Expert Q&A: How Long Do Flares Usually Last?
An expert explains what to expect while waiting out a juvenile idiopathic arthritis flare.
Question: How long do flares usually last? My daughter has been experiencing symptoms for many months. She’s been on Naprosyn the entire time but started methotrexate four weeks ago. She’s still not getting any better. Is this common?
Answer:
I completely understand your frustration. It is so difficult to see your child struggle. A flare is an increase in symptoms. Unfortunately, there is no “usual” time frame for flares. Some flares can be very short- lived, while others may take some time to come under control. No one knows why a child who was doing well might suddenly have more joint swelling and/or pain. Something simple like a cold might cause a sudden increase in pain that goes away quickly. Or sometimes the arthritis just worsens, and a treatment change is needed.
You can help reduce your child’s risk of flaring by following your child’s doctor’s instructions and using medications as prescribed. It’s important to know that even if you and your child do everything right, sometimes JIA can become more active. It looks like you are on the right track; often doctors will start a new medication to decrease the pain and inflammation.
Medications all start to work at different time frames. Methotrexate is slow acting and often doesn’t help until 8 weeks after starting the goal dose. There are things that can help in the meantime. Keeping your child’s room and bed warm can help with morning stiffness as can a warm bath or shower. Physical and occupational therapy to keep muscles strong and joint range normal are important as well. Keeping your child as active and engaged as possible is also very important.
Remember, with the doctor’s help, the flare will come under control and your child will feel better. Reach out to other parents who have children with arthritis; they have been in your shoes and know all kinds of “tricks” that can help get your child back on the right track.
Karen Onel, MD
Professor of Clinical Pediatrics
Weill Cornell Medicine
Chief, Division of Pediatric Rheumatology
Hospital for Special Surgery
Answer:
I completely understand your frustration. It is so difficult to see your child struggle. A flare is an increase in symptoms. Unfortunately, there is no “usual” time frame for flares. Some flares can be very short- lived, while others may take some time to come under control. No one knows why a child who was doing well might suddenly have more joint swelling and/or pain. Something simple like a cold might cause a sudden increase in pain that goes away quickly. Or sometimes the arthritis just worsens, and a treatment change is needed.
You can help reduce your child’s risk of flaring by following your child’s doctor’s instructions and using medications as prescribed. It’s important to know that even if you and your child do everything right, sometimes JIA can become more active. It looks like you are on the right track; often doctors will start a new medication to decrease the pain and inflammation.
Medications all start to work at different time frames. Methotrexate is slow acting and often doesn’t help until 8 weeks after starting the goal dose. There are things that can help in the meantime. Keeping your child’s room and bed warm can help with morning stiffness as can a warm bath or shower. Physical and occupational therapy to keep muscles strong and joint range normal are important as well. Keeping your child as active and engaged as possible is also very important.
Remember, with the doctor’s help, the flare will come under control and your child will feel better. Reach out to other parents who have children with arthritis; they have been in your shoes and know all kinds of “tricks” that can help get your child back on the right track.
Karen Onel, MD
Professor of Clinical Pediatrics
Weill Cornell Medicine
Chief, Division of Pediatric Rheumatology
Hospital for Special Surgery
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