There is no single rule that fits everyone. But knowing what a flare usually looks like, what else it could be, and when to pick up the phone makes that morning decision much easier.

Key points

• • A flare is a period when your condition becomes more active. It can last a few days or several weeks.
  • Infections, stress, overdoing it and missed doses are some of the most common triggers.
  • A flare action plan, agreed with your rheumatologist ahead of time, takes most of the guesswork out.
  • Fever, a single very hot and swollen joint, or feeling very unwell while on immune suppressing medicine needs prompt medical review.
    
    

What does a flare look like?

A flare is a period when inflammation increases and your usual symptoms get noticeably worse. Joints may be more painful, swollen, warm or stiff, and morning stiffness often lasts longer than usual. Many people also feel exhausted, achy all over or generally unwell, sometimes with a mild temperature.

Flares look a little different depending on your condition. In rheumatoid arthritis, they often show up in the small joints of the hands and feet. In ankylosing spondylitis, back pain and stiffness may wake you at night. In lupus, a flare can bring joint pain alongside a rash, mouth ulcers or deep fatigue. Flares also take an emotional toll, and feeling frustrated or low during one is very common.

What can trigger a flare?

Sometimes a flare arrives with no obvious cause. Often, though, there is a trigger. Common ones include an infection such as a cold, a stressful stretch at work or home, poor sleep, and doing more physical activity than your body is used to.

Medicines play a part too. A missed or late dose, a recent change in treatment, or reducing steroids too quickly can all tip the balance. Keeping a simple diary of symptoms, doses and life events helps you and your rheumatologist spot patterns over time.

Could it be something other than a flare?

This is the most important question to ask. Many arthritis medicines, including biologics, steroids and other immune suppressing treatments, lower your body's ability to fight infection. They can also dull the usual warning signs, so an infection may look milder than it really is.

A single joint that suddenly becomes very hot, red, swollen and painful is not typical of a flare. It can be a sign of infection inside the joint, which needs to be seen on the same day. A fever, chills, a new cough, burning when you pass urine or a spreading rash may also point to infection rather than arthritis. Some medicines can occasionally lower your blood counts, so a sore throat, mouth ulcers, unusual bruising or bleeding are always worth reporting.

When should I call my rheumatologist?

Contact your rheumatology team within a day or two if:

• • your flare has not settled after a few days of following your action plan
  • symptoms are getting worse despite what you are doing
  • you are needing steroid courses more often than before
  • you notice side effects or new symptoms you are unsure about.

See a doctor on the same day, or go to your nearest emergency department, if you have a fever of 38°C or higher while on immune suppressing medicine, a single hot and swollen joint, or you feel very unwell. Call 000 for chest pain or difficulty breathing. Many rheumatology clinics have a nurse advice line, so ask for the number at your next appointment.

What should be in a flare action plan?

The best time to plan for a flare is when you are feeling well. Ask your rheumatologist to help you write down what a flare looks like for you, what to try first at home, which pain relief options are safe with your treatment, and whether a short steroid course is part of the plan.

Your plan should also say who to contact and how, and what to do with your regular medicines if you become unwell. Some treatments are paused during an infection, but never stop or change a medicine on your own without advice. Arthritis Australia has a flare action plan template you can take to your next appointment.

How Ace can help

Flares often follow missed or late doses. Ace delivers biologics and other specialty medicines on schedule in cold chain packaging, so running out is not one of your triggers. Our pharmacists can also check whether a new symptom might be linked to a medicine, or whether an over the counter product is safe alongside your treatment. Get started with Ace.

References

Arthritis Australia. Flares action plan.

Arthritis Australia. Rheumatoid Arthritis Consumer Care Guide.

healthdirect. Rheumatoid arthritis.

Better Health Channel. Rheumatoid arthritis.

This article is for general information only and does not constitute medical advice. Flare management should be guided by your rheumatologist based on your condition and treatment.