7. Managing flares

You/your child will be asked about any problems with vision or any other symptoms related to their eyes. Your child’s eyes will be checked with a slit lamp which is a special piece of equipment that allows the ophthalmologist to look for any inflamed cells within the eye which could indicate uveitis. Your child may be asked to read a chart with letters/pictures/shapes from a set distance. The exact method depends on your child’s age and how co-operative they are.

A flare is a severe episode of inflammation. It occurs when you have painful or swollen joints that won’t settle down, or your pain is increased. You may find it very hard to move, especially when you wake up. You may also feel generally unwell and very fatigued. Flareups can last a couple of days but they can also stretch to a month or so.

JIA is a fluctuating condition, and whilst the healthcare professionals aim for control, there may be times when the conditions and symptoms are more active. This is called a flare. A minor flare could be anything from a slightly swollen finger, not impacting daily routine,

to something more significant, causing morning stiffness and difficulty doing normal things like coming down the stairs and doing up buttons. When newly diagnosed it is important to ask the consultant or specialist nurse what specifically you should look out for during a “flare” and how to support your child; this will help to determine whether you should or shouldn’t get in touch. The doctors and nurses are very supportive and happy to help you with advice on how to self-manage JIA in between clinic appointments. During a flare one or more joints will become inflamed and feel tender/painful. If the joint is hot to the touch, the skin looks red and/or your child has a fever, it is important that they are seen by a healthcare professional promptly. This is to ensure that there is no infection in the joint (this is not common but does need urgent treatment if this happens).

A flare can happen at any time, especially after an illness or a stressful period such as school exams. Along with an increase in joint pain, stiffness and swelling, your child may be feeling exhausted, and in a low mood.

The more your son or daughter keeps moving, the less their joints are likely to seize up; maintaining joint movement will help reduce the stiffness. This is especially important when you consider that your child is growing and ensuring that joints maintain their full range of movement is key to avoiding longer term limitation of movement.

Managing these flares and the pain and fatigue that usually come with a flare can involve the use of several strategies; these include non-drug treatments such as using heat (e.g. a hot bath or heat pad) and cold (e.g.

a bag of frozen peas on the joint, always wrapped in a tea towel) and relaxation and distraction techniques. Maintaining movement in all joints is important, as mentioned above, even in a flare, so gentle regular exercises will help to reduce stiffness when flaring.

Use painkillers effectively by ensuring that your child takes them regularly and doesn’t wait until the pain gets worse.

Many common relaxation techniques combine breathing deeper with relaxing the muscles. Such techniques obviously work better for older children who can understand what is being suggested. For some young people the first couple of times they try to deliberately relax can be challenging; it’s hard to focus, seems like a waste of time and isn’t working. Please encourage them to persevere and don’t give up on it too quickly. Yoga and stretching are both good forms of exercise that can help to improve breathing and relaxation. Listening to music and “toe tensing” (repeatedly tightening and relaxing your toes) can also distract from the pain. There are lots of clips on YouTube about relaxing. The point is to focus on something other than the discomfort. Again, this is an activity best suited to older children and teenagers.