Quick answer: In a bad arthritis flare, first check for red flags such as a hot, swollen joint with fever or signs of infection on immune-suppressing medicines. If there are none, use your flare kit: cold or warmth, supports, agreed medicines and gentle movement. Know what to tell NHS 111 or your GP, and keep a grab-and-go bag ready.
When a bad flare hits, it is hard to think straight. This page is a set of short, tick-box checklists you can print and keep on the fridge, by the bed or in your bag. They cover the first minute (is this an emergency?), the first hour (what to do at home), what to have ready before the next flare, and what to say and take if you need NHS 111, your GP or A&E. It works alongside your longer flare action plan, where you record the details agreed with your own clinicians.
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Checklist 1: the 60-second safety check
Before anything else, check for signs that this is not a usual flare. If you tick any box, stop and get help as shown.
Call 999 now if:
- ☐ Chest pain, or sudden severe breathlessness
- ☐ Signs of a stroke: face drooping, arm weakness, speech problems
- ☐ Possible sepsis: confusion or slurred speech, uncontrollable shivering, blue, pale, grey or blotchy skin, lips or tongue, difficulty breathing, or peeing very little or not at all
- ☐ Sudden loss of vision
- ☐ Lips, mouth, tongue or throat suddenly swelling, or struggling to breathe
- ☐ Vomiting blood or passing black, tarry stools
Call 999 or go to A&E if:
- ☐ Back pain with pain, tingling, weakness or numbness in both legs, loss of feeling around the genitals or anus, or changes in your bladder or bowels
- ☐ You cannot put weight on a leg, or a joint looks misshapen, after a fall
Call NHS 111 or go to A&E urgently if:
- ☐ One joint has suddenly become hot, red, swollen and very painful, especially with a high temperature or feeling unwell (possible joint infection)
- ☐ A joint replacement has suddenly become hot, swollen and painful
Contact your GP, rheumatology advice line or NHS 111 the same day if:
- ☐ High temperature, shivers, sore throat, new cough or other infection signs while taking methotrexate, biologics, steroids or other immune-suppressing medicines
- ☐ Over 50 with a new headache, scalp or temple tenderness, or jaw pain when eating
- ☐ Pain, swelling and warmth in one calf
- ☐ Yellowing of the skin or eyes, unexplained bruising or bleeding gums while on methotrexate
No boxes ticked and it feels like your usual kind of flare? Go to checklist 2. If you are unsure, call NHS 111. More detail on each warning sign is in our guide to red flag symptoms you should never ignore.
Checklist 2: the first hour at home
- ☐ Stop what I am doing and get into a comfortable, supported position
- ☐ Cold pack wrapped in a cloth for 10 to 15 minutes on a hot, swollen joint, or warmth for 15 to 20 minutes on a stiff, aching joint
- ☐ Pillows, splint or brace to support the painful joint
- ☐ Take only medicines agreed in my flare plan, within the dose on the label or prescription
- ☐ Gentle movements of the painful joint, 5 to 10 slow repetitions, within comfort
- ☐ A drink, and something to eat if my medicines need food
- ☐ Slow breathing for a few minutes: in for four, out for six
- ☐ Tell someone I am having a flare
- ☐ Cancel or postpone anything that can wait today
- ☐ Note the time it started, which joints, and my pain score (0 to 10)
Our guide to the first 24 hours of a flare explains each step and what to do for the rest of the day.
Checklist 3: my flare kit (prepare now)
Put these together on a good day, so everything is ready when you need it.
Comfort
- ☐ Reusable cold pack in the freezer, plus a cloth cover
- ☐ Wheat bag or hot water bottle with a cover
- ☐ Extra pillows or a long body pillow
- ☐ Splints, braces or supports I have been given
- ☐ Walking aid, if I use one
Medicines and information
- ☐ My regular medicines, with enough supply (order repeats early)
- ☐ Any flare medicines my GP or rheumatology team has agreed, with written instructions
- ☐ Topical anti-inflammatory gel, if my pharmacist has agreed it is suitable
- ☐ Up-to-date medicines list with doses and allergies
- ☐ Steroid emergency card, if I have one. See our guide to steroid emergency cards
- ☐ Printed flare action plan
Practical
- ☐ Easy meals in the freezer or cupboard
- ☐ Large-handled cup, bottle with a sports cap, or straws
- ☐ Easy-on clothes and slip-on shoes
- ☐ Phone charger near the bed
- ☐ Contact list (checklist 5)
Checklist 4: what to tell NHS 111, your GP or rheumatology team
Having this information ready makes the call quicker and the advice better. Fill in what you can before you call.
| Information | My notes |
|---|---|
| My type of arthritis | |
| When this flare started | |
| Which joints, and whether any are hot, red or swollen | |
| Pain score now (0 to 10) and my usual score | |
| Temperature, if I have a thermometer | |
| Other symptoms, such as feeling unwell, shivers, rash, cough or headache | |
| Medicines I take, including when I last took methotrexate, a biologic or steroids | |
| Anything I have taken or tried for this flare | |
| Joint replacements or recent surgery | |
| Other conditions and allergies | |
| What I am most worried about |
Questions to ask:
- ☐ Do I need to be seen, and how soon?
- ☐ Should I keep taking my usual arthritis medicines?
- ☐ What should I do if things get worse, and when should I call back?
- ☐ Can my flare plan be updated after this?
NICE's rheumatoid arthritis guideline (NG100) supports people having rapid access to specialist advice when their arthritis flares, so if you have a rheumatology advice line, use it.
Checklist 5: my contacts
| Who | Number | Hours |
|---|---|---|
| GP surgery | ||
| Rheumatology advice line | ||
| Community pharmacy | ||
| Homecare provider for biologic deliveries, if I have one | ||
| Family member, friend or neighbour | ||
| Nearest urgent treatment centre | ||
| NHS 111 | 111 | 24 hours, or 111.nhs.uk |
| Emergency | 999 | 24 hours |
Checklist 6: grab-and-go bag for A&E or an urgent appointment
- ☐ Medicines list with doses and allergies, or the medicines themselves in their boxes
- ☐ Steroid emergency card, if I have one
- ☐ Flare action plan and recent pain notes
- ☐ Phone, charger and a list of key numbers
- ☐ Glasses, hearing aids and any communication aids
- ☐ Snack and a drink, especially if I have diabetes
- ☐ Comfortable, loose clothing and slip-on shoes
- ☐ Small cushion or support for a painful joint while waiting
- ☐ Walking aid
- ☐ Details of joint replacements or implants
- ☐ A friend or relative to come with me, if possible
The NHS advises not driving yourself to A&E in an emergency; ask someone to drive you or call 999.
Checklist 7: for carers and family
- ☐ Run through the 60-second safety check with them
- ☐ If they cannot tell you how they feel, look for changes: wincing, guarding a joint, not moving, confusion, unusual drowsiness, not eating or drinking
- ☐ Check their temperature if you have a thermometer
- ☐ Fetch the flare kit and help with cold or warm packs and pillows
- ☐ Help them take only the medicines in their plan, checking doses and timings
- ☐ Take over meals, drinks and essential tasks
- ☐ Encourage small, gentle movements
- ☐ Keep notes: start time, joints, pain scores, temperature, medicines given
- ☐ Make the call to NHS 111, the GP or the rheumatology team if needed, with checklist 4 to hand
- ☐ Look after yourself too, and ask for help if you need it
Extra checks for common situations
A suspected gout attack
- ☐ First attack, or high temperature or feeling unwell? Get advice the same day, as joint infection can look similar
- ☐ Take any gout treatment I have been prescribed as soon as possible; the NHS says it should start to work within about 2 days
- ☐ Rest and raise the limb, and keep the joint cool with a wrapped ice pack for up to 20 minutes at a time
- ☐ Drink plenty of water, unless a doctor has told me not to
- ☐ Keep bedding off the painful joint
A flare while away from home
- ☐ Medicines and a copy of my prescription or medicines list with me
- ☐ Urgent advice: NHS 111 in England, NHS 24 on 111 in Scotland, NHS 111 Wales, or the GP out-of-hours service in Northern Ireland
- ☐ Abroad: travel insurance details, and know how to contact local emergency services
- ☐ A local pharmacy can often give advice without an appointment
A flare after an infection or illness
- ☐ Ask my GP or rheumatology team whether to continue my usual arthritis medicines while unwell
- ☐ If I take steroids, follow my sick day advice and show my steroid emergency card
- ☐ Build activity back up slowly once I recover
After the flare: a 10-minute review
- ☐ How long did it last?
- ☐ What might have triggered it?
- ☐ What helped most, and what did not?
- ☐ Did I have everything I needed in my kit?
- ☐ Did I need help sooner than I expected?
- ☐ Restock the kit and order medicines
- ☐ Update my flare action plan
- ☐ Book a GP or rheumatology review if flares are becoming more frequent, longer or more severe
Not sure whether it was a real flare or a bad day? Read how to identify a true flare, or browse our flare-up guide.
When to get medical help
- Call 999 for chest pain, severe breathlessness, stroke signs, possible sepsis, vision loss, a severe allergic reaction or vomiting blood.
- Call 999 or go to A&E for back pain with leg weakness or numbness, loss of feeling around the genitals or anus, or bladder or bowel changes.
- Call NHS 111 or go to A&E urgently for a suddenly hot, red, swollen joint with fever or feeling unwell.
- Contact your GP, rheumatology team or NHS 111 the same day for infection signs on immune-suppressing medicines, a new headache or jaw pain over 50, or calf pain and swelling.
- Contact your GP or rheumatology team within a few days if a flare is not settling or keeps coming back.
What should be in an arthritis flare kit?
A cold pack, a wheat bag or hot water bottle with covers, extra pillows, any splints or supports, your regular and agreed flare medicines, an up-to-date medicines list, your flare plan, easy meals and a contact list. Put it together on a good day so it is ready.
When is an arthritis flare an emergency?
A usual flare is not an emergency. Get urgent help if one joint suddenly becomes hot, red and swollen with fever, if you have signs of infection on immune-suppressing medicines, back pain with leg weakness or numbness around the genitals, or chest pain, breathlessness or stroke signs.
What should I tell NHS 111 about my arthritis?
Tell them your type of arthritis, when the flare started, which joints are affected, whether any are hot or swollen, your temperature, other symptoms and all your medicines, especially methotrexate, biologics or steroids. Mention any joint replacements.
Should I stop methotrexate during a flare?
No, not unless your rheumatology team or doctor tells you to. If you have signs of infection, contact your GP, rheumatology team or NHS 111 for advice about your medicines. Never stop steroid tablets suddenly.
What should I take to A&E with arthritis?
Your medicines list or medicines in their boxes, your steroid emergency card if you have one, your flare plan, phone and charger, glasses or hearing aids, a snack and drink, comfortable clothes, a walking aid and details of any joint replacements. Take someone with you if possible.
How is this checklist different from a flare action plan?
This checklist is a quick, tick-box guide for the moment a bad flare starts. Your flare action plan is a fuller, personal plan you fill in with your clinicians, including agreed medicines and your green, amber and red zones. Use both together.
Sources and further reading
- NHS: When to use 111
- NHS: Septic arthritis
- NHS: Sepsis
- NHS: Back pain
- NHS: Side effects of methotrexate
- Arthritis UK: Managing arthritis flare-ups
- NICE NG100: Rheumatoid arthritis in adults
Educational information for people in the United Kingdom — not a diagnosis or personal medical advice. Charity no. 1218461. Pending clinical review. Everyone's situation is different, so always follow the advice of your own GP, pharmacist or rheumatology team. If you feel very unwell, call 999 or go to A&E. For urgent advice, contact NHS 111.
Continue with related help
- Flare action plan — your full written plan
- Red flag symptoms — when to get urgent help
- First 24 hours of a flare — hour-by-hour steps
- Is it a true flare? — flare or bad day
- Steroid emergency card — if you take steroids
- Flare-up guide — our full hub