Quick answer: In the first 24 hours of an arthritis flare, check for red flag signs first, then calm the joint with a short rest, cold for heat and swelling or warmth for stiffness, and gentle movement every hour or so. Use only medicines your GP or pharmacist has agreed, pace your day, protect your sleep and note your symptoms.
The first day of a flare is often the hardest. Pain is up, sleep may already have been disturbed, and it is easy to either push on as normal or stop moving altogether. Neither usually helps. This guide breaks the first 24 hours into simple stages so you know what to do, roughly when, and what would change the plan. It is general information for adults in the UK with diagnosed arthritis, not a substitute for advice from your own clinicians.
If you already have a written plan from your GP or rheumatology team, follow that first. If you do not, our free printable flare action plan helps you make one once this flare settles.
Hour 0: stop and check for red flags
Before you treat a flare as "just arthritis", spend one minute checking whether something else might be going on. Most flares are a familiar worsening of your usual symptoms. A few situations need medical help rather than self-care.
- A single joint that has suddenly become hot, red, swollen and very painful, especially if you have a high temperature, shivers or feel unwell. The NHS advises urgent help for possible septic arthritis (joint infection): call NHS 111 or go to A&E.
- Signs of infection if you take immune-suppressing medicines such as methotrexate, biologics or steroid tablets: fever, chills, sore throat, a new cough or feeling generally unwell. Contact your GP or rheumatology team the same day, or NHS 111 out of hours.
- A fall or injury after which you cannot put weight on a leg, or a joint looks misshapen.
- Chest pain, sudden breathlessness, signs of a stroke, or collapse: call 999.
- Calf pain and swelling in one leg, particularly with breathlessness: get urgent advice, as this can be a blood clot.
If none of these apply and this feels like your usual kind of flare, carry on with the steps below. If you are unsure, it is always reasonable to call NHS 111 for advice.
Hours 0 to 2: settle the joint
Take a short pause
Stop the activity that is hurting and sit or lie in a supported, comfortable position. A short rest for a very painful joint is reasonable. What tends to make things worse is long, complete rest, because joints stiffen and muscles weaken quickly when they are not used. Think "pause" rather than "bed rest".
Choose cold or warmth
Arthritis UK suggests that cold can help joints that feel hot and swollen, and warmth can help joints that feel stiff and achy. Use whichever suits how your joint feels right now.
- Cold: a cold pack or bag of frozen peas wrapped in a tea towel, for around 10 to 15 minutes. Do not put ice directly on skin.
- Warmth: a warm (not hot) wheat bag, hot water bottle in a cover or a warm shower, for around 15 to 20 minutes.
- Skip either on numb skin, broken skin, or where you have poor circulation. Take extra care with cold if you have Raynaud's phenomenon.
Our guide to heat versus ice for arthritis explains which to use and why.
Support the joint
Pillows under or around the painful joint can take strain off it. If a physiotherapist or occupational therapist has given you a splint or brace, this is the time to use it as they advised. A walking stick held in the opposite hand to a painful hip or knee can take some load off.
Hours 2 to 6: medicines and gentle movement
Medicines you already have
Use only what your GP, pharmacist or specialist team has agreed for you, at the dose on the label or prescription. Do not double up on doses or combine painkillers in ways you have not been advised to. A community pharmacist can check what is safe alongside your other medicines and health conditions, without an appointment.
- For osteoarthritis, NICE guidance (NG226) suggests considering an anti-inflammatory gel rubbed into the skin, especially for the knee, before tablets. If tablets are needed, the lowest effective dose for the shortest time is advised.
- For rheumatoid and other inflammatory arthritis, your specialist team may have a flare plan, which might include a steroid injection or short course of tablets. NICE NG100 says people should be able to get rapid specialist advice when they flare, so use your advice line if you have one.
- Do not stop or change your regular arthritis medicines (such as methotrexate) without advice, and never stop steroid tablets suddenly.
Start gentle movement
Once the joint has settled a little, start moving it gently through a comfortable range. This is not exercise in the usual sense. It is a few slow, easy movements to stop stiffness setting in. Aim for:
- 5 to 10 slow, easy movements of the painful joint, within a range that does not make pain shoot up
- Repeated roughly every hour while you are awake
- Moving other, less painful joints too, such as ankle circles, shoulder rolls and finger bends
Mild extra discomfort during gentle movement is common and usually not harmful. If pain is much worse for more than an hour or two afterwards, do fewer or smaller movements next time.
Hours 6 to 12: pace the rest of the day
A flare day is not the day to catch up on chores. Pacing means spreading what you need to do across the day, in smaller chunks, with planned rests. It helps you avoid the "boom and bust" pattern of doing too much on a better hour and then paying for it.
- Make a short list of what genuinely needs doing today. Most things can wait a day or two.
- Cut each task into smaller pieces. Wash a few dishes, sit down, then do a few more.
- Change position often. Alternate sitting, standing and a few steps every 20 to 30 minutes if you can.
- Ask for help. A partner, family member, friend or neighbour can help with meals, shopping or school runs. Online shopping and delivery can help for a few days.
- Use gadgets. Trolleys, jar openers, long-handled reachers and bags with straps all take strain off painful joints.
Our pacing and energy guide goes into more detail, including how to plan a flare-friendly week.
Eat and drink regularly
It is easy to skip meals when you are in pain. Regular, simple meals and drinks keep your energy up and help if you take medicines that should be taken with food. Easy options for a flare day include soup, eggs on toast, yoghurt with fruit, or a ready meal. This is a good day to lean on convenience food without guilt.
If you work
If you can, let your manager know you are having a flare and ask whether you can work from home, shorten your day or swap to lighter tasks. Under the Equality Act 2010, arthritis can count as a disability, and employers should consider reasonable adjustments. If you need time off, self-certify for up to seven days and ask your GP about a fit note if it lasts longer.
Hours 12 to 18: look after your mind
Flares are frustrating and can bring worry about the future, work and family. Feeling low, irritable or tearful is common and understandable. A few things often help:
- Slow breathing: breathe in gently through your nose for a count of four and out through your mouth for a count of six, for a few minutes.
- Distraction: a phone call, music, a podcast, a familiar film or a puzzle can take the edge off pain for a while.
- Remind yourself it is a flare: most flares settle. Looking back at notes from a previous flare can be reassuring.
- Talk to someone: a friend, family member or a support group. If you feel hopeless or have thoughts of harming yourself, contact your GP, call NHS 111, or call Samaritans free on 116 123.
Our arthritis and mental health hub has more support.
Hours 18 to 24: protect your sleep
Pain often feels worse at night, partly because there are fewer distractions. Poor sleep can then make pain harder to cope with the next day. Try to set up a calm evening:
- A warm shower or bath, or warmth on stiff joints, an hour or so before bed
- A few gentle movements of the affected joint so it does not stiffen as soon as you lie down
- Pillows arranged to support the painful joint. See our guide to sleep positions for each joint
- Pain relief timed as your GP or pharmacist has advised
- Something easy to drink and any medicines you might need within reach, so you are not getting up in the dark
- A plan for waking: if you cannot sleep after about 20 minutes, get up, sit somewhere calm with low light and go back when sleepy
Throughout the day: keep simple notes
A few notes now are very useful later, both for you and your clinicians. You do not need anything complicated. Jot down:
- When the flare started and which joints are affected
- Your pain score from 0 to 10, morning and evening
- How long stiffness lasted after getting up
- Any swelling, warmth or redness
- What you tried and whether it helped
- Anything that might have triggered it, such as an unusually busy few days, an infection, poor sleep, stress or a missed medicine
Our pain tracking journal template gives you a ready-made table to print.
What to avoid in the first 24 hours
- Pushing through as normal to prove you can. It often lengthens the flare.
- Staying completely still all day. Joints stiffen and muscles weaken quickly.
- Very hot heat packs or ice straight on skin. Both can burn.
- Extra painkillers beyond the label or mixing medicines without advice.
- Stopping regular arthritis medicines without speaking to your team.
- Drinking alcohol to cope. It can disturb sleep and some arthritis medicines do not mix well with it.
- Big decisions about treatment based on one bad day. Note how you feel and discuss it with your clinician.
What usually happens next
Many flares start to ease over a few days, though some last longer. Keep going with gentle movement, pacing and comfort measures, and gradually build activity back up as things improve. Our guide to the first 72 hours of a flare covers days two and three, and how to return to your usual routine without triggering another flare.
If you are not sure whether this is a flare or something else, read how to tell if it is a true flare-up.
When to get medical help
- Call 999 for chest pain, severe breathing difficulty, signs of a stroke or collapse.
- Call NHS 111 or go to A&E for a suddenly hot, red, swollen joint with fever or feeling unwell, or if you cannot weight-bear after a fall.
- Contact your GP or rheumatology advice line the same day if you have signs of infection while on immune-suppressing medicines, or new symptoms that do not feel like your usual arthritis.
- Contact your GP or specialist team within a few days if the flare is not easing, flares are becoming more frequent, or you have never had a diagnosis for your joint pain.
Should I rest or keep moving during the first day of a flare?
Both, in balance. A short rest for a very painful joint is fine, but gentle movement every hour or so while you are awake usually helps stop stiffness and weakness setting in. Avoid long spells of complete rest and avoid pushing through as normal.
Is heat or ice better in the first 24 hours?
Use cold if the joint feels hot and swollen, and warmth if it feels stiff and achy. Wrap packs in a cloth, use them for about 10 to 20 minutes at a time, and avoid them on numb or broken skin. Some people find switching between the two helpful.
Can I take extra painkillers during a flare?
Only within the dose on the label or prescription, and only medicines your GP or pharmacist has agreed are safe for you. A pharmacist can advise on over-the-counter options alongside your other medicines. Ask your specialist team about a flare plan if you have inflammatory arthritis.
Should I go to work during an arthritis flare?
That depends on your job and how severe the flare is. Many people manage with adjustments such as working from home or lighter duties for a few days. You can self-certify sickness for up to seven days. Arthritis can count as a disability under the Equality Act, so ask your employer about reasonable adjustments.
How do I know if a flare needs A&E?
Go to A&E or call NHS 111 urgently if one joint suddenly becomes hot, red, swollen and very painful, especially with a fever or feeling unwell, as this can be a joint infection. Call 999 for chest pain, severe breathlessness, stroke signs or collapse. If unsure, call 111.
What can a carer do in the first 24 hours of a flare?
Help check for red flag signs, take over essential tasks such as meals and shopping, fetch cold or warm packs, remind the person to move gently, and help keep simple notes. Following a written flare action plan together makes it easier to know when to call for help.
Sources and further reading
- Arthritis UK: Managing arthritis flare-ups
- NHS: Septic arthritis
- NHS: When to use 111
- NHS: Methotrexate
- NICE NG226: Osteoarthritis in over 16s
- 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 — free printable plan to fill in
- Flare-up: the first 72 hours — what to do on days two and three
- Flare-up guide — our full hub on flares
- Is it a true flare? — how to tell a flare from a bad day
- Pain relief — what helps and what to ask
- Pacing — avoid boom and bust