7 Ways to Avoid a Rheumatoid Arthritis Flare Knowing Triggers Can Keep Pain and Joint Swelling at Bay

If you have rheumatoid arthritis, then you probably know what to do when your symptoms flare: Head straight for the medication! But how can you keep an RA flare from happening in the first place? Here, studies and experts weigh in on how to stay free of joint swelling and muscle pain – and away from the medicine cabinet – for as long as possible... You’ve been free of rheumatoid arthritis (RA) flare-ups for two years when suddenly you develop stiff, achy joints, extreme tiredness and a killer headache. What’s going on? “You’re probably having a rheumatoid arthritis flare, or a temporary return of symptoms,” says Martin Bergman, M.D., a Philadelphia-area based rheumatologist. “Symptoms vary from woman to woman and may include inflammation, tenderness, redness, stiffness and joint swelling, as well as flu-like symptoms and fatigue,” he says. “During a flare, you can have symptoms for a few hours, a few days or even a few weeks.” RA is an inflammatory autoimmune disorder in which your immune system mistakenly attacks and destroys healthy body tissue. It affects about 1.5 million people in the U.S., according to a 2010 study conducted by the Mayo Clinic. The best way to avoid a rheumatoid arthritis flare is to “keep a health journal to track your activities, diet, medications, weather and emotional framework,” says Katherine Molnar-Kimber, Ph.D., a Philadelphia area-based RA researcher who has suffered from RA for about 40 years. She founded the support website rheumatoid-arthritis-decisions.com and is author of 45 Tips That May Help Prevent and Calm Rheumatoid Arthritis Flares (self-published). “By comparing how you feel day to day, you can isolate triggers,” she says. Read on to learn the 7 common causes of rheumatoid arthritis flares and what you can do to prevent them. Rheumatoid Arthritis Flare Trigger #1: Changing medication or dosage “The most common cause of flares is forgetting to take medication or taking less or more than prescribed,” says Stephen Soloway, M.D., a Vineland, N.J.-based rheumatologist. About 60% of RA patients had an arthritis flare when tapering off prednisone, a corticosteroid that reduces pain and inflammation, but has adverse side effects like bone loss, insomnia, weight gain, bruising, diabetes and a puffy face, according to 2004 study conducted at the University of Pavia in Italy. To prevent a flare: “Take medications exactly as directed,” Soloway says. “Don’t assume you have to taper off prednisone.” “Many patients can’t go off it without suffering a relapse,” he continues. “About 75% remain on a low dose [5 milligrams or less daily] to control pain and inflammation.” Provided women stay on a low dose, they can reduce their risk of risk of bone loss and weight gain by getting regular exercise, consuming enough bone-preserving calcium and vitamin D and by getting regular bone scans (DEXA scans) to monitor bone density, Soloway says. “If you develop side effects during a taper, we can back off, increase the dose or increase the dose of other RA drugs you may be taking, such as methotrexate or biologic drugs,” he says. Biologics are genetically engineered proteins that inhibit inflammation. Side effects may include tuberculosis, lymphoma and serious infections. Biologics are also very expensive (up to $2,700 a month) and some health insurance carriers may require patients to cover a significant share of the cost, according to a 2010 study by Consumer Reports. Rheumatoid Arthritis Flare Trigger #2: Getting sick “Because your immune system is already compromised with RA, you’re more likely to get illnesses and infections like bronchitis, pneumonia and the flu, which can trigger a flare,” Soloway says. To prevent a flare: “Avoid situations that might expose you to infection and illness, and stay home if you feel ill,” Soloway says. “For example, if you’re feeling off, it may not be a good time to get on an airplane, go shopping, attend a rock concert or be in crowds where you could be exposed to illnesses and have a higher chance of catching something,” he says. “Ask your doctor about getting vaccinations and immunizations to reduce your risk of infectious diseases like influenza,” Soloway says. Rheumatoid Arthritis Flare Trigger #3: Not exercising Many women with RA are inactive, according to a 2011 study conducted in Bangor University in the U.K. Why? For years, doctors believed intense exercise exacerbated RA symptoms, such as joint pain and inflammation, and advised women with the disease to take it easy. As a result, women with RA became inactive, which increased their risk of obesity and reduced their muscle mass and flexibility – resulting in more joint pain, Soloway says. To prevent a flare: Exercise regularly to strengthen muscles around joints, reduce stiffness, increase energy, avoid obesity (another flare trigger) and release feel-good hormones (serotonin) that improve mood, advises a 2003 study conducted at Arcadia University in Philadelphia. Women with RA who engaged in intense exercise improved mobility, muscle strength and aerobic capacity and reduced inflammation and joint pain, according to the study. Other studies conducted in 2000, 2004 and 2009 at Leiden University Medical Centre in the Netherlands found that an intense exercise program of weight training, cycling and stretching exercises three times a week was more effective at improving muscle strength than a conservative program using range of motion and isometric exercises. Intense exercise also reduced pain and inflammation and reduced bone loss in people with RA, the studies found. But don’t try to exercise during a flare, Soloway says. “Exercise [during remission] also helps women with RA maintain a healthy weight and reduce depression,” he adds. Walking, cycling and strength-endurance exercises enhance cartilage integrity and joint lubrication while mobility exercises increase range of motion, according to the Bangor study. “My sister has had RA for 21 years and she runs marathons,” says Nathan Wei, M.D., an internist and rheumatologist with the Arthritis Treatment Center in Frederick, Md. He advises women with RA to check with their physicians before starting a new exercise program. High-intensity exercise includes running, spinning, rigorous cycling, speed walking, rigorous aerobics, interval training or any exercise where you break a sweat within 3-5 minutes of starting, and your heart rate is 70% or more of your maximum heart rate. Rheumatoid Arthritis Flare Trigger #4: Low stomach acid “More than a third of women with RA have low stomach acid, an imbalance that increases the risk of infection and pneumonia by letting disease-carrying microbes get a foothold in your gut,” Molnar-Kimber says, citing a 2004 study conducted at University Medical Center St. Radboud, Nijmegen, in the Netherlands. To prevent a flare: Eat foods rich in probiotics (“friendly” bacteria that aid digestion), such as yogurt, buttermilk, sauerkraut, kefir (a fermented milk product made by combining milk and kefir grains); soy products like tempeh and miso; kimchi (a fermented Korean cabbage dish found in ethnic grocery stores and health food stores) or aged cheeses, Molnar-Kimber says. “Avoid probiotics supplements because women with RA don’t absorb them properly" due to a lack of digestive enzymes, she adds. Steer clear of over-the-counter calcium supplements that reduce stomach acid, such as antacids like TUMS and Rolaids, Molnar-Kimber suggests. Rheumatoid Arthritis Flare Trigger #5: Lack of vitamin D “Low vitamin D levels increase your risk of flu and also joint swelling and muscle pain,” says Molnar-Kimber, citing a 2007 study conducted at University of Tampere Medical School in Finland. To prevent a flare: Catch some rays. “The best source of vitamin D is direct sunlight, and getting 5-10 minutes three times weekly is enough to meet your needs,” says Michael Holick, M.D., Ph.D., professor of medicine, physiology and biophysics at Boston University Medical Center and author of The Vitamin D Solution (Hudson Street Press). Good food sources of vitamin D include salmon, oysters, shrimp, halibut, egg yolks and vitamin D-fortified foods like milk, soy milk, orange juice and cereals, Holick says. Rheumatoid Arthritis Flare Trigger #6: Cold, damp weather “Many RA patients have flares when the weather turns cold and damp,” says Moshe Lewis, M.D., a pain management specialist in Redwood City, Calif. “They take a winter vacation in Arizona and I get a postcard saying they’re no longer in pain.” A study of 151 people conducted at Centro Reumatológico Strusberg in Cordoba, Argentina, found that people with osteoarthritis, rheumatoid arthritis or fibromyalgia reported more pain on cold days. People with RA also reported more pain on days with high humidity and high pressure. A drop in air pressure (which often accompanies cold, rainy weather) may allow tissues in the body to expand to fill the space, meaning that already inflamed tissue can cause even more joint swelling and pain, according to Johns Hopkins University School of Medicine. Also, pain thresholds may drop in colder weather; cold, rainy days affect mood; and during colder weather people are less likely to be outside getting exercise that keeps arthritis pain in check, says Johns Hopkins. To prevent a flare: “Don’t cheat on your heating bill during winter,” Lewis says. “Bundle up and wear an extra layer or two when you go out. To warm up fast, take a hot bath or soak in a Jacuzzi.” Rheumatoid Arthritis Flare Trigger #7: Not following the right diet “Gaining weight puts extra pressure on hips, knees and other weight-bearing joints and increases pain,” Soloway says. Losing even 5-10 pounds can help ease joint pain, advises the Rheumatoid Arthritis Foundation. Choosing the right fats can also prevent a flare. Omega-3 fatty acids are healthy polyunsaturated fats found in cold-water fish, nuts, seeds and plant-based oils and butters like olive oil and walnut butter. They help fight inflammation, Molnar-Kimber says. Omega-3 fatty acids improve joint swelling and pain in people with RA and reduce nonsteroidal anti-inflammatory drug (NSAID) usage, according to a 2011 study conducted at Children’s Hospital in Boston. To prevent a flare: Shed excess pounds by combining a healthy diet with a regular exercise program, Soloway says. Try a Mediterranean diet, which incorporates fruit, vegetables, whole grains, lean protein, low- or nonfat dairy products and shuns trans fats (found in processed and junk foods). And by adding 4-5 grams of omega-3 fatty acids a day, women with RA more than double their chances of going into flare-free remission, reports a 2006 study at Australia’s Royal Adelaide Hospital. “You can easily add that amount to your diet by eating two handfuls of walnuts,” Molnar-Kimber says. Other great sources of omega-3 fatty acids: cold-water fish such as salmon, tuna and trout; tofu and soybean products, flaxseed and flaxseed oil, and canola oil, as well as fish-oil supplements. “Take fish-oil supplements with food to increase absorption,” Molnar-Kimber says. For more expert advice and information, visit our Rheumatoid Arthritis Health Center. How Much Do You Know About the Types of Arthritis? About 46 million American adults – nearly one in five – suffer from some type of arthritis. It’s estimated that number will rise to 67 million by 2030.