Rheumatoid Arthritis Flare Management

Symptoms and Diagnosis

The American College of Rheumatology suggests that increased joint pain, swelling, and stiffness in previously affected joints are symptoms of RA flare 2, 3
Fatigue and general malaise are common symptoms of RA flare 2
Elevated inflammatory markers, such as CRP and ESR, are associated with RA flare 3
Decreased functional capacity and quality of life are outcomes of RA flare 3

The European League Against Rheumatism recommends colchicine as a first-line treatment for RA flares, with a loading dose of 1 mg followed 1 hour later by 0.5 mg on day 1 1
Colchicine is most effective when given within 12 hours of symptom onset, and should be avoided in patients with severe renal impairment or those taking strong P-glycoprotein/CYP3A4 inhibitors 1
NSAIDs are effective for pain and inflammation control, but should be used with caution in patients with severe renal impairment, and a proton pump inhibitor should be considered if appropriate 1
Oral corticosteroids, such as prednisolone 30-35 mg/day for 3-5 days, are equivalent in effectiveness to NSAIDs in clinical trials, and are particularly useful for multi-joint involvement 1

The American College of Rheumatology recommends resuming or adjusting DMARD therapy based on disease activity after flare resolution 3, 4
A treat-to-target approach aiming for remission or low disease activity is recommended, with monitoring of disease activity using validated measures such as SDAI and CDAI 3, 4
For patients with frequent flares, adjusting baseline therapy is recommended 4

The American Heart Association notes that NSAIDs may increase cardiovascular risk, especially with prolonged use 5
Long-term corticosteroid use increases the risk of cataracts, osteoporosis, and potentially cardiovascular disease 2
Colchicine and NSAIDs should be avoided in patients with severe renal impairment, and drug interactions should be considered when prescribing colchicine 1