- Most patients with inflammatory arthritis have 1–3 flares a year, even on treatment.
- A flare recognised in the first 24–48 hours is easier and quicker to control.
- Suddenly stopping long-term treatment is one of the most common causes of a flare.
What a flare is and why it happens
A flare is a temporary worsening of the disease: joints become more painful, swollen and stiff, fatigue increases, and sometimes a low-grade fever appears. It can last from a few days to a few weeks and can affect joints that were previously quiet.
Triggers vary and are not always identifiable: a viral infection, intense stress, lack of sleep, physical overexertion, changes in treatment or missed doses. Sometimes a flare appears for no apparent reason, and that does not mean you did anything wrong.
Recognise the early signs
Many patients learn to sense a flare a day or two in advance. Listen to these signals and act early, before the pain becomes hard to control.
- Morning stiffness lasts longer than usual
- Unusual tiredness, a feeling of flu without the flu
- A joint that throbs or becomes warm to the touch
- Sleep interrupted by pain
- Weaker grip: you drop things, struggle to open a door
The home plan: the first 48 hours
The goal of the first days is to reduce inflammation and protect the joint, without immobilising yourself completely. This plan is general and should be adapted to the advice you have received from your rheumatologist.
- Relative rest: cut back on demanding activities, but move the joints gently a few times a day so they do not stiffen
- Ice (wrapped in a towel, 15 minutes, 3–4 times a day) on swollen, warm joints; heat (warm shower, heat pad) for stiffness and tense muscles
- Medication as needed, according to the plan agreed with your doctor: paracetamol, an anti-inflammatory at the agreed dose and duration; do not exceed doses and do not combine two anti-inflammatories
- Continue your long-term treatment exactly as before; a flare is not a reason to stop it
- Hydration, light meals, enough sleep; prioritise and postpone what can be postponed
- Keep a diary: which joints, how intense (0–10), what you took, what helped; this information is valuable at your review
What not to do during a flare
A few natural reactions can make things worse. Do not start oral corticosteroids on your own and do not accept injections on someone's recommendation without your rheumatologist's agreement; corticosteroids can mask an infection or raise blood sugar and blood pressure. Do not overload the joint to push through the pain, but do not stay in bed for days either.
Avoid unverified remedies and drastic diets promised online; no supplement stops a flare. Do not stop your long-term treatment thinking it caused the flare; that decision belongs to your doctor, after assessment.
When to contact your rheumatologist
A mild flare that responds to home measures within 3–5 days can be discussed at your next review. There are, however, situations where it is important to call the clinic sooner, because treatment may need adjusting or a complication ruled out.
At Laromed Clinic, patients under treatment can request a prompt consultation during flares. Keep the clinic's number visible and do not hesitate to call if in doubt.
- The flare lasts over a week without improvement or gets worse
- A single joint is very red, hot and intensely painful, especially with fever: it may be an infection
- Fever above 38°C, new rashes, chest pain, difficulty breathing
- You need anti-inflammatories daily for more than 1–2 weeks
- You are on biologic or immunosuppressive treatment and have signs of infection
When to see a doctor
- The flare does not settle after 5–7 days of home measures
- A red, hot, very painful joint accompanied by fever
- You need painkillers or anti-inflammatories every day
- Flares have become more frequent: your long-term treatment may need adjusting
Frequently asked questions
Can I take ibuprofen and diclofenac together if the pain is severe?
No. Two non-steroidal anti-inflammatories should not be combined: the pain-relieving effect does not increase, but the risk of gastrointestinal bleeding and kidney damage does. If one anti-inflammatory is not enough, contact your doctor.
Heat or ice?
Ice for a swollen, warm joint (reduces inflammation), heat for stiffness and muscle tightness (relaxes). Many people alternate depending on the moment. Never put ice directly on the skin.
Can stress really trigger a flare?
Yes, intense stress and insufficient sleep are documented triggers for many inflammatory diseases. Relaxation techniques, a sleep routine and support from those close to you are part of managing the disease.
Sources
- EULAR recommendations for the management of rheumatoid arthritis: 2022 update (Annals of the Rheumatic Diseases)
- EULAR evidence-based recommendations for the management of gout: 2016 update
- WHO – Musculoskeletal health (fact sheet, 2022)
The data presented come from public sources and published scientific studies; they describe populations, not individuals. A diagnosis is made only after a medical consultation. Laromed Clinic updates this page periodically as new data become available.
