Managing a flare
This page gives patients with arthritis advice on how to manage a flare (worsening of symptoms).
What is a flare?
You may experience your arthritis being increasingly painful; with joint swelling and stiffness despite taking medication to treat the condition. It will often settle on its own and an increase in your usual medication is not needed. This is known as a flare.
During a flare you may generally feel unwell and more tired than usual. These symptoms can last for a few days to a couple of weeks.
Possible causes
Often there is no obvious cause for a flare but they can be linked to stress, infection and vaccinations.
How to manage a flare?
Most flares can be successfully managed with self-help methods. Advice is available on the Gloucestershire Hospitals internet rheumatology pages, please visit:
Website: www.gloshospitals.nhs.uk/our-services/services-we-offer/rheumatology/
Medication
Your local pharmacist or GP will be able to provide advice about suitable pain relief and anti-inflammatory treatments.
Pain relief such as paracetamol or co-codamol taken at regular intervals can help manage the pain.
Non-steroidal anti-inflammatory (NSAIDs), such as ibuprofen or naproxen, can also be taken to help reduce the inflammation. If you are over 65 years, have a history of kidney impairment, previous peptic ulcers, heart disease or asthma, and if in the past NSAIDs have aggravated your asthma then before taking NSAIDs you should ask your GP for advice. Do not exceed the recommended dosage stated on the packaging and always read the information leaflet. If you are not sure if you are able to take a specific pain relief, please discuss it with a pharmacist or your GP.
Anti-inflammatory gels can be applied directly to an affected joint but should be used with caution if you are already taking oral NSAIDs.
Self help
If your current pain relief is not effective when taken regularly for up to a week after the start of a flare, you should speak to your pharmacist or GP about an alternative.
Heat packs, such as a hot water bottle or warm water such as a bath can help with pain. It is not advisable to apply heat to already warm to the touch inflamed joints. Ice packs or a bag of frozen peas can be useful to treat pain and help to reduce any swelling. Do not apply ice or heat directly to your skin. Wrapping an ice pack in a towel will avoid damage and irritation to your skin. Ice and heat treatments can be applied for up to 15 minutes at a time. Please ask for a copy of the leaflet GHPI0659 Ice and heat treatment.
Raising your affected limb above your heart height (elevation) or changing your position by using cushions in a chair (positional technique) can help to reduce swelling. Elevation and positional techniques may also help with a flare. Elevation may help with swelling experienced in specific joints such as the knees or feet. Supporting joints with pillows can make them more comfortable, such as a pillow behind your back or neck.
By using splints provided by the hand therapists and insoles from podiatry this may help to rest the affected joints.
If you have not been seen by the hand therapists or a physiotherapist and feel you could benefit from their advice about joint protection or benefit from exercises and splints, you can self-refer. Please enter the following website address into your browser. You will find the self-referral forms in the section ‘See a physiotherapist’.
Website: www.gloshospitals.nhs.uk/physio
Alternatively, you can leave a message on the following numbers:
Physiotherapy
Cheltenham General Hospital
Tel: 0300 422 3040
Monday to Friday, 8:00am to 5:00pm
Gloucestershire Royal Hospital
Tel: 0300 422 8527
Monday to Friday, 7:30am to 5:30pm
Occupational Therapy
Cheltenham General Hospital
Tel: 0300 422 3040
Monday to Friday, 8:00am to 5:00pm
Gloucestershire Royal Hospital
Tel: 0300 422 8586
Monday to Friday, 7:30am to 5:30pm
Similarly, if you have not been seen by podiatry and have continuing foot pain that may benefit from further advice, you can find self-referral forms online at:
Podiatry
Tel: 0300 421 8800
Monday to Friday, 9:00am to 4:00pm
Website: www.ghc.nhs.uk/our-teams-and-services/podiatry
Rest and exercise
Gentle exercise until a flare has passed is known to be helpful in relieving some pain as it releases natural pain relief called endorphins into the body. It can also help with your mood, sleep and general well-being. By keeping moving during a flare, you will reduce stiffness in your joints. Spending long periods in bed or sitting down can increase stiffness.
Exercise can help ease arthritis pain but knowing which is best for you can be difficult. Often an increase in pain is telling you that you have done too much. To avoid this, it is important to pace yourself by doing a steady amount of activity every day.
Some people get caught in the trap of yo-yoing, for example, doing lots on one day and then feeling unable to do anything for the next few days.
Take regular breaks and plan your week. Spreading activities throughout the week, changing the way you do things and asking for help can make things easier. An increase in pain does not mean you have damaged yourself, just that you may have done too much.
For further advice, please speak to either our physiotherapists or hand therapists.
What if my symptoms continue?
If the flare continues for over a week and has not responded to any of the self-help treatments, or you are having regular flare ups, we advise you to call the Rheumatology Advice Line. Please leave your name, contact details and a brief message and we will call you back within 48 hours.
Further help and advice can be found on the Gloucestershire Hospitals internet rheumatology pages:
Website: www.gloshospitals.nhs.uk/our-services/services-we-offer/rheumatology/
Contact information
If you have an appointment query, please contact the booking office:
Tel: 0300 422 5987
Monday to Thursday 9:00am to 4:30pm
Friday, 8:00am to 4:00pm
Email: ghn-tr.OutpatientBooking@nhs.net
If your problem requires urgent attention outside of the Rheumatology Advice Line hours, please contact your GP or NHS 111 for advice.
NHS 111
Tel: 111
Further information
Versus Arthritis
Tel: 0300 790 0400
Email: enquiries@versusarthritis.org
Website: www.versusarthritis.org
National Rheumatoid Arthritis Society
Tel: 0800 298 7650
Email: helpline@nras.org.uk
Website: https://nras.org.uk
Live better to feel better: Gloucestershire self-management
Website: www.ghc.nhs.uk/our-teams-and-services/self-management/
Tel: 0300 421 1623
Website: www.ghc.nhs.uk/our-teams-and-services/self-management/
Email: Gloucestershire.selfmanagement@ghc.nhs.uk
The Pain Tool Kit
Website: www.paintoolkit.org
Pain Concern
Tel: 0300 123 0789
Email: help@painconcern.org.uk
Website: https://painconcern.org.uk
NHS
Website: www.nhs.uk