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How to Manage the Unpredictability of Rheumatoid Arthritis

Your Health / Conditions / Arthritis​​​​​​​ / How to Manage the Unpredictability of Rheumatoid Arthritis

Published on Dec 07, 2018
​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​Authored by Pfizer Medical Team


One of the challenges of living with rheumatoid arthritis (RA) is the unpredictable nature of the disease. Symptoms such as pain and stiffness can appear overnight (often referred to as a ‘flare up’) sometimes with no immediately obvious trigger.

Researchers sometimes describe RA sufferers as moving along a continuum, with the disease moving from the background to the foreground of their lives depending on their symptoms and how they are managed.

The unpredictable nature of flare ups and the way they affect mood, pain and fatigue levels also makes it harder for sufferers to manage their careers, family and social lives and future plans, leaving them feeling anxious and emotionally drained. There’s no way to fully combat the rollercoaster ride of RA symptoms but there are a few things to watch out for and some suggestions which may help.


Feeling stressed isn’t something that just occurs in your head, it also causes the release of stress-related chemicals in your body. The full link between RA and stress isn’t fully understood but research has shown that stress causes the body to release inflammation-promoting compounds in the body.

Sadly, stress is often unavoidable but relaxation techniques such as meditation and breathing exercises can help make it more manageable. There is also evidence to show that Cognitive Behavioural Therapy (CBT) might also help you to better cope with the condition.


Sleep is a very important part of our physical and mental wellbeing but unfortunately many RA sufferers find sleep a challenge. It can become a vicious circle; pain associated with RA makes sleep difficult and then fatigue in turn makes the pain harder to deal with.

Speaking to your GP or rheumatologist could provide advice to help you break the pattern and there are a number of smartphone apps available to help you track your sleep habits.

Pace yourself

It’s natural to want to keep active and avoid having to make sacrifices to your RA symptoms. However it’s important to listen to your body and be realistic with what you can achieve in that moment of time. With any physical activity be conscious of your joints and structure your movements to protect them as well as taking plenty of breaks. If you are having a flare up, take it easy on yourself and know that it is okay to ask for help.


Smoking is linked to a higher risk of developing autoimmune disease such as RA in the first place and can aggravate the symptoms. Speak to your GP about coming up with a quit plan to help you stop smoking for good.


The link between diet and RA isn’t clear but some sufferers believe that certain foods may trigger flare ups. Keeping a food diary could help you ascertain if this might be the case for you. Try and eat a well-balanced diet of leafy greens, fruit, whole grains and low fat proteins.


As well as a food diary, it can be very helpful to keep a note of your symptoms, when they occur and in what circumstances and any possible triggers which may come to mind. Over time, this can help you build a picture of what may lead to a flare up or aggravate your symptoms.​​​​​​​

Tracking your triggers can be very useful when discussing the disease with your doctor or rheumatologist.

Read next: Tackling RA symptoms with regular exercise


    1. Deane KD et al. Genetic and environmental risk factors for rheumatoid arthritis. Best Practice & Research Clinical Rheumatology 2017. 31: 3-18
    2. De Brouwer S, et al. Immune responses to stress in rheumatoid arthritis and psoriasis. Rheumatology 2014;53:18441848
    3. Wolfe F, et al. Sleep Disturbance in Patients with Rheumatoid Arthritis: Evaluation by Medical Outcomes Study and Visual Analog Sleep Scales. Journal of Rheumatology 2006; 33(10):1942-51
    4.  Georgeopoulou S, et al. Motivational interviewing: relevance in the treatment of rheumatoid arthritis? Rheumatology 2016;55:13481356
    5. Parker JC, et al. Effects of stress management on clinical outcomes in rheumatoid arthritis. Arthritis & Rheumatism 1995 38(12):1807-1818
    6. Flurey CA, et al. It’s like a juggling act: rheumatoid arthritis patient perspectives on daily life and flare while on current treatment regimes. Rheumatology 2014;53(4):696-703
    7. Why Are My RA Symptoms Getting Worse? WebMD. Accessed October 2018.
    8. Rheumatoid Arthritis. Better Health Channel – Victoria State Government. Accessed October 2018.

    Last reviewed 15/08/2019


    External Resources

    -Arthritis Australia
    -Arthritis New Zealand
    -Creaky Joints
    -Dragon Claw
    -Musculoskeletal Australia
    -RA Xplained

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