If you are on the correct Dmard/ anti tnf, Biologic, should you continue to have flares?

Just want to throw this one out there. My Consultant said as far as I can remember (1st 6 months), that if your disease is under control, you should'nt have flares. Is that true? Is a flare a swollen joint? Can it be tiredness alone? Can it be achy joints. I would have thought a flare is an actual swollen/ inflammed joint? If your bloods are normal range can a joint swell? The damage that is done will always be sore sometimes if the joint is overused, but that is not flaring or is it? Can anyone define or explain? Hope this makes sense.

15 Replies

  • sure lyn-w will answer this best.. one would hope not !but if things arent quite right eg dose,another infection going on or treatment loosing effectivness then yes

    did you ever sort your syringe/ pen problem??

  • yes I did, rang helpline and they said probably hip a capilary. stopped stressing now!

  • I still get flares 3- 4 a year normally triggered by a virus, an infection, dental surgery or other stressful event! Often a combination of events. My rheumy thinks that this is 'normal' for me and certainly I'm extremely grateful that I'm not like that all the time!

    A flare for me normally involves multiple hot, red, swollen joints; a low grade fever; even more extreme fatigue; mobility problems from stiff / swollen joints and pain that becomes difficult to control if I don't get quick assistance. I also feel generally very unwell, this sometimes manifests before the joints start swelling - I feel like I'm coming down with something.

    I've learnt the hard way to jump on it quickly and have oral steroids to take if it starts when I'm away from home or on a bank holiday weekend - until I can get to the rheumy team.

    Cece x

  • Hi Cece, Thats what I would call a flare too, what meds do you or can you take to control RA? if you don't mind me asking?

  • I'm on max of Mtx and Leflunomide - can't have anti-tnf as it's contra-indicated with my other health problems and history of serious infections (septacaemia twice + chronic kidney infections).

    Cece x

  • just reas my answer it shouls say hope not to flares but hope lyn-w or some similar eg cece answers.. realise it could be miss read and cause offence xx

  • Summer, What do you mean cause offence, I understood what you meant fine. : ) you worrier.


  • Hi Gina, generally a flare would start when your ra is no longer controlled by the drugs you take which could happen at any time. Our Ra could be well controlled for weeks/months even years if your lucky, same old story I'm afraid we are all different in our ra.When a flare starts you can get all the symptoms you mentioned, fatigue/swollen joints/more pain/inflamed joints, with me I'm just absolutely drained of all energy my joints start to get hot and swollen (inflammation) until they are nearly all affected,so difficult just to get about can't sleep etc. Like cece said you learn to jump on it quickly mine starts in my fingers and then continues through my body.

    Generally you have your meds reviewed as obviously what you are currently taking is no longer doing the job it once did, we are all different in how long it lasts some of us who have had ra for years find it very difficult to get control of a bad flare. My bloods aren't usually affected at first, I'm the one who can recognize when a flare is imminent.

    Joints that have been damaged will nearly always be a problem, always be sore and swollen if you do to much with them. Then comes the surgery route, my ra is as controlled as it will ever be at the moment but I've been told that I will always need further surgery to my damaged joints. We do need to look after and protect our joints as much as we can by wearing splints etc.

    Hope that was a little helpful Gina

    Take care

    Mandy xx

  • Hi Mandy,

    Yes that was very helpful, I hav'nt really had a bad flare yet, but good to know what to look out for! I do get tired & achy, but nothing like the initial illness, re pain & swelling & HEAT.

    Hopefully the Humira & mtx & plaquinil will continue to work for a while. I will be straight bk to doc when I see a change, from what I have learn on this site.

    Thanks to all.

  • As time goes by Gina you will learn to listen to your body and recognise when things aren't right, or we could say what's normal and what not for you. We say so many times we are all different and its true we are, what works for some doesn't work for others and so on. I know my ra is the best it will probably ever be, I still get pain, still have stiff joints,still have fatigue but I can cope and that's the difference. These symptoms change and vary every day, but when a flare is upon me things just get worse every day until I just can't cope anymore. But that's what I've had to learn to do,to recognise the flare symptoms and get it sorted before it gets me!!

    It's all about being in control Gina, you've probably learned loads talking to others on here, I know i have.

    Take care

    mandy xx

  • This is a bit complicated, isn't it? Because we know what we feel, and then we're advised that we shouldn't feel like this. I recall the last time I saw my consultant in February. He questioned the pain relief that my GP was giving me (GP that I see every 4 weeks, rather than consultant every 12). He asked if I could do without the Butrans patches because, "you shouldn't need them". Oh! Is that right then, that I don't know how much pain I'm in? Now my GP has prescribed morphgesic, following my assessment with oramorph. My GP has been absolutely wonderful. I thought I was having a flare up because I could barely move my hands. Bloods revealed eveything normal, no inflammatory markers. I couldn't understand it, because I felt pain, and my hands were swollen. My GP could see things for what they were: when she read out my results off the computer, and I became very distressed, she couldn't do enough to say that she believed me. I think that my consultant's a wonderful man, and although he specialises in RA, he doesn't have it himself.

  • Andrea,

    I've also had this happen - no 'high counts' but obv swollen hot joints - I've also had sky-scraper 'blood counts' and no significant worsening in joints etc!

    Both my gp and rheumy go by what is 'my normal' - plus as you say, they can use their eyes to see what's happening. My rheumy's attitude is that they'll worry about all the tramadol I take when there's a cure for RA. and that I need to keep on top of the pain - I step up and step down pain meds as required.

    As Mandy says, joints already damaged are always going to be stiff and painful until replaced - so it's great that more people are getting there RA dealt with quicker and more effectively:-)

    Cece x

  • Hi. I was told that I would still have flare ups on meds but that they wouldn't be as bad. I believe that severe bouts of fatigue, depression etc are flare ups but usually followed by painful joints. x

  • I aksed my rheumy whats the difference with a flare and he told me that becuase I still dont have any control over my diease activity then at the moment I will only have bad and very bad days, however Im 8 weeks into Enbrel cant take todays shot due to infection, but Im really hoping to get some control so I can have a flare and not just everyday in pain, swelling etc. I must admit though the steriods were keeping me out off swelling as bad but they have started to drop my steriods in hope the enbrel will work!

    Fingers crossed, well if I could lol!

    Take care

  • Flares can be just like RA, very personal! here's the link to a blog I wrote a few months ago nras.healthunlocked.com/blo...

    Hope it helps :)

    Lyn x

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