Triggers for Rheumatoid Arthritis Flares

While flares can seemingly come out of nowhere, certain factors may increase the likelihood of symptoms worsening. Identifying your personal triggers may help you avoid them, or at least reduce their frequency, severity, or duration.

The exact cause of an RA flare isn't always clear. Over time, many people with RA notice that certain circumstances tend to precede a flare. Although triggers differ from one person to the next, experts have identified many common culprits.

Environmental Triggers

“One of the most common questions I get from patients with rheumatoid arthritis is whether certain environmental factors can trigger their symptoms,” says Priyanka Dongare, MD, a fellow in Stony Brook Medicine’s Division of Rheumatology in New York. “While environmental triggers don’t cause RA flares in every patient, many people notice patterns.” These triggers include:

• Weather Changes “Cold weather and sudden weather changes are probably the most frequently reported triggers,” says Dr. Dongare. But the weather may not have as much of an impact as patients may think. A meta-analysis found only that weather’s impact on RA symptoms appears to be minimal.

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• Air Pollution Higher levels of air pollution have been linked to an increased risk of RA flares. One study found that exposure to pollutants including PM2.5, PM10, nitrogen dioxide, and ozone was associated with greater disease activity and higher levels of inflammation.

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• Occupational Exposures Dust, fumes, and chemical irritants may aggravate symptoms in some people with RA. But most research has examined these exposures as risk factors for developing RA rather than triggers for flares.

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• Cigarette Smoke and Secondhand Smoke Tobacco smoke causes whole-body inflammation, one of the main triggers for arthritis.

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   “Multiple studies have demonstrated that smoking not only increases the risk of developing RA, particularly seropositive RA, but can also worsen disease activity and reduce response to treatment,” says Dr. Dongare.

Physiological Triggers

Changes in the body, some of which you can manage through lifestyle modifications, can affect inflammation and increase your risk of a flare.

• Sleep Deprivation “Poor sleep is one of the most common triggers I see in clinical practice,” says Dr. Dongare. Research has shown that inadequate or disrupted sleep can increase inflammatory cytokines such as IL-6 and TNF-alpha, which are key drivers of RA inflammation. “Patients often say that after several nights of poor sleep, they experience increased pain, stiffness, and fatigue.”

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• Physical Overexertion There’s a fine line between exercise and overdoing it. While regular movement is recommended for people with RA, pushing your body too hard can temporarily increase joint pain, stiffness, and fatigue. Repetitive motions, heavy lifting, or unusually strenuous activity may aggravate already sensitive joints, making flare symptoms feel worse.

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• Hormonal Shifts Hormones help regulate immune function. Sharp drops in estrogen, such as after childbirth, around menstruation, and during menopause, may increase disease activity and trigger flares.

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• Inconsistent Medication Skipping doses, delaying refills, or stopping medication because you think you feel fine can increase the risk of a flare. Disease-modifying antirheumatic drugs (DMARDs) and biologics help keep the immune system's inflammatory activity under control, and can worsen symptoms if not taken as prescribed.

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• Added Sugars and Ultra-Processed Foods Diets that include these foods may promote inflammation and worsen RA symptoms over time. These foods have been linked to immune dysregulation and increased inflammatory signaling, which may contribute to greater disease activity.

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Emotional Triggers

The state of your mental health can also affect your RA symptoms.

• Stress “While stress doesn't directly cause RA, it can amplify inflammation and make symptoms feel significantly worse,” says Dongare. One long-term study found that those with greater perceived stress had worse pain, greater fatigue, and lower physical function.

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• Grief Research suggests that intense grief is associated with higher levels of inflammation, and experts note that the emotional strain of losing a loved one may increase disease activity and flares.

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• Anxiety A systematic review found that about 1 in 5 people with RA experience clinically significant anxiety symptoms. Research has linked anxiety to greater pain, fatigue, and disease burden.

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• Depression Depression and RA have a bidirectional relationship. One review found depression is associated with higher disease activity and worse treatment outcomes in inflammatory arthritis, suggesting that depressive symptoms can make flares more difficult to manage.

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Because RA affects everyone differently, tracking your triggers and symptoms can help you identify patterns that may otherwise go unnoticed. Dongare suggests keeping a symptom diary or using a smartphone app to track these variables:

• Pain levels
• Stiffness
• Fatigue
• Sleep quality
• Stress
• Diet
• Exercise
• Environmental concerns

“Tracking can also help rheumatologists distinguish between inflammatory disease activity and other contributors to pain such as osteoarthritis, fibromyalgia, sleep disorders, or mood disorders,” says Dongare.

Tracking is a tool, not a diagnosis. She cautions against assuming that every flare has a clear cause, since RA symptoms can naturally fluctuate. If you consistently notice the same pattern, though, you should discuss it with your rheumatologist.

• Prioritize sleep. Poor sleep can worsen inflammation, pain, and fatigue, so maintaining good sleep habits may help keep symptoms in check.
• Manage stress. "Stress management should be part of every patient’s treatment plan,” says Dongare. Meditation, counseling, exercise, and strong social support systems can help reduce the physical toll of chronic stress.
• Stay physically active. “Many patients worry that exercise will worsen their arthritis, but the evidence consistently shows the opposite,” she says.
• Follow a healthy eating pattern. Dongare says maintaining a healthy weight and following a Mediterranean-style diet may support overall health and help reduce systemic inflammation.
• Quit smoking. It’s not good for any part of your body — joints or otherwise.
• Take medications as prescribed. Skipping doses or stopping treatment can increase the risk of disease activity and flares.

“Avoiding triggers can help manage symptoms, but controlling the underlying inflammation with appropriate medical treatment remains the foundation of RA care,” she says. Keep up with regular rheumatology appointments and talk with your healthcare provider before making changes to your treatment plan.

If you notice possible RA flare triggers, share them with your healthcare professional. They can interpret symptoms, adjust treatment if needed, and keep your disease under control.

• What symptoms or patterns should I track to better identify my RA flares?
• Could my current medications or dosing schedule be adjusted to better prevent flares?
• Are there environmental or lifestyle triggers I should be most cautious about?
• How can I safely modify my diet, activity level, or daily routine without making my symptoms worse?
• Should I adjust or preplan treatment around known triggers like stress, illness, or travel?
• When should I contact you if I think I’m having a flare?