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!!