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Person holding their neck and head sweating and stressing over flares

Flare Scares

The role that fear plays as it pertains to our RA is an important concept to keep in mind as we manage this chronic disease.  Fear is not just an emotional response but, in fact, a physical one as well.  It is this physical response that can often lead to some real trouble when it comes to our RA.

How does fear affect us?

We all know how fear feels mentally and emotionally. It can play tricks with our perception of reality and our memories can become distorted. There are many examples of this in daily life. Fear of public speaking, fear of heights, fear of snakes, and on and on. Fear can weaken the creation of long-term memories and damage the hippocampus, short-circuiting the response paths and causing constant feelings of anxiety.1 Learning to control or at least respond to this, can be the key to not having the eventual physical side effects that fear creates.

How the body responds to fear

How fear plays out in our bodies can influence our RA in physiological ways we need to be alert to.  Fear, at its height, induces the “fight or flight” response starting with the part of the brain called the amygdala and moving on to the hypothalamus.  Bodily changes include sweating, dry mouth, freezing in place, increased heart rate, rapid breathing, tightness in your chest, nausea, dizziness, constriction of blood vessels, heightened mental focus, etc. as your body prepares to “fight or flee”.  The fact is, this response is our body’s way of protecting us by producing the stress hormones, cortisol, and adrenaline, to prepare us to respond to the danger, either perceived or real. That is where we can get into trouble.  It is the differentiation of real or not that can be the issue for many of us who combat uncontrollable fear.

Can fear trigger an RA flare?

When you glance at the potential physical side effects of fear it is clear that they could all play a role in triggering flares.  Since flares are often an elevated response to inflammation, and the hormones released during a fear-induced reaction indicate inflammation, it follows that fear and anxiety can be factors in the onset of a flare.  And beyond that, if you are in a flare and fear takes over, the exacerbation of the flare itself is likely, or, at least, possible.

How can I manage my fears?

I have certainly experienced this over the years.  The most difficult part is that I know, without a doubt, that I am letting fear take over, and yet, I find it incredibly challenging to counter this reaction.  That said, there are strategies that work and can really make a difference in allowing you to properly manage your fears.


Exercise can help because it requires you to concentrate on something else.  Gentle Tai Chi, yoga or walking, just to name a few, requires concentration and takes your mind off the fear.  Physical movement also releases endorphins, that feel-good hormone, which counters the others.  Simply get up and move, while focusing on that movement, and you will notice a positive difference.  Making this a regular part of your life may actually prevent it!


Relaxation techniques like meditation, guided imagery, and even simple breathing exercises slow the mind down and bring us to a better mental state.  Massage is a great way to combine physical and mental relaxation components.


Healthy eating can make a big difference!  Lots of fruits and vegetables are best while reducing sugar to avoid those dips in blood sugar levels that can lead to feelings of anxiety as can too much caffeine.

Be careful about using alcohol to give you “liquid courage” as it can lead to feelings of depression and anxiety long term.

Have a support system

Faith and/or spirituality may be the answer for you as feeling that there is something bigger to connect with beyond ourselves provides many people with a sense of peace.

Support groups for RA or anxiety can be useful as a way to connect with others who are experiencing the same thing.  These groups offer companionship, encouragement, advice and a common purpose that can be extremely helpful.

Talk to your healthcare team

Sharing your fears with your medical team is important as well.  They may suggest a medication or other therapy to counter your fear response.

These are just a few possibilities for handling the fear that is a part of RA and chronic disease.  With some thoughtful implementation of these and other strategies, you can not only combat fear, but manage it!


This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

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  • Lawrence 'rick' Phillips moderator
    4 months ago

    But I am afraid of Sheryl and she scares me most of all. And even worse I fear her attorneys, meaning I have no choice, but to roll into the corner and cover my head.

    Shh dont tell her i said that.

  • Cynthia Ventura moderator
    4 months ago

    Thank you Nan for such an informative post about fear and how it increases stress and possible negative RA outcomes. My greatest RA fears concern flares and meds especially Biologics ceasing to work at slowing down RA damage. Is there any worse feeling than being on an effective med and then suddenly realizing it’s not working any longer? It makes me feel so helpless and desperate.

    Blessedly, I have a great rheumy who is my go-to to discuss my fears. He has an NextMD system set up so I can chat with him anytime. He’s even replied to me on weekends while on vacation! I wish everyone had such a great rheumy.
    I’ve also added Meditation to my go-to kit. It was a recommendation made in another post by Tamara Haag:

    Meditation has really helped me control the worry and fear that increase my stress. I’m still working on it but every success empowers me to keep at it.

    This forum has also been a wonderful support for me. Not only posts by Advocates but comments posted have also added to my knowledge and overall feelings of peace. Just knowing I am not alone in this has helped my mental health. My faith as well is a great refuge. The times I feel I alone cannot handle all the worries and anxieties of RA I know God is there to uphold me

  • Richard Faust moderator
    4 months ago

    Hi CynthiaV. It is great to hear that you have such a dedicated rheumatologist who you have a trusting relationship with. In reading your post I could not help but think of this article from our contributor Michael about a doctor who would not let him settle for the occasional flare, due to the damage that could ensue:

    The fear of a treatment failing is certainly understandable, but know that treatments have come a long way in recent years and new ones are being made available regularly. Our contributor Kelly Mack (full disclosure – I’m her husband) was diagnosed at two, has had RA for 40 years, and has seen a lot of treatments. She wrote this article about the evolution of treatments: She notes “What is powerful to me about recounting this progression of treatments is understanding how far we have come in developments and options. Sure, no treatment is perfect nor one size fits all. But we have a few tools to fight RA.” Wishing you the best. Richard ( Team)

  • Cynthia Ventura moderator
    4 months ago

    Hi Richard. Thank you so much for your informative reply. I will definitely check out the links you provided. I’m always amazed at the breadth of topics discussed on the Forum. Just when I think I’ve read the majority of posts someone like yourself comes along and kindly points me to another. I’m always enriched by my time spent on the Forum. Just the comradeship of knowing others understand what you are going through makes a huge difference in all our lives.

    My rheumy also tells me all the time not to worry about my meds falling off, that there are many more biologics in the pipeline. But as you know, the time from stopping the old med, TB testing, load dosaging and the time it takes to discover if a new med is working at an acceptable percentage can be very stressful. But because my rhuemy and I have such a trusting relationship and he knows what works and doesn’t work for me his recommendations are usually very effective for me. Knowing this does lessen the stress and anxiety of new meds. I’ve also started taking medication to lessen my overall anxiety and it has helped me immensely. More reasons to find a great rheumy. One who is willing to commit to your overall health for the longterm.

    Thank you again for taking the time to reach out. It means a lot to me knowing that members here care so much for one another. My best to you and Kelly.

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