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Flares during treatment

I have been told that the goal of treatment is to minimize symptoms as much as possible. And I have also been told that treament will never eliminate flares. So how do you distinguish between a flare and treatment failure?

  1. Hi Cheryl - This is a really tricky question and unfortunately there just isn't a solid answer. The best thing you can do to attempt to tell the difference between a flare and the need for a new treatment is to try to play close attention to your body and discuss any/all changes with your rheumatologist. See if there are any patterns. See which symptoms seem to be the worst or stick around the longest regardless of what you do to try to fix them. It may help to keep a journal or log of your symptoms - there are even some apps out there that can help you track these changes on your phone or computer (in fact, I think RheumatoidArthritis.net is actually working on creating just such a symptom journal to go with this site!). Gather what information you can and take it to your rheumatologist. Together you can decide whether your current treatment needs more time or whether it is time to move on. Unfortunately it is often a long and frustrating process to figure out whether a treatment is actually working or not, and not every treatment works for every person. It takes time and patience to find one that works. And though it is easier said than done, it helps to try to stay positive through the process! And remember we are here for you if you need to chat/vent/complain!! Hang in there!!

    1. Cheryl,

      Here are a couple articles that may help...

      https://rheumatoidarthritis.net/living/time-to-change-your-treatment/
      https://rheumatoidarthritis.net/living/treat-to-target-t2t-the-goal-for-all-ra-patients/

      And here's what rheumatologists recently recommended for what is called "treat to target"...

      "The treatment aim was defined as remission with low disease activity being an alternative goal in patients with long-standing disease. Regular follow-up (every 1–3 months during active disease) with appropriate therapeutic adaptation to reach the desired state within 3 to a maximum of 6 months was recommended." http://ard.bmj.com/content/69/4/631.abstract

      With that in mind, if symptoms last 3 or more months, then it may be time to switch treatment plans.

      1. "So how do you distinguish between a flare and treatment failure?"
        I have always felt that a flare is a temporary treatment failure due to stress, temperature fluctuations or a new food. If it happened too often or in more than joint at a time, my rheumatologist asks me to take a a short course of prednisone to calm the flared up situation down. That usually helps to restore the treatment coverage. If it had happened too frequently, then I suppose I would have concluded that the treatment had completely failed and I needed new or different medications.

        1. Hi . Thank you for sharing how you monitor flares and overall treatment. It sounds a lot like how my wife, Kelly Mack (a contributor here), approaches it. First is activating the flare action plan (often the emergency prednisone prescription) and then, as you said, evaluating if it is something that keeps happening. Kelly also wrote about some additional things to consider in deciding whether to change treatments: https://rheumatoidarthritis.net/living/when-to-change-medications. Best, Richard (RheumatoidArthritis.net Team)

        2. I totally agree with you!

      2. I do keep a journal day to day in which I chronicle my whole day pain & fatigue included.

        1. , that's a good idea! Does the journal help you recognize pain patterns and perhaps help you spot an oncoming flare?

          Best, Erin, Team Member.

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