Flare occurance rheumatoid arthritis
by Nathan Wei, MD, FACP, FACR
Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.
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A flare refers to a worsening of the disease process.
A flare is characterized by an increase in joint pain, joint swelling, malaise and fatigue. The cause of flares varies, depending on the specific disease in question.
Examples of things that can cause RA to flare include emotional, physical, surgical stresses that may cause a worsening of disease.
Peri-operative disease-modifying anti-rheumatic drug (DMARD) therapy remains a topic of debate. Studies have demonstrated conflicting data; both increased and decreased incidence of infectious complications have been reported when MTX is continued peri-operatively.
However, it is clear that postoperative flares increase when MTX therapy is withheld for 1 month or longer. Communication between
the rheumatologist and the surgeon can minimize complications while decreasing the risk of disease flare. As a compromise, we recommend withholding MTX for one dose pre- and postoperatively.
Discontinuation of corticosteroid therapy is another cause of flare.
Inadequate response to DMARD or biologic therapy can lead to flare.
Too long an interval between injections of anti-TNF therapy or worsening of disease despite appropriate anti-TNF therapy can also lead to flare.
Flares are helpful in that if they are severe or too frequent, they indicate that current treatment is inadequate.
A complicating feature occurs in patients who have concomitant fibromyalgia because a flare of the fibromyalgia is often indistinguishable from a flare of rheumatoid arthritis.
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