Rheumatoid arthritis (RA) is a disease of ups and downs. One day your joints may feel fine, and the next they might be painful, swollen, and even leave you stuck in bed and unable to go to work or run errands.
“The immune system is very mysterious,” says Ashira Blazer, MD, a rheumatologist at NYU Langone Medical Center. “A person can have a flare without any sort of trigger, but there are certain things that trigger flares, such as stress and infections.”
An RA flare is a period of increased disease activity (inflammation) or worsening symptoms. During a flare-up, the medications you normally rely on to control your RA don’t seem to work as well.
For many people, RA flares can come about if treatments are tapered or stopped. But there are other everyday, avoidable, “predictable” things that can trigger them as well, even if you’re following your medication regimen consistently.
Common Rheumatoid Arthritis Flare Triggers
1. Not coping with stress. Stress is hard to measure, but research has shown that there’s a positive link between stress and RA. “People who are chronically stressed are more likely to develop flares, so we try to have patients, minimize sources of stress as much as possible,” says Dr. Blazer.
One way to do this is to try and let go of things that you can’t control, says Dr. Blazer. “A lot of the time we try to control what we can’t and really get wrapped up in the outcome of certain situations. You have to understand that when you’re doing that, it’s affecting your health.”
2. Catching a cold or flu. “Any sort of cold or flu can cause a flare of rheumatoid arthritis,” says Dr. Blazer. “RA is an immune system problem, so when the immune system becomes active for other reasons such as a cold or flu, it can then spill over into having some rheumatoid arthritis activity.”
To help prevent catching a cold or the flu, wash your hands frequently, avoid close contact with or sharing food and drinks with people who are sick, and make sure you’re not guilty of these “innocent” habits of people who always catch colds.
3. Not getting enough shuteye. “Poor sleep will certainly trigger a flare,” says Dr. Blazer. Lack of sleep can increase levels of stress hormones, which can aggravate flares.
Besides increased flares, RA patients with sleep disruptions tend to have more trouble with depression, chronic pain, and performing normal daily functions than RA patients who don’t have sleep problems. “Patients with RA are vulnerable to developing fibromyalgia, and healthy sleep habits are really important in helping your body and your brain modulate those pain signals,” says Dr. Blazer.
4. Smoking. Not only is smoking a risk factor for RA, but one study published by the American College of Rheumatology found that current smokers had higher RA flare rates than non-smokers.
“Smoking directly contributes to the number of abnormal proteins that drive rheumatoid arthritis,” says Dr. Blazer. “So it’s very important to quit smoking, not only to lessen your chance of developing arthritis if you’ve got a family history, but also to lessen the severity of arthritis.”
5. Over-exercising. Exercise is important for coping with rheumatoid arthritis fatigue, keeping joints healthy, and improving your overall health, but there is such thing as too much of a good thing.
Overexertion—putting stress on your joints and muscles from a physical activity—can trigger rheumatoid arthritis flares and fatigue. “Overexertion can damage joint structures, and that can be more fodder for immune activity," says Dr. Blazer. “So you want to make sure that you’re protecting yourself; keep activity moderate to prevent doing structural damage.”
6. Eating too many processed foods. “Diet is very important, and maintaining healthy body weight, and maintaining a healthy balance in your immune system.” says Dr. Blazer. “Processed foods, heavy sugar and excess sugar can worsen the immune response.”
Along with eating a well-rounded diet full of produce and whole grains, manage your RA flares by incorporating these rheumatologist-approved home remedies to your day, as well as these life-changing joint pain hacks.
Rheumatoid arthritis flares can vary in intensity, duration, and frequency, but they’re usually reversible—if treated promptly. “If you’re having a flare, it’s very important to seek care as quickly as possible. So make sure you tell your rheumatologist, get in for an appointment, and have your medications adjusted such that you can end the flare,” says Dr. Blazer.
Untreated RA flares can put you at greater risk of joint damage, poorer long-term outcomes, and may contribute to cardiovascular disease. That’s why it’s important to listen to your body and be able to identify a flare when it starts and care for it ASAP, such as making medication adjustments (with your doctor) and self-management strategies, such as these tips to cope with RA flares.
“It’s important that you don’t try to push through a flare, so take some time out,” says Dr. Blazer. “Take some time off work or maybe reduce the number of obligations you have in your life to really care for yourself and have that rest in order to improve your flare.”