Osteoarthritis (OA) Flare up? Don't panic!
Flare ups are often a normal part of OA, whichever joint(s) you have it in, and tend to be characterised by a sudden onset of symptoms such as increased pain, stiffness and or swelling generally lasting more than a day or two. These can sometimes affect sleep and are different to your normal everyday aches and pains, and frustratingly can come out of nowhere, but are often associated with factors such as unaccustomed (new or suddenly increased) activity, low mood, poor sleep, change in the weather, diet or inactivity, among other things. If you do get a flare up though, don't blame yourself and dwell on what you should or shouldn't have done. It's not your fault and sometimes something that's been no issue before can cause a flare.
Flare-ups can be stressful, frustrating, worrying and really get in the way of daily life and plans, but try not to panic. Worry and stress over a flare-up may actually make the situation worse. For more in depth information about the effect of stress on pain you may want to read my article on the subject here.
Evidence suggests that flare-ups are not correlated with a worsening of osteoarthritis, but they do need to be managed. Persevering and pushing yourself through high pain isn't ideal, and getting on top of the flare as quickly as possible is important. On average they tend to last five to eight days, and just knowing this can be reassuring, so when things aren't all better after 48 hours you know why.
Here are a few things that can help to manage an Osteoarthritis flare:
1. Modify your activity and exercise. It is ok and actually good to continue with activity, exercise and gentle movements but you may need to bring it down a level or two for a few days while things settle, or undertake a different type of activity to keep moving whilst you have pain. If you undertake repetitive activities at work, is it possible to modify this for the next week or so? Rest more frequently and don't cause yourself high pain. Once things start to settle you can then start building this back up again gradually. Keep an eye on pain and swelling; if activity is causing pain over 24 hours following activity or increased swelling then you need to bring it down to a more tolerable level.
2. Pace yourself. Pacing is key, and you've probably learnt aspects of pacing following a diagnosis of osteoarthritis. Pacing is basically breaking up your activities in the day to make them more manageable, especially those activities associated with higher pain levels (red on the traffic light system method of pacing - see diagram below). For more information on pacing you may want to read my more detailed article on the subject here.
3. Try some cold/ice packs on the area every now and again for a few days. Normally for larger joints I suggest up to 15-20 minutes, a maximum of once every two hours, or 5-10 minutes on smaller joints. Don't use ice/cold if you have altered sensation or numbness in the area affected though as you may end up with a cold burn. Always monitor the skin regularly when you apply cold/ice and I would suggest wrapping the ice pack in a damp cloth, or use a bag of frozen peas (keep the same bag for reuse at a later date...don't eat them)! You may want to try using it for less time to start with to see how you get on with it.
4. If you have a stick or walking pole then you may want to use one for a few days to reduce some of the load and keep you moving comfortably. Personally I find a lot of people don't like the stigma attached with walking sticks, so a nice walking pole could be another option if the thought of a stick is a bit too much at the moment. Also, if you weren't using one before and it's a flare up then it's only temporary and a means to an end.
5. Try some form of relaxation to calm your system down. Some relaxation exercises can also act as a distraction as well. I have a great set of relaxation exercises that I use, however there's so much out there now to try like Breathwrks, Headspace, Calm, just to name a few. Have a look and see what works for you. Also, relaxation could be having a bath, reading a book, listening to music...the list goes on and it's definitely not the same for everyone.
6. Consider some analgesic medications. These are just for short-term pain management. The Clinical Guidelines from NICE (UK) recommend the use of regular topical NSAIDs (e.g. ibuprofen gel), before considering oral NSAIDs such as ibuprofen tablets. The use of paracetemol has now been removed from the guidelines (updated 2022). I would always recommend taking or using any of these things as per the instructions (make sure you don't take too much), and ask the advice of a pharmacist, especially if you're not sure about taking them, concerned about side effects or if you have any other underlying medical conditions or are on any other medications.
7. If your flare up is not showing signs of settling after a week then it may be worth discussing your pain medication with a Pharmacist and/or GP/MD, and you can also consider seeing a physiotherapist / physical therapist for personalised guidance on activity modification/exercise, pacing and further assessment where required. You can see a physiotherapist through the NHS (in the UK), and more often than not you can self-refer rather than go via your GP. Contact your local MSK Physiotherapy service to find out if this is an option. Currently due to Covid-19 restrictions, many appointments are undertaken over the phone, but often this is quite adequate for flare-up management and physiotherapists will be able to give some good, useful advice over the phone (or video consultation). Alternatively there is the option of seeing a private physiotherapist, which has a cost implication but in many cases is likely to be much quicker, in some places being able to book a same-day appointment. Again this may be a telephone or virtual consultation, but often all that may be required initially.
For longer term management in order to reduce the chance of flares then there are a few things you can do:
Learn more about Osteoarthritis and self-managing the condition.
Get more active (or start being more active if you're not already), including some activity that strengthens your muscles. It's important you try to find things you enjoy so that you're more likely to continue long term.
Understand what triggers your flare ups and how to manage them.
Lose weight if you are overweight or obese. This can be really hard and this should not be underestimated, but a 5-10% reduction in body mass has been found to have positive effects on pain, and also function, especially with further weight loss (where necessary/indicated). Get support, and get your family and friends on board. Alternatively look for a health coach or weight loss professional to help keep you motivated and on track, and set goals.
There's so much more work going in to Osteoarthritis research these days, so it's exciting times for the world of Osteoarthritis, and those that have this condition, and I'm looking forward to the outcomes of some high-quality studies in the future.
References:
Joint Action Podcast (2021) - Osteoarthritis Flares with Dr Martin Thomas. [Online] https://www.jointaction.info/podcast/episode/4b8deea3/osteoarthritis-flares-with-dr-martin-thomas
March, J. (2021). Osteoarthritis. Clinical Edition. Available at: https://rheumatology.physio/product/osteoarthritis-printed-clinician-edition/
PEAK Osteoarthritis Information Booklet - Centre For Health, Exercise and Sports Medicine (University of Melbourne, Australia). This is supplied as part of the PEAK Program I offer for people with Knee Osteoarthritis. For more information, click here.
Please note: This article is intended to be for educational purposes only, and does not constitute medical advice or replace professional assessment or personalised advice.
I do not hold responsibility for the information on any links to external websites within thisarticle and information within these links/websites may change at any time or no longer be accessible. Any website pages/links added are also for education purposes only.
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