No two days are the same for the 32 million people¹ affected by osteoarthritis (OA) in the US. An osteoarthritis flare-up is an episode of increased pain, stiffness, and fatigue that appears without warning to disrupt your normal routine. Usually, flare-ups can last for hours, days, or weeks. The best way to manage these episodes is to figure out the triggers and find a way of dealing with them.
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The symptoms of OA flare-ups may include:
Increased joint pain
If you suffer from osteoarthritis, you may experience increased joint pain, swelling, and stiffness in the affected area whenever you suffer from flare-up episodes.
Fatigue can occur during and after episodes of OA flare-ups. This could potentially be triggered by a lack of adequate sleep due to increased pain.
Reduction of flexibility and range of motion
With OA flares, you may experience a worsening loss of flexibility and range of motion. In severe cases, you may find it challenging to accomplish everyday tasks such as dressing, bathing, climbing stairs, putting on shoes, and getting in and out of chairs.
Flare-ups can be caused by several factors. However, the most common triggers of the episodes are overdoing an activity or trauma to the joint. The following are some of the primary risk factors associated with OA flare-ups:
Too much activity
When you feel good about a physical activity you are doing, there is a high chance of overdoing it and creating the perfect conditions for a flare-up. OA often flares after overexertion of the joint or joints involved in vigorous physical activities.
Pressure changes and humidity can also lead to increased joint pain in persons living with osteoarthritis. Patients with OA and other types of arthritis or inflammatory conditions often complain that their joints are achier in cold and humid weather². However, studies are not conclusive on the relationship between flare-ups and the weather.
Infections that affect the immune system, including respiratory viruses, can also cause OA flare-ups.
Several studies³ reveal stress can induce OA flares. Typically, stress leads to the production of high amounts of pro-inflammatory cytokines responsible for worsening OA symptoms.
If you have suffered an injury to the part of the body affected by OA, you may suffer a flare-up as the symptoms will be aggravated by the injury.
Rapid weight gain can trigger flare-ups due to the relatively sudden and large increase in weight that the joints need to support.
Contact your primary care doctor if you believe you are going through an OA flare that has not improved with time. The doctors will monitor your symptoms and order a range of tests.
A physical test is crucial in determining the extent of OA flares. The doctor will examine the affected joint(s) to evaluate the degree of pain, swelling, and range of motion.
The doctor may also order X-rays to check the stage of osteoarthritis and exclude deterioration of the condition of the joint as the reason behind the worsening symptoms.
When visiting your doctor, ensure you let them know whether your current symptoms are similar to those of previous flares.
The treatment for an OA flare-up may involve over-the-counter medication, prescription drugs, and/or home remedies. Let's take an in-depth look at each of these options:
The first course of treatment for OA flare-ups is usually OTC pain medication. Your doctor may recommend nonsteroidal anti-inflammatory drugs (NSAIDs) commonly used to treat arthritis-related pain. These drugs include:
Creams or ointments containing NSAIDs
If you can't tolerate NSAIDs, your doctor may recommend acetaminophen (Tylenol). It is crucial to keep in mind the adverse side effects of these medications. Talk to your physician about the best option, their side effects, and how to take them.
If the symptoms get worse, it implies OTC medications are not effective. The doctor will likely prescribe common prescription drugs such as:
Corticosteroid injections are one of the most effective medications for short-term relief of severe pain. However, it is not recommended for regular use due to its known side effects.
Duloxetine is a second-line agent for treating OA of the knee that has not responded well to acetaminophen or NSAIDs. Duloxetine⁴ is an antidepressant that was found to help with some chronic pain. Clinical trials⁴ reported that duloxetine was found to reduce pain in patients with osteoarthritis of the knee significantly.
Prescription-strength NSAIDs such as Nalfon, diclofenac, Indocin, and Mobic are more effective in terms of relieving pain and improving function.
If the symptoms of OA flare-ups are severe, the doctor may recommend joint replacement surgery to resolve the symptoms. Joint replacement surgery offers a more effective solution to OA flare-ups and is often performed with the objective of pain relief and resumption of normal activity.
Various home remedies can help manage OA flare-ups. These include:
Heat or cold therapy
Applying a heating pad or ice pack to the affected area can reduce the symptoms of OA flare-ups, including pain and stiffness in your joints. For the best result, alternate between hot and cold therapy. Avoid applying the ice packs directly to the skin as this may damage the skin. Instead, cover the area with a cloth or towel first.
Additional weight puts extra pressure on the affected areas in your knee(s), thus making the symptoms of OA worse. Losing weight can significantly alleviate symptoms of OA. Additionally, adding braces and joint supports and undertaking gentle exercise, yoga, and tai chi are effective home remedies that help manage OA flare-ups.
Prepare in advance
It is essential to closely track when your flares usually happen, enabling you to recognize when you may need to prepare for it. For example, if you usually experience flare-ups due to weather changes, you need to prepare accordingly by wearing warm and compression gloves or knee braces when sleeping or doing an activity. If you suspect your diet is the cause of your flare-ups, monitor the foods you eat to determine what is causing a reaction in your symptoms.
You must also stick to your medication regimen. Importantly, having a clear plan for when flares will inevitably occur allows you to make arrangements with your employer to work from home or make any other necessary adjustments.
Get adequate rest
If you feel so overwhelmed by the symptoms of the flare-ups that you feel you can't get anything done, take a rest. Though this is a simple tool that you can turn to, it can also be powerful. Curling up on a cozy couch with a good book or magazine or watching your favorite comedies on TV, or simply taking a nap can help you cope with symptoms of flare-ups.
Reduce your stress
As mentioned earlier, stress is one of the leading causes of OA flares. Learning to manage stress and its triggers is an effective way to manage flare-ups. Some of the recommended stress reduction and relaxation techniques include:
Trying cognitive behavioral therapy (CBT)
Practicing meditation, mindfulness, and relaxation techniques
Taking yoga classes
Talking to someone
Getting enough sleep
You can also reduce the symptoms of OA flare-ups by distracting yourself. Focusing your attention on the pain will only serve to aggravate your pain.
Gentle exercises have proven to be highly effective in reducing inflammation. If you can handle it, engage in some light movement to help you feel mentally and physically better. However, it is crucial to check with your physician first to advise on the appropriate light impact exercise for you.
Some assistive devices help reduce stress on the joints and make your life easier. Some of the helpful devices that may be worth investing in include walking canes, grabbing tools, dressing aids, and adaptive cutlery.
Reach out for help
OA patients often believe they can handle flares on their own and won't reach out to those who may be in a position to help them. However, speaking up and communicating with your support system, including family, friends, and doctors, can help ease the burden.
Can I use opioids to treat OA flare-ups?
The American College of Rheumatology and the Arthritis Foundation⁵ doesn't advocate using opioids to treat OA flare-up symptoms. Opioids can result in adverse effects, including the risk of dependency, and physicians typically restrict their use.
How long does an OA flare-up last?
An OA flare-up can last from one or two days to a week or more. If you suspect you are going through a flare-up episode, it is crucial to seek medical attention before the symptoms worsen.
What does an OA flare-up feel like?
The symptoms of an OA flare-up can vary from moderate to debilitating and can knock you off your usual pace. Some of the typical symptoms include increased joint pain, stiffness, swelling of the affected area, and reduced range of motion of the affected joint. You may also experience fatigue if the pain disrupts your sleeping pattern.
Does OA flare come and go?
The main symptoms of OA flare-ups are pain and stiffness in the joints that usually make movement difficult. These symptoms may come and go within a single episode, depending on your activity level and even the weather. In more severe cases, the symptoms could be more persistent.
What triggers OA flare-ups?
The most common causes of OA flares are overdoing an activity and injury or trauma to an affected joint. Others are cold weather, repetitive motions, bone spurs, weight gain, infections, and even changes in barometric pressure.
How do you ease an OA flare-up?
One of the effective home remedies to ease the pain of an OA flare is hot and cold compresses. The heat helps increase blood flow to the painful area, thus relaxing the muscles and soothing the painful joint, while cold constricts the blood vessels and eases the inflammation.
Why does OA flare up at night?
It is not fully established why OA pain increases at night. However, some scientists suggest that more inflammatory chemicals such as cytokines travel to the affected joints during sleep, while less anti-inflammatory hormones are produced within this time. This could stiffen the joints and worsen the symptoms of a flare.
There could also be a heightened perception of pain during the night because you are not as distracted by activity while sleeping as you would during the day. Scientists also found that the connection between sleep and OA pain is reciprocated, so the less quality sleep you get, the more pain you will feel.
What happens if OA is not treated?
If untreated, osteoarthritis could impact your quality of life and mental health for years. You should talk with your doctor if it's affecting your life. The doctor may recommend OTC medications to ease the pain or surgery to replace the affected joints.
Undoubtedly, osteoarthritis is the most common form of arthritis that causes pain, swelling, and reduced motions in your joints. The condition can be diagnosed in any joint but usually affects your knees, spine, hips, or hands. If you have got OA, you have probably experienced some intense pain from flares. Flares cause increased joint pain, swelling, stiffness, and reduced range of motion that can impact the quality of your life.
Osteoarthritis (OA) | Centers for Disease Control and Prevention
Association between chronic knee pain and psychological stress in those over 50 years of age: A nationwide cross-sectional study based on the sixth Korea national health and nutrition examination survey (KNHANES 2013–2015) (2021)
Management of osteoarthritis of the knee (non-arthroplasty) | American Academy of Orthopaedic Surgeons