Flare-ups – ‘my joints are on fire’

The symptoms of rheumatoid arthritis vary from person to person. They can come and go, and they may change over time. You will experience flare-ups when, from time to time, your condition worsens and your symptoms become more intense and severe. This may be fairly short term or may last weeks. A flare can include not only joint pain and swelling but also fatigue, stiffness and feeling low in mood, this can be both painful and frustrating.

A flare may occur following an infection, a vaccination, surgery or when you are stressed. Sometimes however there is no obvious cause. Some people are able to recognize when a flare is going to happen, as their symptoms start getting worse over a period of days, but for many people they can wake up in flare with no warning, or it develops in a matter of hours.

It is possible to self-manage flares with a few days of rest, taking prescribed painkillers i.e. Paracetamol and anti-inflammatory medications i.e. ibuprofen. In some cases where the symptoms do not improve you may need to see a health care professional. This may be your GP or one of your rheumatology team to discuss treatment options. This can include short-term management with steroids or if your flares are persistent or occur on a regular basis you may need your treatment plan revisiting.

Although it is important to rest, being stationary for too long can make the joints feel stiffer and more painful to move afterwards.  Moving your joints gently and slowly on a regular basis can help reduce the stiffness and help to shift stubborn swelling.  If you have swelling in your hands and wrists or in feet and ankles, then elevate them e.g. feet up on a stool, or hands on a pillow so they are higher than the elbow.  This can help fluid drain, helping your joints to feel less stiff.

Sometimes it can help to try some of the following –

  • Do rest, but maintain some gentle physical movement to help relieve the stiffness that can make the pain worse.
  • Do use aids to help, such as a walking pole if you have a painful knee, or a splint to rest a wrist.
  • apply an ice pack, a heat pack, or a wheat pack (you can buy these at your local chemist) to an individual joint that is causing pain. If you find an ice pack helps, be careful not to burn yourself, use a cloth to protect the skin.
  • warm baths or showers in the morning can help relieve early morning stiffness and pain.
  • Take your medications regularly, and at the correct dose. You can always speak to a pharmacist about your medications and pain relief.
  • Let people around you know how you feel, so they can support you whilst you aren’t managing as you normally do.
  • See our page on self-management

If flares continue to persist on a regular basis, it is important to ensure you have an appointment with your rheumatology team so that your medication can be reviewed.

Image of a doctor and a patient

If you have a persistent flare you can contact:

  • Your GP
  • The Rheumatology telephone advice line (provided at the top of clinic letters for rheumatology patients)
  • This service can be extremely busy, so we appreciate your patience.
  • Please note that this service is unable to deal with emergency calls. It allows contact with a nurse specialist for advice only. Calls are answered as soon as possible, but at busy periods, there may be a wait for your call to be answered. There is no facility to leave a message
  • Can look for advice on the Versus Arthritis or National Rheumatoid Arthritis Society websites (click on the names).  They also have advice lines you can call.

Adapted from :

NRAS Managing flares 2022


Royal National Hospital for Rheumatic Diseases, Royal United Hospitals Bath NHS Foundation Trust