Just what is a “flare”? Medically speaking the term is not recognized as a medical condition because a set of guaranteed symptoms cannot be assigned to the term. “Flare” is the name that patients refer to as an exacerbation of symptoms that one normally may experience from time to time as a set of symptoms associated with illness, but magnified. To put it simply, flare means to break out or intensify rapidly per the Merriam Webster Dictionary. Because autoimmune disease patients have adopted this terminology many medical doctors recognize the term, “flare” as being a rapid intensifying of symptoms associated with a chronic disease.
There is much debate among patients with autoimmune disease as to what constitutes a “flare” which is why I would encourage you when communicating with your doctor to explain your symptoms during a flare vs. saying, “I am in a flare”. Using myself as an example, I have several autoimmune diseases and they don’t all flare the same. Flares vary in duration. The symptoms experienced during a flare of one disease may be different from another and if more than one disease is flaring at a time well then that gets down right confusing to me much less the physician! I have also noticed when comparing my flare symptoms to other patients with the same disorder there are some similarities but there are also significant differences too.
Remember, when communicating with your doctor about a flare:
- Be specific about symptoms
- Describe how you are feeling
- Tell the doctor when the flare started and how long it lasted
- Be sure to relay what interventions you tried that failed or helped
Most of the time, a seasoned Rheumatologist will ask you specific questions to collect the information needed about your flare. Please know that the doctor isn’t doing this to be difficult. Even with my nursing background, I remember seeing my Rheumatologist on a flare day and I rolled my eyes with an exasperated sigh of frustration when he asked, “What do you mean you are in a flare?” In my head, as a patient I was thinking, What? You’re the doctor and you don’t know what a flare is? Well of course the doctor knows what a flare is, but he didn’t know what a flare was to me vs the five patients he saw before me! 🙂
What causes flares? There is a lot of speculation about that too. Patients have identified changes in the weather, other illness, hormone shifts, stress, diet, activity level, and sometimes plain old bad luck. Since researchers have yet to identify the actual cause of many of the autoimmune diseases out there it is no wonder physiciansknow little about what can precipitate a flare other than what patients have told them. Your own body is the best predictor of what may trigger your flare. You might consider keeping a flare journal to share with your doctor and see if a pattern emerges by documenting:
- Date of onset
- Does the date of onset correspond with cyclical events (menstrual or ovulation cycles, recurring deadlines, stressors)
- Activity a few days prior to flare – Active? Inactive?
- Weather before/during/end of flare
- Deviation from your normal diet – A friend of mine has IC (interstitial cystitis) which affects the bladder and she can usually trace a flare back to something she ingested out of her norm like something she ate at a gathering that she didn’t prepare, etc.
- Symptoms – how did they start, what was happening at the worse part of the flare, how did it abate?
- Duration of the flare
- Date it ended
- Interventions that failed
- Interventions that worked
- Observations made
In searching for patterns to my flares, it has been my observation as my disease has progressed that I cannot have several days of outings in a row anymore. I’m just coming out of a bad flare that involved three of my autoimmune diseases that lasted 10 days. The flare was precipitated by scheduling back to back trips out of town to see doctors in an attempt to get the visits done. The flare was sealed by two snow/ice events a matter of days apart. I suspected in the past that busts of activity prior to a flare might be one of my culprits, but now I’m certain. Armed with this knowledge, I can make sure that I incorporate a 24 hour rest period between outings. Yes it is inconvenient and people don’t get it, but it is what it is. I won’t go through ten days of hell again if I can prevent it!
My prayer would be that cures could be developed for autoimmune disease so that no one would ever have to endure the insidious, life-stealing pain of a flare again. This is meant to be a practical advisory for speaking to your doctor about flares and about helping you to identify patterns to your flares. With that said, know that sometimes there just is no rhyme or reason to flares and sometimes our healthcare providers fail to listen to us because they become desensitized after hearing about it over and over again. Sadly no one but the sufferer of a flare really knows what it feels like. I would encourage you not to give up, seek a healthcare provider who will listen, and never self blame.
If you’d like specific information about how to endure a flare, the Arthritis Foundation has an excellent short article with practical advice at this link http://www.arthritistoday.org/about-arthritis/types-of-arthritis/rheumatoid-arthritis/what-to-expect/flares/rheumatoid-arthritis-flare.php.