Exacerbation of Knee Arthritis (Osteoarthritic Flare)
You’ve been managing your arthritis symptoms well and doing all the right things to stay healthy, but one day you wake up and feel like it was all for naught. Your joints ache the worst you can remember in a long time. It could be an arthritis flare.
Although arthritis is a chronic disease, you can have acute episodes of pain and inflammation, known as flares. This pattern of exacerbations and remissions is not unusual in an arthritic knee.
How do you diagnose an osteoarthritic flare?
A flare will cause acute deterioration in pain, swelling with loss of mobility and function – symptoms of knee osteoarthritis. An acute flare may even be the very first symptom of arthritis that you may have suffered. As such it is usually diagnosed with weightbearing X-rays, and not uncommonly an MRI if the X-ray appears near normal.
Not uncommonly the MRI will reveal a combination of arthritis, bone oedema (bruising) as well as a degenerative meniscal tear. Caution must be taken in assessing these atraumatic meniscal tears on MRI in middle aged or older patients. Usually the pain is due to the co-existing osteoarthritis and bone bruising.
What triggers a flare-up?
Flares may be seen after trivial injuries, after a jolt or impact, or a sudden increase in activities. Most often, however, it isn’t clear what triggers a flare. You may have long periods of time when your arthritis is quiet, or in remission. Then, suddenly, the inflammation becomes more active and you have an arthritis flare.
Flares can be alarming, not only because of the pain, but because of their unpredictability. You may feel discouraged or afraid of further damage to your joints. You sometimes wonder whether something you did may have caused the flare.
What can you do to manage a flare?
Flares do calm down. You may want to think about how you handle the inevitable “bad days” and flares before you experience them.
Temporarily increasing your arthritic pain medication (within the prescription guidelines) may all that is required. Be aware that your medications may not control the flare right away, even if your doctor increases the dosage. Or they may only have a limited effect on your flare. It may also be recommended to gradually increase activity after a short period of rest, start physiotherapy and consider a corticosteroid injection to help settle the knee down.
Preparing for a flare can help you jump into action when it happens.
Balance periods of activity with periods of rest. Although more rest can help during a flare, you probably don’t need to abandon your regular activities, work or exercise program. Spending long periods of time in bed is counterproductive; it usually will prolong your pain. Instead, try to intersperse periods of rest with some light activity.
Have a plan to deal with your obligations. Plan ahead so that you can still get things done. At work, try to arrange for coverage, work fewer hours per week, or bring work home. Discuss your plan with your supervisors and co-workers ahead of time and assure them of your commitment. At home plan to apportion a few extra jobs among family members, and make sure everyone knows what they are expected to do to keep things running smoothly.
Communicate with your family and friends. The time to let your family and friends know that you may need more help is when things are going well, not when the flare hits. They will understand better what is needed and how they can help when you call to say that you’re having a particularly bad day. If someone volunteers to help you through a flare, give them a specific job to do or else their assistance may go unused.
Apply a hot or cold pack to inflamed joints. Different people prefer one or the other. Some people even prefer warm packs for certain joints and cold packs for other joints. You will learn your own preferences through trial and error.
How long do the symptoms last?
While troublesome and unpredictable, flares are temporary. They do not signal a failure in your efforts to control arthritis symptoms. A flare may last from a few days up to a month or so.
Does this mean I need surgery?
Whilst not necessarily, the accumulative increase in symptoms and the less effective these flare-ups are able to be managed successfully, the ongoing deterioration may be an indication that surgery may be the next option.