I can never sit for longer than an hour or so without getting quite stiff. Yesterday, I got up from my chair at church in order to move around a little. As I arose from the chair and put weight on my legs, a sharp pain hit my left knee causing me to almost buckle and fall down. I could barely walk. My right knee has always been the “problem child”…an MRI demonstrated damaged articular cartilage in that joint. But the problems with the left knee were new. On top of this new experience, I noticed an increase in pain and swelling in my fingers, wrists, elbows, and ankles and a decrease in energy. I’ve also experienced tingling in my hands to past few weeks (See earlier post . On a side note, my doctor called me back on Friday evening at 7:00 p.m. – how’s that for service? He didn’t think that the tingling was a side effect of Humira but wanted to see me as soon as possible – I have an appointment tomorrow at noon). I found myself reaching for the prednisone yesterday in an effort to knock down the inflammation and applying Voltaren gel to affected joints. I hadn’t done that in a long time. It became obvious that I’m experiencing a rheumatoid arthritis flare.
The term flare is bantered around routinely. Yet a clear understanding seemed to elude me. Dictionary.com’s medical dictionary gives the following definition for the term flare:
1 : a sudden outburst or worsening of a disease flare s in rheumatoid arthritis —
Interestingly, this definition is applied to RA. But it doesn’t define what it looks and feels like. I suspect that the vagueness of the term is because of the lack of its use in science and the fact that RA affects people differently. One website describes it as “acute episodes of pain and inflammation.” [i] Scientists routinely use the term “flare” in the research literature but fail to adequately define it. (see this study for example). In one research study, the scientists stated,
“A flare was defined per protocol as an increase of five in active joint count or an increase from zero to three compared with the situation at week 28 (an active joint is swollen or tender on pressure; counting of joint groups in one hand or foot as above)”.[ii]
This definition, while perhaps practical for documenting the efficacy of a particular treatment, doesn’t seem to capture the essence of a flare. In 2009, one group of researchers attempted to develop a standardized definition. Using interviews with 120 rheumatologists and 11 patients, they proposed the following definition:
“(a) flare is any worsening of disease activity that would, if persistent, in most cases lead to initiation or change of therapy; and a flare represents a cluster of symptoms of sufficient duration and intensity to require initiation, change, or increase in therapy.” [iii]
While lacking clarity regarding duration (how long is a flare?), this definition starts to provide meaning with which I can relate. RA patients could fill in the blank on this sentence, “I know I’m having a flare when….”. For me, it’s when I reach for the prednisone and Voltaren gel and feel worn down. That’s a sure sign of a flare. How long will the current flare last? Who knows. But it will pass and I’ll hopefully return to “normal”…as normal as it can be with RA!