Management of Osteoarthritis Flare-ups

Non-Pharmacological Interventions

Exercise should be continued even during flare-ups, though potentially modified in intensity, as it remains strongly recommended for all OA patients regardless of pain level, according to the American College of Rheumatology 2
Thermal interventions, such as locally applied heat or cold, are conditionally recommended for symptom relief during flare-ups, as suggested by the American College of Rheumatology 3
Cold packs may provide symptomatic relief during inflammatory flares, as noted by the European League Against Rheumatism 1
Joint protection techniques should be emphasized during flare-ups to minimize stress on affected joints, as recommended by the American College of Rheumatology 2
Self-management strategies should be reinforced to help patients cope with flare symptoms, according to the American College of Rheumatology 2

Topical NSAIDs are recommended as first-line pharmacological treatment for OA flares, especially for hand OA and in patients ≥75 years old, as suggested by the European League Against Rheumatism 1
Topical NSAIDs show similar pain relief as oral NSAIDs with better safety profile, according to the European League Against Rheumatism 1
Topical diclofenac gel has demonstrated improvements in pain and function, as noted by the European League Against Rheumatism 1

Oral NSAIDs should be considered for limited duration when topical treatments are insufficient, as recommended by the European League Against Rheumatism 1
In elderly patients or those with comorbidities, caution is needed due to gastrointestinal, cardiovascular, and renal risks, according to the European League Against Rheumatism 1

Orthoses/splints are strongly recommended for thumb base OA flares, as suggested by the American College of Rheumatology 4
Custom-made orthoses are preferred over pre-fabricated ones for better compliance, according to the European League Against Rheumatism 1
Paraffin wax therapy is conditionally recommended for hand OA, as noted by the American College of Rheumatology 3

Walking aids, such as a cane, may be temporarily needed during flares, as recommended by the American College of Rheumatology 5
Knee sleeves or braces may provide stability and pain relief during flares, according to the American College of Rheumatology 5
Tai Chi is strongly recommended and may help manage both physical symptoms and psychological aspects of flares, as suggested by the American College of Rheumatology 5

OA flares often impact mood, sleep, and coping abilities, according to the American College of Rheumatology 2
Cognitive-behavioral therapy may be beneficial for patients experiencing significant distress during flares, as recommended by the American College of Rheumatology 5
Addressing sleep disturbances is important as they often worsen during flares, according to the American College of Rheumatology 2

Intra-articular corticosteroid injections are not recommended as first-line treatment for flares but may be considered when other approaches fail, as suggested by the European League Against Rheumatism 1
Long-term use of oral NSAIDs should be avoided due to potential adverse effects, according to the European League Against Rheumatism 1
Opioid analgesics are conditionally recommended against in the initial management of OA flares, as noted by the American College of Rheumatology 4
Disease-modifying antirheumatic drugs should not be used for OA flares, according to the American College of Rheumatology 4