This is because, like exercise, laughter makes your body release endorphins, painkilling chemicals. Try also to distract yourself from pain while doing everyday tasks. For example, if going upstairs is painful, try naming a different animal or movie title etc. with each step. Complementary therapies There is no evidence to suggest that they will change the progression of your disease. Complementary therapies can help you to manage your RA symptoms though. This can make everyday tasks easier, improving your quality of life. If you are considering trying complementary therapies, the following tips may help: Look for products, therapies or supplements with good evidence to support their use. Be wary of information about effectiveness on websites that also sell the product. Try instead to use independent and trusted sources or ask a healthcare professional. ‘Natural’ doesn’t always mean ‘harmless’. There are, after all, many ‘natural’ poisons! Check whether any supplement you take has potential side effects. Speak to a member of your healthcare team before taking any supplements. They may interfere with your medication or make it less effective. St. John’s Wort, for example, is a supplement that some people take to treat mild to moderate depression. However, it can cause side effects and interferes with a large number of medications. Weigh the cost of anything you try against the benefit you get from it. If a supplement or therapy gives you little or short-lived benefit, is it worth the money it costs you? Think ‘complementary’ rather than ‘alternative’. A complementary supplement or therapy that works well for you can improve your RA. It ‘complements’ the other ways you treat your RA. This incudes medication and the self-management techniques described in this booklet. It is not a good ‘alternative’ to medication, but it can be a useful addition to it. Managing fatigue Fatigue isn’t just tiredness. It is a more extreme level of tiredness that isn’t always relieved by sleep. People with long-term conditions such as RA can feel a level of fatigue much of the time. It can be one of the most difficult symptoms to manage. There is a great deal that can help to prevent and reduce fatigue. Above all, it’s important that your RA is well controlled. If you’re more fatigued than usual and it’s getting hard to manage, don’t ignore it. Talk to your rheumatology team, rather than struggle until your next appointment. “Little things help to make life easier, for example with clothes. Coats with slippy linings are so much easier to get on and off!” You may need to experiment to find a technique that works best for you in managing your fatigue. Fatigue and pain are often connected, and the advice on managing pain can also reduce fatigue. The following may help you to manage your fatigue: Get a good night’s sleep Get plenty of rest and relaxation Pace your activities and plan ahead for what you want to do Follow a healthy diet and make sure you drink enough fluids Find easy-to-use gadgets (such as electric tin-openers or a long-handled hairbrush etc). An occupational therapist can make suggestions for useful products. They can also help you to do activities in a way that puts less strain on joints, helping to relive pain and fatigue. Connect with other people who have RA to ask them what works for them and to share your own tips. You can do this through our online forum: www.healthunlocked.com/nras Updated: 01/11/2025 Next review: 01/08/2028 Fatigue Matters For more information on how to manage fatigue, download or order our fatigue booklet. Living better with RA This booklet will give you information relevant to someone with established disease, giving you the information you need to be able to best manage your condition. Read more RA medication → RA is a very variable condition so, doctors do not start all patients in exactly the same way on the same drug regimen.
At a glance Managing flares What is a flare? – When your RA symptoms become a lot worse and harder to control. This can affect the whole body or specific joints. Causes – Sometimes flares occur after periods of stress or illness or after ‘overdoing’ things. At times, they may not have an obvious cause. Speak to your rheumatology team if you are getting regular flares or have a flare that isn’t going down with self-management. How to self-manage flares Rest and relaxation a Taking pain medication regularly and at the right dose Hot baths or showers Use of cool packs Aids Gentle exercises Comfortable, supportive shoes Managing pain Pain is personal and specific to you. The best way to ease the pain of RA is to aim for effective and continuing control of the disease process. Pain-management techniques Pain medication – taking painkillers on a regular basis, as prescribed can help to reduce pain. Especially useful for long-term pain. Exercise – to strengthen joints, keep your heart healthy and help manage pain. Heat therapy – relieve pain and stiffness in muscles and joints. Cold therapy – Relieve swelling in joints. TENS machines – relieve pain. Relaxation techniques – Make you less tense, helping to relieve pain. Sleep – Improving the quality and quantity of sleep can help relieve pain. It can also improve how well you cope with pain. Positive thinking – Can help you to cope better with pain. Distraction – Can help you to take your mind off the pain you are experiencing, which can reduce pain levels. Complementary therapies – Make sure any complementary therapies you try will not interfere with your medication. Some people find some complementary therapies help to relieve symptoms including pain. Managing fatigue Fatigue isn’t just tiredness. It is a more extreme level of tiredness that isn’t always relieved by sleep. People with long-term conditions such as RA can feel a level of fatigue much of the time. Get a good night’s sleep Self-management of fatigue rest and relaxation Pace your activities and plan ahead Follow a healthy diet and make sure you drink enough fluids Find easy-to-use gadgets (such as electric tin-openers or a long-handled hairbrush etc). Connect with other people who have RA, e.g. through our online forum: healthunlocked.com/nras
Article Exercise for rheumatoid arthritis Exercise is important because it helps reduce the risk of further joint damage. It also helps by reducing pain and the risk of heart disease and by improving muscle strength and mental wellbeing. There are exercises for people at all stages of their RA journey.
Article Exercise for rheumatoid arthritis Exercise is important because it helps reduce the risk of further joint damage. It also helps by reducing pain and the risk of heart disease and by improving muscle strength and mental wellbeing. There are exercises for people at all stages of their RA journey.
Article Sleep Getting a good night’s sleep can be tough, especially when you are suffering from the symptoms of RA. We hope that this article will help to give you some tips for getting a good night’s sleep.
Article Sleep Getting a good night’s sleep can be tough, especially when you are suffering from the symptoms of RA. We hope that this article will help to give you some tips for getting a good night’s sleep.
Fatigue Matters For more information on how to manage fatigue, download or order our fatigue booklet.
Living better with RA This booklet will give you information relevant to someone with established disease, giving you the information you need to be able to best manage your condition.
Read more RA medication → RA is a very variable condition so, doctors do not start all patients in exactly the same way on the same drug regimen.