When you live with a chronic illness like rheumatoid arthritis, it can feel like your body has its own weather patterns. Everything from medication changes to fatigue can change the forecast.
Rheumatoid arthritis (RA) is the most common type of autoimmune arthritis. There are 1.5 million cases in the United States alone. If you have RA, you may be familiar with the pain and inflammation caused by your immune system mistakenly attacking your joints, causing the tissue inside those joints to thicken. Although RA is known for the impact it has on your joints, the disease is systemic. In other words, it can impact your whole body.
If you live with RA, you may notice that your symptoms seem to get worse at times. While an increase in symptoms can be unpredictable, other times you can identify the triggers that increase your symptoms.
We spoke to The Mighty’s rheumatoid arthritis community and two rheumatologists to learn what can trigger an RA flare to help you minimize your exposure. Here are eight of the most common RA triggers.
The most common RA trigger people in The Mighty’s RA community reported was the weather. Though weather is a common trigger, medical professionals aren’t sure why changes in humidity cause joint stiffness.
“The truth is we don’t understand why humidity makes joints feel more stiff, even though almost all of our patients report this,” Anne R. Bass, M.D., a rheumatologist at the Hospital for Special Surgery, told The Mighty.
According to Brian D. Golden, M.D., a rheumatologist at NYU Langone, drops in barometric pressure before it rains may explain why your joints feel different based on the weather. “You can imagine that [people with RA] feel, so to speak, the pressure from the inflammation of their joints, they feel it relatively more.”
Unlike some of the other RA triggers, weather is not something that you can control. This frustation is something The Mighty’s RA community knows all too well:
I could go for months doing the right things. Eating well, exercising, listening to my body… with no flare, but no matter how well I look after myself, one cold snap can take it all away. — Rebecca M.
It starts sometime between 18-24 hours before the storm hits, my joints feel like they’re on fire. My fingers and toes lock up and all my muscles start cramping. It hurts to sit, it hurts to stand, & it hurts to lay down for any length of time so I have to kinda rotate between the three. It usually stays this way until the storm is over and begins to move out, off to terrorize some other RA warrior, no doubt. — @justpeachy3
2. Sitting for Long Periods
Because RA is an inflammatory type of arthritis, your symptoms may increase if you are stagnant for too long. When you finally move and notice that everything is stiff, it’s what is known as a “gelling phenomenon,” Golden said. When this happens, the inflammatory molecules and fluid in your joint get “thicker or polymerized,” making it difficult to move the joint.
Fortunately, once you get moving, the “gel” gets a bit looser so it’s easier to move. It’s hard, if not impossible, to keep your joints engaged while sleeping, but if you work at a desk or anticipate sitting for a long time, schedule breaks to make sure you can move your joints to prevent stiffness.
Here are some of the positions The Mighty’s RA community said triggers their symptoms:
Sitting in my university classes for too long [can cause a flare up]! I need to get up several times to stretch during each class. — Kayla C.
Sometimes the way I sleep can trigger my RA in my wrists! — Makayla Marie G.
3. Medication Changes
Living with RA can make you particularly sensitive to changes in medication. Any type of medication change, whether increasing, decreasing or stopping a medication, needs to be made under the guidance of your physician.
When you shift or change your medication, you may experience a flare, Golden said. People who miss their medications or adjust their dosage of steroids are particularly susceptible to an adverse reaction.
Sometimes medication changes are unavoidable and can aggravate your symptoms even under a physician’s care.
“One time after a year of taking methotrexate, the [doctor] tried to get me off that drug,” community member Genevieve M. recalled. “Three weeks of no methotrexate triggered off a systemic flare that took six weeks to go away when the medication was resumed.”
While infections generally make people feel worse, your RA symptoms may get surprisingly better when you are sick.
“Interestingly, during infections, patients’ joints often feel better, perhaps because the immune system is diverted away from the joints and to the site of infection,” Dr. Bass said.
Not everyone gets relief from their symptoms, however. “When people develop, let’s say a flu-like illness or virus or cold or something like that, they also described that their joints and their rheumatoid will be more symptomatic,” Golden said.
While you may get some relief, frequent infections can cause your RA to flare. If you take drugs that suppress your immune system, like biologics or corticosteroids, the more likely and frequent infections will be, the Arthritis Foundation reported.
There’s also “reactive arthritis,” an inflammatory type of arthritis caused by certain bacterial infections, which community member Karen W. said she gets. “Getting any type of infection flares my arthritis into what my doctor calls ‘reactive arthritis.’”
If frequent infections are causing your flares, talk to your doctor about your medications as well as other ways you can reduce your risk. Practicing good hygiene, like washing your hands, and quitting smoking, can reduce your risk of infection. Those susceptible to infections can also try wearing face masks when traveling or around large groups of people.
Food can make us feel good or bad for many reasons. Even though many in The Mighty community identified food as a trigger for their RA, the doctors we talked to say it is unlikely certain foods increase symptoms.
“Although lots of patients identify certain foods as triggers, this has not been proven scientifically and I generally recommend eating healthily rather than recommending against any particular food items,” Bass said.
While there is no hard evidence food will cause a flare, if you notice certain food types aggravate your symptoms, you can modify your diet to avoid or limit those foods and see if your symptoms improve. The Mighty’s RA community reported sensitivities to foods such as gluten, alcohol, wheat, dairy, nightshades and fast food.
Work with your doctor or a nutritionist to make sure the changes you make to your diet won’t negatively affect your health.
6. Fatigue and Stress
Stress can make anyone feel bad. Whether you are working nonstop to get a project done or are struggling to manage your chronic illness, the symptoms of fatigue and stress can be debilitating and varied.
While we know stress can take its toll on the body, medical professionals aren’t exactly sure why. “There is a strong mind-body connection that can affect almost any medical condition, and also make people more sensitized to symptoms such as pain, but we don’t necessarily understand this on a biological level,” said Bass.
“Within a few hours of being [at the office] […] my body is on fire and I am in horrible pain for days,” Mighty community member Mindy said. “Being dragged around to see many colleagues, sitting uncomfortably in an office chair during meetings, and the stress of the commute causes me major pain in my joints and entire body.”
If stress and fatigue trigger your RA, try building time to relax into your schedule and make sure you get enough sleep at night. You can also work with a mental health professional to try and identify and then reduce any stressors you have going on. Check out this list of 101 self-care suggestions to get you started on your rest and relaxation journey.
7. Being Postpartum
Like infections, your hormones — especially pregnancy hormones — can sometimes relieve symptoms. In the old days, Golden said doctors would tell their female patients to get pregnant if they wanted to see a reduction in symptoms. Of course, bringing new life into the world is a highly personal decision and not an acceptable remedy for an illness.
Your immune system is less active during pregnancy. This prevents your body from attacking the fetus like it would an infection. Because the immune system isn’t as active, your immune system doesn’t attack your joints, thereby lessening your RA symptoms.
Unfortunately, the benefits women see during pregnancy don’t last long. Once pregnancy is over, you can expect to see an increase in your symptoms, Golden said.
Certain types of exercise may actually provide relief from your RA symptoms. Bass recommends exercising three times per week to keep your joints mobile. However, if you have secondary damage to your joints from RA, exercise can be painful.
“Some people with rheumatoid have sustained a lot of secondary damage to their joints. They may have rheumatoid and then end up with osteoarthritic knees because the knees have been inflamed for so long,” Golden said.
Those who find exercise painful or have osteoarthritic knees should avoid high-impact exercises. High-impact exercises include running, skiing, gymnastics and certain Cross-Fit exercises.
It can be tough to give up your favorite exercises, something Mighty community member Wendy M., who said she “will forever miss running,” knows all too well. Fortunately, there are ways you can modify your favorite workouts to make them work for you. If you love running, try running underwater. You can also try other low-impact exercises like yoga, barre, pilates and swimming.
If you don’t know what’s causing your triggers, try keeping a journal of your activities, the weather, stress levels, etc. to see if you can find patterns on your bad pain days.
“If flares are happening frequently, then it’s helpful to document how often and for how long so you and your doctor can decide if a change in medication is indicated,” Bass said. “You can make a simple notation in your phone calendar (you can ‘grade’ your arthritis on a scale from one to 10). Make note whether your symptoms get better when you’re on vacation. That can point to lifestyle issues that may be impacting your arthritis activity level.”
Don’t see your RA trigger on this list? Let us know in the comments below or join The Mighty’s RA community to post a Thought or Question about living with RA and get feedback from a community that cares.