When Your RA Flares, What Do You Do?

As a freelance writer and professional musician, I use my hands a lot; I mean really a lot! It is not uncommon to be keyboarding away for hours on end.

Normally this isn’t an issue. My rheumatoid arthritis has basically been in remission since I began using my current biologic and disease-modifying anti-rheumatic drugs. I am very fortunate.

Aside from the occasional stiff wrist, ankle, toes, or shoulder, I haven’t experienced much disruption in my daily routine from RA. I certainly haven’t experienced any pain that approaches the excruciating horrors that plagued me prior to diagnosis. For that, I am thankful.

But lately, something is going on. A few days ago, I thought that I had been typing too much, causing some pain and stiffness in my left hand, particularly in the metacarpophalangeal (knuckle) and proximal interphalangeal (mid-finger) joints of my 4th and 5th fingers.

Day 1
I tried to rest my hand and allow the pain to dissipate. But after letting my hand rest in a partially closed position, the joints would hurt even more. So I tried to rest my hand in a flat, relaxed position. This was hard to maintain because it meant I needed to basically stop using my hand entirely.

Day 2
I finally broke down and dug though my “prescription drawer” to find an old bottle of naproxen. I took a pill and a few hours later it seemed like my hand might be feeling better. But I’m aware that some doctors recommend avoiding NSAIDs (non-steroidal anti-inflammatory drugs) when you take methotrexate, which I do. So I was reluctant to take too much.

Day 3
After thinking that overuse may be the cause of my pain, I realize on day 3 that perhaps something more is going on. Grrrr. I can still feel the pain. Maybe my body is reacting to the bag of Twizzlers that I indulged in? I’ve been craving a jelly donut like crazy lately, but I haven’t had one so I can’t really blame any baked goods for my troubles. (Bakery cookies are the worst. I am sure to swell and become stiff after having a few of those.)

Day 4
I really should think about getting an ice bag out of the freezer and using it on my knuckles; maybe that will feel good. Or, perhaps soaking my hand in some warm water will be soothing. I take some more naproxen and notice that my arm is feeling a little numb. The numbness is left over from nerve damage caused by the MS. It’s a sign that there is inflammation messing with my body.

Day 5
This is so unusual, I think to myself. It has been so very long since I’ve experienced an honest-to-goodness RA flare-up (not caused by food reactions or overuse) that it is difficult to admit to myself that a flare-up is probably exactly what’s going on. Dang. My wrist has also begun to “click” and my elbow is just a bit more noticeable than usual.

Since I’ve responded beautifully to my current RA treatments for so many years, I don’t plan to entertain the thought of switching. But this constant pain and discomfort causes me to ponder a few questions:

  • Are my RA treatments starting to lose their effectiveness?
  • Did I do anything to cause this flare-up?
  • Should I call my rheumatologist? What would she suggest that I don’t already know to try?
  • Why don’t you actually do some of the things you know to try, Lisa? Get on with it.

I basically know what I should do, but somehow having the knowledge doesn’t always translate into immediate action. I suppose that I should decide what my plan of action will be if I’m still experiencing increased pain, interfering with my ability to use my hands, by the end of the week.

I would feel silly, however, if I called the doctor then everything was back to normal by the time I got to see her. But I suppose that it is important to have this episode, especially if it continues, documented in my record. If the pain gets worse, I will definitely call, but fortunately it is still at a tolerable level right now.

I guess I’m opting to stay in a holding pattern for now. Wait and see. In the meantime, my husband is taking care of a few more things around the house for me. For that, I am also very grateful.

What do you do when a minor flare-up emerges, especially if you’ve been in remission for quite some time? Please share your experience; your story will help others dealing with the effects of RA.

 

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

Comments

View Comments (8)
  • Tich
    3 years ago

    Hi Lisa,
    I had a minor flare turn into a major one in September. I eventually emailed my rheumy and he sent in an order for a Medrol dosepak. It seemed forever to take effect. When I reviewed this later with him he said I should come in to the office immediately for a steroid injection. I would think this would be the best for you. See your doc immediately and get the fire put out.

  • Nanci Burns
    3 years ago

    I absolutely refuse to take DMARDs or biologics. When I flare I call my primary and he calls in a course of prednisone. I take Tramadol & Flexeril when I hurt. I also have osteoarthritis in my spine and pretty much all my peripheral joints as well as a Rheumatoid Disease.

  • Lynn
    3 years ago

    I don’t have minor flare ups. I get major flare ups and when I do, I am out of commission for a good 3-5 days. My only relief is ice and Prednisone. I take 5mg of Prednisone daily to function but during a major flare up I take up to 20mg sometimes 30mg. The pain level is a 10. I personally believe stress can contribute to flare ups for others I know. Mine come out of the blue. My hand turns into a claw and I cannot even hold a paper cup. Not sure what to recommend for your except to rest as much as you can and use heat and ice. NSAIDS help me so much but I am on Arava, not Methotrexate.

  • Lisa Emrich author
    3 years ago

    Hi Lynn,

    Thank you. It’s hard to slow down and rest sometimes, but this disease definitely doesn’t make considerations. It depends attention.

    I did finally use ice and heat, and that helped tremendously. Adding a splint helped me to allow my fingers to relax as much as they could.

    I hope that your major flare ups become infrequent. Be well.

    Lisa

  • Sharon Fritz
    3 years ago

    I am having one right now. Have felt very good last week. So I try to do less and rest. Try to keep my mind thinking good thoughts. Sometimes a little hard but I try.

  • Lisa Emrich author
    3 years ago

    Hi Sharon,

    I know what you mean; keeping your mind on good thoughts can sometimes be difficult, especially when there is always an underlying fear of “what if my RA continues to get worse and won’t stop?” Doing less and resting are so very important, and they help with the emotions too.

    I hope you feel much better soon!

    Lisa

  • jj
    3 years ago

    Hi Lisa,
    I’ve been on Rituxan for over a year, but still have mild flares in my hands and wrists.
    I have a great specialist just for my hands, I hope you can find one where you live. Even with methotrexate, I have noticed the last few weeks before an infusion are challenging and fatigue becomes an issue. My splints are helping though.

  • Lisa Emrich author
    3 years ago

    Hi jj,

    Thank you. Since I started Rituxan in 2009, my RA has been quite under control. However, like you, I would notice symptoms returning. At first, we (my doctor and I) would wait until symptoms started to increase before scheduling the next infusion which would be at around month 7. Now, we stick to a 6-month schedule which works nicely to head off moderate flares.

    Some time ago, I wanted to see how my RA might do if I were to stop taking methotrexate (with the thought of maybe having children). But symptoms came back fiercely in just two weeks that I decided it would not be an easy choice. I went back on the methotrexate immediately. It takes both drugs to keep me feeling ‘normal.’

    Lisa

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