From the Guidelines
A rheumatoid arthritis flare-up should be addressed promptly with both immediate symptom management and potential adjustments to your long-term treatment plan, prioritizing the use of disease-modifying antirheumatic drugs (DMARDs) and biologics as recommended by the 2015 American College of Rheumatology guideline for the treatment of rheumatoid arthritis 1. For immediate relief, take your prescribed NSAIDs such as ibuprofen (400-800mg every 6-8 hours) or naproxen (500mg twice daily) with food to reduce pain and inflammation. If you have a prescribed corticosteroid like prednisone, a short course (typically 5-10mg daily for 3-7 days) may help control severe symptoms. Rest the affected joints, apply ice packs for 15-20 minutes several times daily, and consider gentle range-of-motion exercises when tolerable. Contact your rheumatologist within 1-2 days of a flare beginning, as they may need to adjust your DMARDs such as methotrexate, hydroxychloroquine, or biologics. Some key considerations for managing rheumatoid arthritis include:
- Using validated composite measures of disease activity to guide treatment decisions, such as the disease activity score (DAS) or the DAS employing 28 joint counts (DAS28) 1
- Considering structural changes and functional impairment when making clinical decisions, in addition to assessing composite measures of disease activity 1
- Maintaining the desired treatment target throughout the remaining course of the disease, and being cautious when reducing or stopping synthetic or biological DMARD treatment 1 Flares often result from medication non-adherence, infections, stress, or overexertion, so identifying and addressing triggers is important for prevention. It is essential to track your symptoms daily during a flare to provide your doctor with accurate information about its severity and response to treatment. The patient should be appropriately informed about the treatment target and the strategy planned to reach this target under the supervision of the rheumatologist 1.
From the Research
Rheumatoid Arthritis Flare Up
- Rheumatoid arthritis is a common disease that causes substantial morbidity and mortality, and its treatment often involves disease-modifying antirheumatic drugs (DMARDs) such as methotrexate, sulfasalazine, and hydroxychloroquine 2.
- Combination therapy with methotrexate, sulfasalazine, and hydroxychloroquine is more effective than either methotrexate alone or a combination of sulfasalazine and hydroxychloroquine in patients with rheumatoid arthritis 2, 3.
- The combination of sulfasalazine and methotrexate is also more effective than either drug alone in patients with rheumatoid arthritis with a suboptimal response to sulfasalazine 4.
- Triple DMARD therapy, including methotrexate, sulfasalazine, and hydroxychloroquine, is better than various DMARD monotherapy and dual therapy regimens 5, 3.
- Early aggressive treatment of rheumatoid arthritis is associated with improved disease control, slower radiological progression, and improved functional outcomes, and combination therapy is a widely used therapeutic alternative 5, 6.
- The management of rheumatoid arthritis requires a multidisciplinary approach, and good management requires an early and accurate diagnosis associated with optimal personalized treatment to achieve better outcomes for patients 6.