Managing Psoriatic Arthritis Flare-Ups

Psoriatic arthritis (PsA) is a type of arthritis affecting people with the skin condition psoriasis. Flare-ups­—also called flares or relapses—are periods where symptoms of PsA get worse. Not everyone with PsA has psoriasis, but psoriasis and PsA­—also called psoriatic disease—are chronic inflammatory diseases resulting from a problem with the immune system.

PsA can cause the joints to become swollen, stiff, and painful. Some people with PsA may also have nail and skin changes and chronic fatigue. Treatment can help manage these symptoms and their causes, but PsA does get worse with time and persistent inflammation can cause permanent damage to joints.

It is difficult to know when a flare-up­ may come about but avoiding certain triggers may prevent disease flares. Your treatment plan can also reduce the risk and severity of flares. And if when flare-ups occur, there are things you can do to heal quicker, manage the flare, and reduce the risk of damage to joints during this time.

Here is what you need to know about flare triggers, signs of flares, and treating and preventing flares.

Flare Triggers

Every person with PsA has unique triggers that cause PsA to flare up. Something that may cause your disease to flare up may not affect others with PsA. Common PsA triggers may include the following.

Stress

Stress is one of the most common triggers of PsA flares. Stress unleashes chemicals that cause inflammation. With PsA, you are already vulnerable to inflammation, and the increased stress causes further inflammation, eventually causing symptoms to flare-up.

Injury or Illness

A skin infection or injury can cause symptoms of PsA to flare up, especially at the site of injury. Sunburns, in particular, can trigger flares, so protect yourself when outdoors with sunscreen and clothing that blocks ultraviolet rays.

Other illnesses­—such as a cold—can also trigger a flare. Bumps and bruises are additional triggers, as trauma to any area with PsA means inflammation will follow.

Not Taking Your Medications on Time

Even if you are feeling fine, you should still be taking your medications as prescribed. If you miss a mediation dose or two, PsA can flare-up. In addition, skipping your medications can make it harder for the medicine to do its job.

If you have side effects that are bothering you, talk to your healthcare provider about switching to another medicine. To avoid missing doses, keep a daily pill log or download a smartphone reminder app.

Medication Changes

A person with PsA may find their symptoms get worse when they change medications. This is because it may take some time for the medication to be effective. If you experience a flare after starting a new treatment, talk to your healthcare provider about a prescription steroid treatment, like prednisone, that may help to reduce the intensity of the flare and help you to recover quicker. However, steroids should always be prescribed with caution, as the eventual discontinuation of these drugs can sometimes cause a severe exacerbation of psoriasis.

Having an Unhealthy Diet

Eating sugary and fried foods can cause PSA to flare up more often. It helps to limit fatty meats, processed foods, and sugary treats. Weight gain can also overload joints and make it harder to move. It can also cause PsA medications to be less effective.

Smoking

You shouldn’t smoke with PsA. Studies have shown people with PsA who smoke experience more pain and don’t respond as well to treatments, in comparison to people with PsA who don’t smoke. Smoking can also set off flares and cause them to occur more often. Talk to your healthcare provider about the safest ways to quit smoking.

Alcohol

Research shows alcohol consumption interferes with the effect of PsA medications and causes more flare-ups. Additionally, it can weaken the immune system and cause problems in the brain, heart, liver, and pancreas.

Talk to your healthcare provider about whether it is safe for you to consume alcohol and how alcohol may affect PsA and the medications you take to treat it.

Not Getting Enough Sleep

Your body needs sleep to stay healthy. But PsA pain and disease flares can keep you up at night. To reduce the effects of PsA on your sleep, follow some good sleep habits, such as keeping electronics out of the bedroom, a warm bath before retiring to bed, or nighttime meditation.

Signs of a Flare

The symptoms and intensity of PsA flares vary from person-to-person. But there are some red flags to look out for with a flare. You may experience some of these or all of them during a flare-up.

Malaise

The term malaise is used to describe a feeling of discomfort, illness, or a lack of well-being. When a PsA flare-up starts, you will feel very off. Malaise may come on gradually or it may appear suddenly. For some people, this feeling comes and goes throughout a flare-up, while others may experience it for the entire length of the flare.

Malaise ranges from mild to severe, and for some people, malaise is so severe it interferes with work performance, family life, and other aspects of their life.

Fatigue

Your body needs sleep to heal and so you can wake up refreshed and rested. But PsA can make you feel exhausted even after 8 hours of sleep. While fatigue is one of the most common and debilitating symptoms of a PsA flare, it tends to be an underestimated symptom.

Skin Symptoms

It is not uncommon for a psoriasis flare-up to happen alongside a PsA flare. For people who don’t have psoriasis, they may still experience skin symptoms, including rashes. Anytime, you feel you are starting to experience a PsA flare, be on guard for skin symptoms.

Asymmetrical Joint Swelling and Pain

If you are experiencing asymmetrical joint pain and swelling, it means you have stiffness, pain, and throbbing in a joint or multiple joints on one side of the body only. For example, you may experience knee and hip pain on the left side and wrist and elbow pain on the right side.

Other types of inflammatory arthritis may cause symmetrical joint pain or pain that affects the joints on both sides (i.e. both hands or both knees). Each person with PsA will have different joints affected by a PsA flare.

Sacroiliac Joint and Back Pain

Your sacroiliac (SI) joint is located between the sacrum and the ilium bones of the pelvis. This joint is strong and supports the entire weight of the upper body. With a PsA flare, the sacroiliac joint and the back can become inflamed, causing stiffness, swelling, and pain.

Knee Pain

Many people with PsA complain of knee pain. Chronic inflammation can cause pain, swelling, redness, and warmth in the knee joints, and for some, knee pain is a key sign of an impending flare.

Hand and Finger Pain

Tenderness, pain, and swelling can affect the joints of the hands. Often people with PsA experience a condition called dactylitis, or sausage fingers, where the small joints fingers swell, resembling sausages.

Foot and Toe Pain

You can also experience dactylitis in your toes. Additionally, you may also have foot, heel, and ankle pain. If you experience skin symptoms with PsA, you may have red, scaly skin on the soles of your feet and between your toes.

Eye Problems and Other Symptoms

A PsA flare may cause you to experience blurred vision, and/or redness and pain in the eyes. These symptoms should prompt a visit to an eye doctor, as they may be signs of a condition called iritis, in which their is inflammation of the iris.

It is possible to experience additional symptoms with a PsA flare, including joint pain in the jaw, elbows, or shoulders. You might experience anxiety or digestive issues.

It is a good idea to write down symptoms you experience during a flare so you can prepare before a flare gets worse and it takes you days or weeks to recover.

Treating a PsA Flare

Sometimes, it may be impossible to avoid a flare-up of your psoriatic arthritis. Even then, there are things you can do to keep a flare from getting worse and to manage its effects.

Hold and Cold Therapy

Cold and hot packs can make a difference in how you feel. Cold packs have a numbing effect, so they can dull pain. A heating pad can relieve pain and swelling in joints by relaxing the muscles.

You don’t have to use an ice pack or a heating pad for relief. For cold therapy, you can use a bag of frozen veggies wrapped in a towel, or for heat, try a warm bath. If you are applying heat or cold for a long period, wrap the ice or heat source in a towel before applying it to your body.

Cut the Junk Food

Avoid foods that are high in fat, sugar, and salt when you are flaring. Instead, eat foods that fight inflammation, including fresh produce, lean proteins, and whole grains.

Manage Stress

You manage stress during a flare by relaxing your mind and body. A 2015 report in the American Journal of Public Health finds by simply taking several deep breaths and letting go of tension, you can regain calmness.

Ways to relax your mind include breathing exercises, soaking in a warm bath, listening to calming music, or writing about your feelings. You can relax your body with yoga, progressive muscle relaxation, a walk, or massage.

Take an NSAID Pain Reliever

Taking a nonsteroidal anti-inflammatory drug (NSAID), like ibuprofen or naproxen, can help relieve inflammation, pain, and discomfort. If pain persists or a flare-up seems to be severe, talk to your healthcare provider about a prescription-strength NSAID or a corticosteroid drug to shorten and reduce the effects of the flare.

Incorporate Gentle Exercise

Exercise is key to keeping your joints and tendons loose, strengthening muscles, and keeping at a healthy weight. During a flare-up, try gentle exercises, such as walking, swimming, or yoga. If you are struggling with exercise outside of flare-ups, ask your healthcare provider about a referral to a physical therapist to help you get active again.

Rest

It is important to get proper rest when your PsA is flaring. Of course, you don’t want to get too much or will end up with more joint stiffness and swelling. It is also important to pace yourself with a flare.

Put the most important activities on the top of your to-do list and leave other activities for when you are feeling better. Ask for help if you need it and focus on taking care of yourself.

Call Your Healthcare Provider

Sometimes, a flare-up requires more than self-management. If you are experiencing severe flares often, your rheumatologist can adjust a medication dose, add a new medication, or switch you to a different drug. They can also prescribe a more powerful NSAID or a corticosteroid to help you get through the flare.

Prevention

Part of better disease management is working towards preventing flares in the first place. This starts with knowing and avoiding triggers.

Keeping track of PsA symptoms and what you are doing daily—how you are eating, sleeping, and managing stress—can help you figure out what triggers you may have and how to avoid those. Explore some ways to prevent flare-ups of PsA.

Incorporating arthritis-friendly exercise: Proper exercise is important for strengthening muscles, managing stiffness in joints, and keeping you at a healthy weight.

Reducing stressors: Since stress is a PsA trigger, it can make you more sensitive to pain. Find ways to reduce daily stress to keep PsA symptoms at bay, including stress relief techniques, such as mindfulness mediation or yoga. Or you could consider talking to a therapist to help you learn to manage daily stressors and find a balance to avoid flares in the first place.

Getting plenty of rest: Make sure you are practicing good sleep habits, including maintaining a consistent sleep schedule, limiting daytime naps, and making sure your sleep environment is pleasant.

Protecting your joints: You may think you have to give up favorite activities to avoid flares. You don’t; you just have to find ways to take the stress off of your joints. The way you walk, stand, sit, and carry things needs to change. Mobility aids and assistive devices can also help, including grab bars, a cane, or sit/stand stools.

Looking at your diet: Since PsA is an inflammatory condition, following an anti-inflammatory diet can help you control symptoms and prevent flare-ups. Any balanced diet heavy in fruits, vegetables, lean proteins, whole grains, fish, nuts, and plant-based fats is considered an anti-inflammatory diet.

Additionally, you should avoid foods considered pro-inflammatory, such as fatty red meats, foods high in sugar (i.e. sweet snacks and soda), and refined carbs (like white bread, rice, and pasta). If dairy triggers PsA symptoms, try to limit your daily intake.

A Word From Verywell

Without proper treatment, symptoms of psoriatic arthritis will get worse over time and chronic inflammation can cause permanent damage and deformity of affected joints. But treatment can manage inflammation and reduce your risk for flares.

In fact, the newest medications for treating PsA—called biologics—can actually reduce your risk for flares and minimize the severity of a flare should it occur. Follow your healthcare provider’s advice and treatment plan, and tell your practitioner about any problems or concerns that may impact your willingness or ability to take your PsA medications.