A Cheat Sheet for Coping with Rheumatoid Arthritis Flares

It may seem as if flares are the most difficult tests of all to endure. Every time I experience a flare, I think that I know what to expect but regardless of experience, it seems that every flare is different.

Yet, in some ways, they are all the same. In the moments where I feel a great deal of pain, the fatigue is at its worst and I am extremely overwhelmed, it is hard to have a clear perspective. What I have found, however, is that having a plan, or a cheat sheet, for dealing with a flare makes coping so much easier.

What ignites a flare?

What we all know about rheumatoid arthritis (RA) flare-ups is that they are unpredictable. Sometimes they come often, and other times you can enjoy longer periods of remission with only sporadic attacks of inflammation and fatigue. A flare can occur in few joints or it can affect the whole body, and it can last for days or even weeks.

Any number of things can trigger flares and they are not necessary specific to certain foods, hormones or even stress. Other factors that can ignite flares include smoking and the weather. That is why it is so important to educate yourself on living with RA and dealing with its effects. Further, being informed allows you to quickly evaluate an oncoming flare and to work towards coping through it successfully.

My cheat sheet for coping

I have a yellow post-it note in my medicine cabinet (taped to the inside part of the door) that has the following written on it: “For Flares: No drugs, rest and exercise, watch what you eat, try alternative therapies, drug options and call your doctor.” When a flare happens, I try to follow these in order depending on the severity of the flare, and then continue them throughout the duration of the flare.

Here my cheat sheets tips for coping with a flare:

Start with No Drugs. The reason I keep my cheat sheet in my medicine cabinet is to remind myself to consider non-drug therapies before medicinal approaches. Heating pads and cold packs can be applied to affected areas to reduce pain and swelling.

Doctors recommend resting affected joints and applying ice for 20 minutes on and 20 minutes off for a period of two hours. Alternate between hot and cold every two hours with the same schedule – 20 minutes on and 20 minutes off.

Alternate Between Rest and Exercise. We know that rest is essential during a flare period, but so is exercise. This is because if you do nothing, your joints will become stiff. Having a flare-up is not a reason to avoid activity. In fact, it is necessary to keep moving as well. However, avoid strength training and endurance exercises as you deal with the flare. Instead, try gentle stretches to maintain a range of motion.

Watch What You Eat. While eating is the last thing on your mind during a flare period, eating foods rich in fish and plant oils and avoiding meat can help to reduce inflammation. If you take an omega-3 supplement, increase your intake to 3,000 milligrams daily. Most likely, that consists of taking two omega-3 supplement capsules. However, check the bottle’s label to confirm.

Try Alternative Therapies. As you know, chronic pain and RA patients have found relief in practicing relaxation techniques, mediation, yoga and acupuncture. While I have not tried acupuncture, I have tried and benefited from relaxation, meditation and yoga. All three help during a flare by alleviating stress, relaxing the mind, and relieving pain. When you first try these therapies, becoming relaxed can seem like a nearly impossible task, but it is something that can in fact be learned.

As for acupuncture, researchers have questioned whether it holds any helpful value, but according to many it is a practical alternative for managing arthritis pain. If available during the flare period, it is a viable option that can relieve RA related pain and help to minimize stress and anxiety.

Drug Therapies. When all else fails, it is time to call the big guns. I consider medicinal approaches a last option. RA patients already take plenty of medications to slow down and the stop the progression of the disease, so it makes sense to consider non-medicinal approaches when possible.

Start with over the counter (OTC) anti-inflammatory gels that can be applied to inflamed joints. Use sparingly because overuse of gels can cause skin irritation. If gels are not working, your next option can be anti-inflammatory OTC medications (e.g., Advil or Aleve). Please note that the overuse of anti-inflammatory OTC medications can cause additional risks such as stomach irritation and ulcers so, as with gels, use in moderation.

Call your Doctor. When non-medicinal approaches, exercise and rest, watching diet, alternative therapies, and anti-inflammatory gels and pain relievers are not working, work with your doctor to create a plan that will help you bounce back quickly. Your doctor can raise the dosage of RA medications and prescribe additional medications to help with pain and reduce inflammation. If your flare is especially severe, strong anti-inflammatory corticosteroids can be temporarily used.

Having your own Cheat Sheet

Having rheumatoid arthritis requires you to constantly be on top of your game. This is because a flare-up can keep you out of commission for days on end. As a result, planning for a flare is critical and it is similar to planning for a disaster. Prepare your own cheat sheet even if it is as simple as a post-it note reminder. Keep in mind that planning for flares will help you to cope from the first onset and will allow you to remain capable and focused during a flare period. It will also save you time and energy that is better suited for coping.

What’s on your flare-up cheat sheet?

Arthritis Tip: Stay Active to Ease Arthritis Pain

Staying active is one of the most important things you can do to ease arthritis pain. In fact, research has shown that exercise, physical therapy and lifestyle changes can help to keep people with arthritis active, reduce pain, and slow the progress of arthritis. 

A recent study found that 90% of osteoarthritis patients were not getting the minimum amount of recommended activity per week. Experts say that exercise can help to reduce both long and short term pain and improve physical function in arthritis patients. People with joint pain can benefit from functional strength training that includes strength, endurance and balance exercises that help to ease everyday movements such as walking. 

Physical therapy can also bring pain relief and can be an alternative to surgery. Physical therapy consists of soft tissue massage and keeping joints mobile. Additionally, ice and heat, ultrasound, and electrical stimulation can be used to reduce pain. 

Lifestyle changes can also help to keep joints mobile and ease pain. In fact, maintaining a healthy weight and keeping muscles balanced can help to slow down joint damage and progression of osteoarthritis.

How does chronic illness define you?

 

The first piece of advice you can from people when you are newly diagnosed is to not let the disease define you. While there is good intention behind that, chronic illness is going to define because it changes you and your very way of living. You have to find ways to live with chronic illness successfully and most changes in your life are due to chronic illness being a part of it.

Living with a disease like chronic illness throws you into a whole new world and you start to question who you are and who you are becoming. You can no longer define yourself on the things you accomplished or had plans to accomplish. A part of us knows that the people who love us always will but the other part wants so desperately to connect to those people as we were before chronic illness came into our lives. Many of us have had to quit jobs, change jobs or cut our hours. We have also had to limit our involvement with friends and activities we once enjoyed.

Depression is also factor because getting depressed is a response to all the affects that the disease has our lives and our bodies. When you are depressed, you feel unworthy and it is hard to see through that logic. It is no wonder so many of us feel defined by our diseases.

Living with both fibromyalgia and rheumatoid arthritis, I know that my health defines my day to day. It defines whether I can spend time with family and friends or whether my laundry and housekeeping will get done. It also defines my work day and whether I will make into work. We are always working so hard not to let our diseases define us but we don’t stop to wonder why they do. The only way to NOT let disease define you is work toward disease management but as hard as you try, your disease will always define you in some way or the other. How can living with chronic illness NOT define you?

I have learned that HOW chronic illness actually defines me is more important than the actual idea of NOT letting it defining me. Does it define me with anger, self-pity, sadness or resentment or does it define me with patience, empathy, endurance, and determination? I pick the latter every time. Does chronic illness push me further way from loved ones and God or does it bring me closer? Again, I pick the latter option.

Instead of spending so much time not allowing chronic illness to define us, we should allow it to re-define us in positive ways. HOW does chronic illness define you? Does it define you with anger, self-pity, sadness or resentment or rather does it define you with empathy, patience, endurance and determination? Does it push you further away from loved ones and God or does it bring you closer to these things? What things do you do so that chronic illness defines you in a positive light?

Do you know about the possible complications of Rheumatoid Arthritis?

As you may already know, rheumatoid arthritis (RA) is both a disfiguring and debilitating disease.  Joint pain, stiffness, inflammation and damage can make it difficult to perform daily tasks.  Most RA patients find themselves worn out by daily activity and eventually some are unable to continue doing them.  We have been fortunate, however, that new therapies are available and more effective in slowing down or stopping joint damage. 

Unpredictability

The hardest part for most patients, including myself, is the unpredictable nature of RA.  In other words, we never know when the next flare up will be.  We cannot plan for them and we cannot always stop them from happening.  It is possible to control to severity and we can find that some days are better than others.  With flare-ups being so unpredictable, it is not usual to become depressed as a result of associated anxiety and stress.

Joint pain, added stress and anxiety and depression make RA patients more vulnerable to developing disease complications.  This is because the autoimmune process that causes joint inflammation can also affect the eyes, lungs, skin, heart, blood vessels and other organs of the body.  Medications also cause unwanted side effects.

Recognizing early symptoms of potential complications

To manage complications of RA, it is important to recognize symptoms early and get appropriate treatment.  Here are some potential issues you should look out for.

  • ·         Skin problems: About 20% of RA patients will develop rheumatoid nodules.  These are lumps of tissues that generally appear under the skin on elbows, forearm, heels or fingers.  They are an indication of severe disease activity.  It is also possible for them to appear on the lungs or heart.  Inflammation of blood vessels called vasculitis causes skin changes and appear as ulcers on the skin. Other types of rashes/skin changes are possible with RA as a result of disease activity or medication so it is important to alert your doctor of any skin changes you develop.
  • ·         Eye problems: RA can affect the eyes in several ways.  These include inflammation on thin membrane and covering the white of the eye, called the sclera, or inflammation of the sclera. I have gone into detail about the eye conditions associated with RA in this post
    • o   Sjogren’s syndrome: With RA, you are at a higher risk of Sjogren’s.  This is a condition in which the immune system attacks the lacrimal glands, the glands which help us to produce tears.  Eyes can feel gritty and dry and if not treated can lead to infection and scaring of the membrane that covers the eye. RA patients should have regular eye exams but if you are already showing symptoms, let your doctor now about them.
  • ·         Heart and blood vessels:  Many RA patients have a collection of fluid between the pericardium and heart itself called pericardial effusion.   However, not all RA patients have symptoms.  Episodes of pericarditis or inflation of the heart membrane usually develop during flare periods. Persistent pericarditis can interfere with the heart’s ability to work property.  For more information on heart complications with RA, please review this article.
  • ·         Disease of the blood and blood forming cells: Many RA patients experience anemia which causes symptoms such as fatigue, rapid heartbeat, shortness of breath, leg cramps, insomnia and dizziness.  Sometimes, treatment to suppress the immune system can lead to thrombocytopenia, a condition where low levels of blood platelets are present. Felty’s syndrome is also a complication of RA, but fairly uncommon.   This is a condition where the spleen is enlarged and the white blood cell is low.  Felty’s syndrome increases the risk of lymphoma cancer (cancer of the lymph nodes).
  • ·         Lung problems: The same inflammatory process affecting the lining of the heart can also affect the lining of the lungs.  For more information on the various lung complications, please refer to this article.  RA treatment can also affect the lungs.  Methotrexate, for example, can affect the lungs and cause shortness of breath, cough and fever.  Symptoms, in this case, improve after the medication is stopped.
  • ·         Infection susceptibility:  People with RA are prone to infection which is both associated with the disease and medications to treat it.  If you think you have an infection, contact your treating physician for monitoring and treatment.
  • ·         Depression:  As mentioned, living with RA pain and limitations can take a toll on your emotional health.  For more information on RA and depression, please check out this article.

How you protect yourself from RA complications? 

Most patients do not think to mention things like moods, chest pain or dry eyes to their doctor, but it is very important to let your doctor know that you are experiencing these kinds of symptoms.  Your doctor can work with you to either treat your symptoms or act more aggressively in treating rheumatoid arthritis.  Whatever the route taken, your speaking up is the first and most important step in managing and resolving problems that have the potential to turn into serious complications.  

Can rheumatoid arthritis affect your lungs?

Despite misconceptions, rheumatoid arthritis doesn’t just affect joints. It can also damage the tissue around the joints, as well as the eyes, heart and lungs. Realistically, they should call it rheumatoid disease because it can damage the whole body. Additionally, lung complications of RA can be quite serious and contribute to about 20 percent of the deaths related to rheumatoid arthritis.

Lung related complications of RA include interstitial lung disease, pulmonary fibrosis, nodules, and pleurisy.

Interstitial Lung Disease: Also referred to as RA-ILD, it is the most serious lung complication for people with RA. It can be hard to detect but occurs when the tissues surrounding the lung became inflamed and scarred. Men are at a higher risk than women for RA-ILD. Smoking increases the risk but non-smokers with RA are also at risk. Symptoms include breathlessness and dry cough, but often times, there no symptoms at all, making early detection impossible. Unfortunately, RA-ILD is difficult to treat and aside from treating RA, few options are available. Of late, there was one clinical trial for rituximab (Rituxan) and its role in treating RA-ILD but nothing has been successful to date.

Pulmonary Fibrosis: Inflammation similar to that that leads to RA-ILD can lead to pulmonary fibrosis or permanent scaring of the respiratory tissues. This scarring causes shortness of breath, since healthy air sacs become scar tissue. Unfortunately, methotrexate has been known to cause pulmonary fibrosis and patients who take this drug should be monitored for respiratory status.

Nodules: RA can cause nodules to form in the throat and vocal chords causing hoarseness and other changes. Nodules can also develop in the lungs but often times they do not cause symptoms and patients will not notice them.

Pleurisy: Research finds that nearly 50% of RA patients have damage to the lining of the lung or pleura but only about 15 to 20 percent of those affected have symptoms. Pleurisy is defined as inflammation of the pleural issue. Symptoms include chest discomfort and difficulty breathing. Fluids called effusions build up the in the pleural space and around the lungs. This can lead to persistent cough, shortness of breath, and a collapsed lung.

What You Can Do

Having RA puts you are at higher risk for lung complications. Therefore, prevention is key to reducing your risk.

Don’t Smoke: If you do, ask your doctor how you can quit smoking. In addition to smoking being a risk factor, chemicals in cigarettes can irritate already affected lung issue and this can lead to even more serious complications.

Have regular checkups: Your doctor should listen to your lungs and monitor your breathing at each visit. If lung problems are found early, they are easier to treat. Additionally, if you have RA and suffer from shortness of breath, coughing, or other respiratory symptoms, get in contact with your doctor right away. These are pretty serious issues that need immediate attention.

Source: Brichford, Connie (Medically reviewed by Niya Jones, MD, MPH), How Rheumatoid Arthritis Affects the Lungs; http://www.everydayhealth.com/rheumatoid-arthritis/rheumatoid-arthritis-lungs.aspx