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.

Click here: Second Opinion Arthritis Treatment Kit

A flare generally refers to a worsening of the disease process. If you have arthritis, you've probably experienced a flare at one time or another -- your disease seems to be pretty well under control for a while, then suddenly your joints become extremely inflamed and painful.

You may experience general malaise and fatigue. The cause of flares varies, depending on the specific disease in question. In rheumatoid arthritis, for example, a flare can be related to natural, but not well understood, fluctuations in the immunological processes that drive inflammation.

Examples of things that can cause RA to flare include emotional, physical, surgical stresses that may cause a worsening of disease.

Perioperative 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 perioperatively.

However, it is clear that postoperative flares increase when MTX therapy is withheld for 1 month. A dialogue with the surgical team is often helpful in assessing perioperative infection risk in order to determine how best to 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.

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