This leaflet is for parents who have a child with Juvenile Idiopathic Arthritis (J.I.A) and for young people who have Juvenile Idiopathic Arthritis (J.I.A).
This leaflet explains what a flare-up is, and how to prepare for and manage flare-ups in J.I.A. We hope it answers some of your questions but the doctors and nurses who know you /your child are very happy to answer any other questions you may have.
What does A FLARE-UP mean?
The term flare-up means a worsening of J.I.A symptoms, which may last for days, weeks or months.
Flare-ups can sometimes develop after an infection but they can also start with no warning or obvious trigger.
The signs are:
- increased stiffness, that lasts for more than a few minutes, especially in the morning or after sitting still for a long time;
- feeling more tired than usual;
- pain when resting; for example, if joints won’t ‘settle’ at night;
- swelling, warmth, pain in a joint;
- difficulty with usual activities / tasks e.g. limping, not being able to walk as far; and
- some types of JIA have fevers and rash with flare-ups .
Managing flare-ups
Don’t ignore flare-ups because untreated inflammation can interfere with usual activities, cause avoidable pain and if not treated, can cause lasting joint damage.
Anti-inflammatory painkillers
- Start taking a regular anti-inflammatory painkillers such as Ibuprofen, Naproxen, Diclofenac or Piroxicam (as advised by your doctors) if you are not already doing so.
- This often helps reduce pain and arthritis if you use them as directed. They can take several days to have their maximum effect.
- If any side-effects develop (e.g. indigestion or tummy pain on this medication, please stop and discuss with the Paediatric Rheumatology team or your GP)
Painkillers
- Painkillers such as Paracetemol (tablet or suspension) in between regular anti-inflammatories don’t treat the inflammation but they often reduce the pain
If you are unsure what to take, please discuss with the Paediatric Rheumatology team
The Paediatric Rheumatology team
- Contact the Paediatric Rheumatology team via Clinical Nurse Specialists. Please telephone or email if concerns are not settling at 5 days, or if concerns are severe earlier on e.g. affecting school attendance / very distressed.
- Do not wait until your next appointment if it is a long time off, things may get worse.
- You are probably aware from past experience that there are a number of measures that the Paediatric Rheumatology team can provide to help if arthritis persists, including steroid injections into the joints, a course of steroid tablets and / or changing the long-term medications.
Young people with J.I.A
- Some young people with J.I.A find heat and cold in the form of warm wheat bags or cold packs can help soothe an inflamed joint.
- Ensure you follow the instructions on how to use the wheat bag or cold pack safely.
- Sometimes, a warm bath or shower in the morning can help to reduce morning stiffness.
Resist the temptation
- It is tempting to crawl into bed when you have a flare-up but inactivity can make your joints feel stiffer and more uncomfortable.
- Try to keep on your feet and moving but don’t push yourself / your child too much.
- Try to move the affected joint(s) through their full movement at regular intervals through the day.
- If you are concerned that a joint is becoming restricted in movement, it may be useful to contact your physiotherapist to arrange an appointment.
Tips to minimise flare-ups
- Take your medication correctly.
- If you have any problems with medications, please let your Paediatric Rheumatology team know so they can advise.
- Always treat a flare-up early.
- Plan ahead for future flare-ups by making sure you have an anti-inflammatory painkiller as previously described to use when needed.
- Enjoy life!
Who can I contact between my visits?
If you have any questions or concerns between your clinic visits, you can contact the Children’s Rheumatology Nurse Specialists who can provide you with information, support and guidance.
Children’s Rheumatology Nurse Specialists
(Please leave message on the answer phone if we are not around to answer).
