What is an RA Flare?

Reviewed by: HU Medical Review Board | Last reviewed: September 2013. | Last updated: March 2020

RA is considered a chronic disease, which means that it is long-lasting and persistent. Other examples of chronic diseases include diabetes, asthma, and heart disease. Although in most patients RA is a long-term illness that requires ongoing treatment, it typically does not progress on an even or predictable course. Most patients with RA experience periods when the disease worsens beyond normal day-to-day variations, and is more active. These periods of worsening disease are called flares.1

What does an RA flare up feel like?

For a patient with RA, flares seem to follow a distinct pattern in terms of early signs and the onset of symptoms. Although initially you may not be conscious in a concrete way that a flare may be starting, you may have the feeling or sense that something is wrong. For instance, a daily exercise routine may become a little more difficult than usual, with increased muscle tightness and soreness. Exercise may still be followed by a positive feeling. However, you may start to feel more tired and lethargic than usual and experience difficulty with sleep. This early stage might last for a few days.2

Symptoms of the start of an RA flare up

After this initial stage when you feel that things are not quite right, you may start to notice distinct symptoms that signal the onset of a flare. These include occasional twinges of stabbing pain that evolve into a constant, aching pain. Your pain may be accompanied by fatigue and a feeling of malaise. Additionally, you may experience swelling in your joints accompanied by symptoms associated with active inflammation, including a low-grade fever or chills.2

You may find that the onset of a flare affects your mood. Depression can accompany the worsening of symptoms and loss of functioning and well-being that you experience with a flare. As pain and swelling increase and mobility decreases, it becomes difficult to engage in daily tasks and routines, and you may experience a loss of enthusiasm and enjoyment in daily activities that normally give you pleasure.2

Going through the peak of a flare

A dramatic worsening of pain marks the peak of a flare. This pain may be characterized as burning or stabbing and may affect different muscles and joints simultaneously. During the peak of a flare, you may find it difficult or impossible to sleep soundly. With a lack of sufficient rest, you may not be able to concentrate or function normally. This loss of normal functioning can affect every facet of life, from meal preparation to grooming and hygiene. Consequently, flares may be accompanied by a loss of weight and neglect in appearance.2

How an RA flare ends

Just as the onset of the flare was marked by a gradual worsening of symptoms, the end of the flare will be marked by a gradual lessening of the severity of symptoms. Intense, constant pain will give way to less intense pain, a decrease in joint swelling, and a gradual return of movement. Additionally, as symptoms become less intense, the ability to sleep soundly returns.2

How is an RA flare defined?

Although there is currently no set definition of what constitutes an RA flare, there is agreement that a flare is associated with a worsening of key RA symptoms and an impact on certain areas of daily functioning. Your doctor may use clinical tools including standard RA laboratory tests, counts of swollen and tender joints, and a global assessment of your condition to determine whether you are experiencing a flare.1

Worsening of RA symptoms

  • Pain
  • Swollen joints
  • Tender joints
  • Stiffness
  • Fatigue

RA flares are associated with decreased functioning

  • Daily functioning
  • Participation in activities
  • Self-management
  • Emotional distress
  • Ability to sleep

How long does an RA flare last and what are my treatment options?

An RA flare may last for weeks or months, depending, in part, on how quickly you get treatment to address the underlying inflammation. If you experience a flare, you should talk to your doctor immediately and start a course of treatment to reduce inflammation. Typically corticosteroid therapy is used to reduce the inflammation associated with a flare. It is important to address the inflammation that occurs during a flare to limit damage to joints, bones, and cartilage.

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