How to manage a flare up
A flare can be short lived lasting several hours or more severe lasting several days or weeks. Managing a flare can be frustrating especially if it is affecting your ability to perform basic daily tasks.
A flare can happen at any time especially during periods of stress or infection. Over time patients often become more familiar with recognising a flare and how to manage these. A flare can start with either increased joint pain or stiffness or swelling with heat or redness to a joint.
A flare does not necessarily mean that your medication is not working or your arthritis is becoming worse. It can take up to three months for a new medication to work for arthritis, and you may need a combination of drugs until you find the right one which helps control your arthritis. Everyone is different and what works for one patient may not work for another.
If you have one joint that has become swollen, red and hot to touch and you feel you have fever you may have an infection in that joint-this is a medical emergency, and you should attend A/E as you may need to have fluid drained from the joint along with a course of antibiotics.
Often simple self-management techniques (see below) and a few days rest are enough. It is a good idea to keep a record of your flares, if flares are becoming more frequent or lasting longer then medications may need to be adjusted; this is when you would need to contact our advice line to discuss a review. Assessing your symptoms and taking blood tests does help to determine whether your disease is becoming more active and less well controlled or whether experiencing increased pain is caused by other reasons.
Simple tasks you can do to help yourself during a flare-up:
- Ensure you are taking your medication at the dose and frequency prescribed.
- Take pain relief at regular intervals and as prescribed.
- Get rest and relaxation early on.
- Do gentle exercise; this can help with relieving stiffness.
- Use heat on a joint or take a warm shower or bath to relieve early morning stiffness and pain (see below).
- Use cold items on a joint such as a bowl of cool water or ice packs (see below).
- Wear the correct shoes; often foot wear that gives better support or has thick spongey soles are more comfortable.
- Use aids, such as a stick to support a knee flare or gadgets to open jars.
- Speak to those around you and let them know why you are not coping so they can help and support you. Asking for help only when you feel you need it gives a sense of still being in control.
Learn about your condition the more you know this easier it is to manage, start by viewing these links:
You may also find our trust physiotherapy web page useful which has resources on pain to specific parts of the body: Musculoskeletal (MSK) Physiotherapy
Tips on using heat: Using heat therapy either dry or moist can help to relieve pain in a muscle or joint. Dry heat such as a hot water bottle, heat lamps, wheat bag or deep heat creams can be useful but ensure the item is not too hot and you protect your skin with a towel. Check the skin regularly to ensure it is not burning. Wet heat can be things like a warm shower or bath, or a bowl of warm water. Gentle heat will be enough you do not want to burn or scold the skin.
Tips on using cold: Some patients find cold works better at calming an inflamed (red/hot) joint. Use a bowl of cool water with ice cubes for hands and feet or wrap a towel round a bag of frozen peas/beans as a moulded ice pack. A damp towel or flannel kept the fridge or wrap ice cubes in a plastic bag or towel. Always monitor your skin and remove the ice pack if the skin turns bright pink or red, the key is cool not ice cold.
Relaxation: Having a flare can be stressful but do not panic relaxation techniques can help. Ensuring good rest does not mean just taking things easy it means learning how to let go of physical tension and emotional stress, relaxing both the body and mind. Being in pain over long periods of time can mean becoming emotionally and mentally tense without realising it, leading to being “trapped” in a cycle of pain. Relaxation techniques can help to break this cycle and help to reduce pain but it takes practice, once learnt it can be done anywhere. Mediation, deep breathing techniques and guided imagery are some methods along with mindfulness or gentle yoga. No method has shown to be better than the other just find the one or ones that works for you. Apps such as Headspace are useful or ask your local library if they have any books or tapes on relaxation.
Breathing exercises for stress
Importance of Sleep: Having the right amount of good quality sleep has many beneficial qualities for your physical and mental health, evidence shows it is just as important as a healthy diet and regular exercise. Good sleep helps your body to repair itself and improves your body’s natural defences against illness and injuries. Poor sleep can leave you with poor concentration, lacking in motivation and increase your pain levels.
Establishing good sleep habits (sleep hygiene) can help. Try keeping fixed times to go to bed and waking in a morning rather than napping throughout the day. Create a relaxing bedtime routine such as a warm bath, soft music or reading. Avoid caffeine, alcohol, nicotine or eating big meals before bed. Maintain a comfortable sleeping environment that is not too hot, cold, bright or noisy.
Some people find changing their thought process to a more positive mind set helps them to cope better. But this is not for everyone and some find it easier than others. If you want to give it a go try focusing on the things you can do instead of the things you cannot. Diversion and distractions is a methods used to divert your pain by performing activities you enjoy or interest you. To read more around this then follow the links below: