Understanding Flare-ups: How our research is helping those most at risk of frequent flare-ups

Whatever form of arthritis you are managing, flare-ups can be difficult to deal with. Joint pain, swelling, fatigue and stiffness may strike suddenly and without any apparent trigger.

During a flare-up, you may have little idea whether your symptoms will last for days or weeks and feel anxious that you might have to put your life temporarily on hold.   

Living with flare-ups 

Before he began treatment for rheumatoid arthritis, Mike, 76, was having flare-ups around every six weeks.

“The flare-ups would feel like a very heavy dose of flu…. I couldn’t be bothered to lift a cup of tea, to have a shower. Everything was a chore. Everything was getting in the way of normal living.”

Mike’s medication helped bring his flare-ups under control, but many people living with arthritis are not as fortunate.

Flare-ups can vary in symptoms and intensity, but they may interfere with your ability to work, sleep, perform daily tasks, focus and maintain relationships. In short, a flare-up can create a perfect storm of physical discomfort and emotional anxiety.

Our funded researchers are working hard to try and understand what happens to our bodies during a flare-up, so that people with arthritis are able to take more control of their lives.

Our research at a glance

Could we predict flare-ups and treatment success in JIA

Doctors currently don’t know which children and young people with juvenile idiopathic arthritis (JIA) will respond well to treatments, continue to have flare-ups, and not respond to treatment at all.

Dr Anne Pesenacker, a Versus Arthritis Bridging Fellow at University College London, is studying a type of immune cell called a Treg cell (Regulatory T cell).

Treg cells help to maintain balance in the immune system and prevent other cells from attacking our own tissues. These cells become ‘unfit’ in JIA and other forms of autoimmune childhood arthritis. This means that they no longer prevent our immune systems from damaging our joints.

By measuring how fit an individual’s Tregs are, Dr Pesenacker believes that we may be able to more quickly determine if medication is working and predict flare-ups, helping patients and clinicians get an early start on preventative treatment.

Monitoring flare-ups from home

Blood tests are essential for measuring disease activity and tracking how well patients with inflammatory arthritis are responding to medication. But for most people living with arthritis, a blood test means one more hospital visit - and one more needle - they would be happy to avoid.

Dr Gibson, Senior Lecturer in Personalised Medicine at the University of Ulster, has been testing the potential of BloodTrackR, a finger-prick blood collection device designed for home use alongside a mobile phone app.

With funding from Versus Arthritis, Dr Gibson is working to make the technology consumer-ready and begin clinical testing. Beyond empowering people with arthritis to self-manage their condition and track their flare-ups, BloodTrackR has the potential to reduce hospital visits.

Discovering new ways to control arthritis flare-ups

Net-forming neutrophils are one of the few immune cells that can cause direct damage to tissues in the body. In conditions such as rheumatoid arthritis, lupus and vasculitis, neutrophils do this by releasing toxic chemicals that are typically used to fight off infection.

Dr Helen Wright, a Senior Lecturer at the University of Liverpool, is researching how neutrophils become activated during inflammatory flare-ups.

Using large data sets, Dr Wright is building a computer model to predict the molecules that activate neutrophils during flare-ups. She will then test these findings on patients, with a view to developing targeted medications that can switch off the release of harmful enzymes.

We’re here to help

Are you struggling with a flare-up and not sure what to do? Call our free helpline on 0800 5200 520 (Monday–Friday, 9am–6pm) for confidential support, or email us at helpline@versusarthritis.org

You can also find more tips on joint protection and managing flare-ups in our free ‘Living with Arthritis’ booklets.

In the meantime, here are few things you can do to help yourself during a flare-up:

• Keep taking your medication exactly as prescribed.
• Take a regular dose of a painkiller or non-steroidal anti-inflammatory for up to a week to help settle the flare-up.
• Do gentle exercises to help reduce stiffness.
• Apply a cold pack or ice wrapped in a cloth to swollen joints. 
• Use a hot water bottle or heat pad on stiff or painful joints that are not swollen.
• Let people around you know, so they can give you a helping hand.
• If the flare-up persists, ask your GP or rheumatology team if a steroid injection might help.
• If you’re experiencing frequent flare-ups, consult your doctor or specialist nurse, as your treatment plan may need adjustment.