What to Do During a Severe Flare While Waiting for Medical Help

Why this matters

A GP appointment might be days away. A specialist callback might come tomorrow. The time between recognising something is wrong and getting help isn’t just waiting. There are things that can make a meaningful difference in that window.

This is for severe but non-emergency flares

Seek emergency care immediately if there is breathing difficulty, chest pain, sudden severe headache with vision changes, neurological symptoms, high fever with severe symptoms, severe unrelenting pain, or heavy bleeding. Those require Emergency Department (ED) care, not home management.

General principles

Rest and reduce demands. Take time off work, if possible, reduce household responsibilities, cancel non-essential commitments, and sleep as much as the body needs. Rest is medical management, not laziness.

Pace energy carefully. Break tasks into small chunks with rest in between. Prioritise ruthlessly and accept help.

Stay hydrated and maintain nutrition. Drink regularly, aim for pale urine, and eat small, frequent meals when possible.

Symptom-specific management

Joint pain: Heat for stiffness, cold packs for hot swollen joints, elevate swollen limbs, and paracetamol regularly up to recommended limits for you.

Skin flares: Avoid irritants and harsh soaps, moisturise frequently, use cool compresses for itching, apply prescribed topical treatments, and use sun protection if photosensitive.

Fatigue: Rest without guilt, short naps of 20 to 30 minutes, gentle movement if tolerable, and reduce screen time.

Digestive symptoms: Low-residue diet during acute flares, small frequent meals, stay hydrated, and use heat pads on the abdomen for cramping.

Fever: Monitor temperature regularly, take paracetamol, rest in a cool environment, and contact the clinical team if fever above 38°C persists for more than 24 hours, particularly when on immunosuppression.

Medications

Only adjust medications if there’s a pre-agreed plan. Some patients can temporarily increase prednisolone during flares if explicitly agreed with the specialist. Never self-adjust without prior discussion. Don’t stop DMARDs, biologics, or immunosuppressants without medical advice, as stopping suddenly can trigger rebound flares.

When to escalate

Contact the clinical team for an earlier appointment if symptoms are worsening after 48 to 72 hours of home management, new concerning symptoms are developing, or it becomes impossible to eat, drink, or care for yourself. Don’t suffer unnecessarily.

This article is for general information purposes only and doesn’t constitute legal, financial or benefits advice. For advice specific to your situation, please speak to a qualified professional or contact an organisation such as Citizens Advice, who may be able to assist you further.

References:

‘EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2019 update’ (2020) https://doi.org/10.1136/annrheumdis-2019-216655

‘Neutropenic sepsis: prevention and management in people with cancer (NICE guideline CG151)’ (2012) https://www.nice.org.uk/guidance/cg151

‘Suspected Sepsis: recognition, diagnosis and early management (NICE guideline NG51)’ (2016) https://www.nice.org.uk/guidance/ng51

‘Therapeutic ultrasound for osteoarthritis of the knee (Cochrane review)’ (2002) https://doi.org/10.1002/14651858.CD003132