RA Flare – fact or fiction?
If you want to laugh out loud, just Google RA Flare. No, not right now. Finish this first. Anyway, the topic of RA flare produces some very silly and contradictory discussions. For example Web MD offers How to Prevent Rheumatoid Arthritis Flares. If only.
So today we approach one of the most misunderstood aspects of rheumatoid disease (RD). Like morning stiffness and fever and some other RD symptoms we’ve examined, the only straight scoop comes from asking people living with RD (PRD). I hope you’ll share your thoughts in the comment box below.
You might also like to read:
- Poll Shows Textbooks Wrong on Rheumatoid Arthritis Morning Stiffness
- Sustained Rheumatoid Arthritis Remission Is Rare
5 simple facts on RA Flare
1) Flares are not a universal pattern by any means. Disease patterns can be unique. Many people with rheumatoid disease (PRD) do not experience a flaring and remitting disease pattern, but constant disease activity.
2) Flares are only relative to usual disease activity. If usual disease activity is mild, then moderate disease activity would be considered an RA flare. If usual disease activity is severe, then flare would be very severe.
3) Injury or activity can create or exacerbate flare. If inflammation is present, then any insult or extreme activity is likely to make it worse in the same way it would with an injured joint.
4) Flares are not limited to joints. Rheumatoid disease activity is not limited to joints, so the concept of RA flare should not be either.
5) We do not know the cause of RA flare. But PRD are not to blame. The expression of rheumatoid disease patterns may be a function of subtypes of the disease.
Normal between RA flares?
Most medical articles sound like rheumatoid disease activity is quiet most of the time with occasional active periods called flares. They actually seem to imply that “between flares,” people with rheumatoid disease (PRD) live a normal life. For example, the American College of Rheumatology (ACR) RA page: “It is important to be physically active most of the time, but to sometimes scale back activities when the disease flares.”
U.K.’s NHS says “treatment enables many people with rheumatoid arthritis to have periods of months or even years between flares.” I’ve never heard of PRD having years between flares – that would be called remission, which is limited to about 6% in the real world.
Questions about the common notion of RA flare
However, the U.S. National Institutes of Health Handout on Rheumatoid Arthritis has a more sensible position: “For many people, periods of relatively mild disease activity are punctuated by flares, or times of heightened disease activity. In others, symptoms are constant.” (Never mind that the next paragraph perpetuates the hand disease myth.)
That is a fairly accurate description of mild RA and I was glad to read it on the NIH site. It reminds me of my experience for over 20 years before I was ever diagnosed with RA. That mild type of RA seems to be mostly undiagnosable, except for in very early RA clinical trials.
The U.S. Centers for Disease Control and Prevention differentiates between a polycyclic (flaring and remitting) course of RD and a progressive course that “continues to increase in severity and does not go away.” Up To Date also recognizes the fact of individual disease courses in RD: “Rheumatoid arthritis often has a variable course: it can go into remission, follow a fluctuating course, or worsen steadily.”
Seeing the NIH, CDC, and UpToDate acknowledge that RA flare is not universal is reassuring since most ACR members I’ve met insist that all rheumatoid disease is polycyclic (flaring and remitting). I have always believed other patients (and myself) even though I wished constant worsening disease wasn’t possible.
How many PRD get time between flares? Let’s get to the bottom of it. Please share your experiences.
AS A PATIENT OR CAREGIVER, WHAT IS YOUR EXPERIENCE WITH RA FLARE?
How often does RA flare in your experience? Choose one & answer in the comment box below.
1) Constant disease activity, the 24/7 kind of RA
2) Good and bad days, but never back to normal pre-RA
3) Normal most of the time with only occasional flares