How do you guys manage a flare up?

[jf211]

Hi

I’ve had RhA since 2019. Has been in remission for the last 6 months - on baricitinib, chloroquine and methotrexate but I’m starting a flare now.

My question is - how do other people manage a flare? Do you wait for it to get bad, hoping it will settle- if next appointment is months away? Contact rheumatology for an urgent appointment? Contact GP?

I’m a retired doctor so basically very impatient and I know that these things should be treated quickly…

[Hidden]

Ok this is me . If a flare lasts more than a week I contact my team for a steroid injection. A flare comes and goes fir me but if it lasts longer it’s normally a sign my disease is active and in my experience my drugs are no longer working.

Rest rest and more rest . Ice/heat and Epsom salts bath along side painkillers for me .

Hope you get relief soon .

[jf211 in reply to Hidden]

Thanks

[Neonkittie17]

Hi, I’d let your rheumy/nurse know tomorrow via the helpline. It may take a while to be able to see a rheumy/speak on the phone. Maybe they can bring your routine clinic appointment forward. Obviously, as you know they are likely to want blood tests to see if your CRP/ESR results are in keeping with what they should be. Hope it’s just a blip and you return to the med induced remission you’ve been having. Good luck. 🙏🏻

[jf211]

Thanks. Unfortunately, even at diagnosis and when my biologics were started because I had so many joints involved and a really high rheumatoid factor, my ESR and CRP remained within normal limits

[Hidden in reply to jf211]

I’m exactly the same

[Neonkittie17 in reply to jf211]

That’s going to be a little different then. Mine mirror how I feel and what my RA is doing.

Despite those, the rheumy should ascertain why those three meds, and one a powerful JAK, are letting you flare, but it could be something else you’ve had .. a milder infection affecting you. Are all other bloods normal for you? I won’t say anymore as you are the retired GP! Wishing you luck to control this flare and feel better soon.

[helixhelix]

For me flares come in different flavours. Sometimes all it needs is a week of calm and stronger anti-inflammatories (usually if flare caused by overdoing things), sometimes needs steroids, and sometimes (very rare now) it’s a sign of the disease changing and need drug tweaks. I have a rescue pack at home of 2 different anti-inflammatories and a pack of pred.

Like you my inflammatory markers are pretty stable. After 11 years of tracking I can feel when my ESR goes over 8, but that’s so minor that it doesn’t really make my rheumy do more than laugh. Luckily she’s not one to rely on blood tests rather than examination.

[vonniesims]

I slow right down, sleeping a lot and taking anslgesics. Dont leave too long to book a phone call with the nurse specialist as there is a weeks wait for ours. I have gone privately before for reassessment as the wait for NHS is so long

[runningbracken]

I was flaring terrible for for years on and off while taking oral MTX and folic acid. In the end i couldnt cope and my blood results were really high.Just before last Christmas i asked about the injections and was moved on to them. Ever since i've got better an better, back working and keeping fit. Almost feel as good as i did before RA showed up.

[Zoppy89]

This is me. I very rarely have flares but have been having one for the last few weeks. I tried a week of rest. Over the counter medication and hot compress then contacted the nurses.

They were particularly unhelpful and having got me in tor a f2f they decided they wanted me to persevere with over the counter as in her opinion there weren’t enough swollen joints to warrant steroids.

When asked fine stronger painkillers she was not allowed to prescribe so asked me to get a GP appointment.

My GP is so swamped so that was not easy and after being in a few queues I have given up on that as well.

I think I will just try and ride it out ash rheumy team are being quite difficult.

[jf211 in reply to Zoppy89]

Poor you. That’s really hard to feel so unsupported.

[oldtimer]

I have an arrangement with the rheumatology team that I start on 10mg prednisolone when I have a flare. If after three days I'm not responding (I often do and then take it for a week before going back to 5mg) I then contact the rheumatology nurse, she usually says, up the dose to 15mg or 20mg if necessary. That usually does the trick and then I have a slower tail down to 5mg. I just wish I didn't have flares...four between October and March. But in between I'm not eligible for biologics (although perhaps with the new NICE recommendations that will change?)