Rheumatoid Arthritis Flare Up Treatment
By Dr Anne Parfitt-Rogers
Why do rheumatoid arthritis flare-ups occur?
You may get a flare-up if you stop taking treatment, for instance:
If you forget
If you miss a hospital appointment for monoclonal antibody (mab) therapy
If you experience stress. A study in women with RA found that those with relationship problems had higher T cell counts and inflammatory markers, and better ratings of disease activity by their doctor. If you are married, this may be protective, as these markers did not rise in married women even during times of stress. This affects the hypothalamic-pituitary-adrenal axis which controls release of stress hormones.
If you have to stop medication before surgery. Studies are currently trying to look into this to reduce this risk. One clinical trial in a New York hospital found that although most drugs only stay in the blood for a few days, many people stop taking them several weeks before their operation. It also found that taking mabs did not increase the risk of blood clots or infections.
If the weather changes. One study found that a third of patients believe this is a reason.
If you over-exercise.
Some drugs can cause flare-ups. For example, the drug Granulocyte Colony Stimulating Factor, which is used in low white cell count associated with a type of RA called Felty’s syndrome, can induce flares in certain people by stimulating inflammatory compounds in the blood. If you are allergic to metals, gold therapy may cause skin rashes.
Flare-ups can also happen for no reason at all.
One drug which can reduce the risk of flares is the non-steroidal anti-inflammatory drug namebutone, which is useful for adult and childhood rheumatoid arthritis.
What are the signs?
You may notice your joints swelling and becoming stiffer, an increase in pain, a fever, or your healthcare team may find a rise in your blood levels of C-reactive protein or other markers of inflammation. One or more joints may be affected and you may feel more tired.
Sometimes the flare-ups affect other parts of your body such as your eyes. You may also find it more difficult to use your joints and participate in daily activities. If you have a rise of more than 1.2 in your Disease Activity Score 28, you are likely to be experiencing a flare-up.
Occasionally your joints may become infected. This is known as septic arthritis and can also be very painful. If you get septic arthritis you will need hospital treatment. There are various bacteria and other micro-organisms that can cause this.
Treatments of Rheumatoid Arthritis Flare Up
The National Institute for Health and Care Excellence in the UK has produced guidelines for managing flare-ups. These include paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs) such as naproxen or ibuprofen for pain relief. Steroid injections may also be helpful if they are available. If you have a severe flare-up, you may need hospital treatment.
Various treatments are available to prevent flare-ups in rheumatoid arthritis. One study looked an antibody to tumour necrosis factor a (TNFa), which is involved in inflammation. The drug, cA2, produced a good response, with an 80% improvement in number of swollen joints and C-reactive protein (CRP), an inflammatory blood marker.
Monoclonal antibodies are given into the vein
Another study looked at adalimumab, another antibody and methotrexate in the treatment of children with juvenile idiopathic arthritis. It found it to be effective at preventing flare-ups, with 37% of subjects having flare-ups compared with 65% taking the placebo.
The combination of a mab and methotrexate was also shown to be effective in adults, with 60% responding to the mab ca2 with or without methotrexate, and the group receiving methotrexate showing a longer action where the effects did not wear off over time. Patients experienced a 70-90% reduction in the number of swollen joints, number of tender joints and CRP level.
Another mab known as etanercept may be useful in juvenile arthritis that has not responded to first-line treatment. It can be used to prevent or reduce the risk of flare-ups. For more information on mab drugs, see the “New Drugs” section.
Steroids have also been shown to reduce flare-ups. The most common form is prednisolone, which is usually taken in tablet form at a dose of 7.5mg once a day. They do have certain side effects, including indigestion, abdominal distension, muscle wasting, increased risk of diabetes and osteoporosis, and a “moon”-like face at higher doses.
What you can do
During a flare-up you may need to reduce your level of exercise or use less strenuous exercises until your joints have recovered. When you are not doing essential activities, make sure you get plenty of rest and leave the non-essential ones. Keep your painkillers ‘topped up’ to avoid the pain getting too severe and take a warm shower or bath in the morning to ease your joints.
Here are some tips for treating RA holistically from YouTube:
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