Background/Purpose:

Flares are exacerbations of rheumatoid arthritis (RA) symptoms of sufficient intensity to require some change in treatment. Even when well-managed, more than half of people with RA experience flares within six months.¹ Despite their common and debilitating nature, there are few studies that examine flare-management.  Many people with RA may not know the best methods to control their own flare activity. 

We held two 90-minute focus groups with RA patients to discuss their experiences with flares and to identify flare warnings, triggers, and flare-management strategies, both preventative and treatment.

Methods:

We recruited 11 people with doctor-diagnosed RA, 9 females and 2 males, 10 white and 1 African American, aged 40 to 78.  Their disease duration ranged from 1 to 44 years.  Seven reported flare activity within the previous 3 months.  We analyzed group transcripts for participant responses and identified common themes about flares.

Results:

We found that experiences varied widely, but there were two important commonalities.  Flare activity diminished participants’ ability to take part in important activities, such as work, family gatherings, playing with grandchildren, and socializing.  Flare activity affected simple tasks typically taken for granted.  One participant commented, “It’s so ridiculous that my feet hurt so bad that I didn’t want to go to the bathroom.”  Group members agreed that coping with RA was challenging without flares, and that the uncertainty of flares made the disorder that much more difficult to manage.  As one participant said, “You never know what it’s going to be, but it’s always something.”

Participants reported few concrete signs of imminent flare (Table).  They identified multiple flare triggers, many of which related to changes in their lives, such as stressful events, the weather, or overdoing activities.  Flare prevention strategies tended to be healthful habits, such as taking prescribed medications, diet, exercise, and sticking to routines.  Flare management focused on short-term pain relief, such as increased medication or modalities, and methods to distract and rest the system.

Conclusion:

Despite advances in medications for RA, flares are common and triggered by multiple common activities and events.  Patients with RA currently have few opportunities to predict flare activity, and are dependent upon their flare management strategies to cope when flares occur.  We need more focused research on how to prevent flares, and barring prevention, the most effective methods to manage flares when they occur.

¹ Bykerk et al. J Rheumatol. 2014;41(2):227-234.