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Psoriatic arthritis is an autoimmune disease and a chronic form of inflammatory arthritis that commonly affects people with psoriasis. The main symptoms of psoriatic arthritis include joint pain, swelling, and stiffness, which can become worse over time. However, most people diagnosed with psoriatic arthritis go through periods when their symptoms improve or resolve (remission) and then return or worsen. A period of worsened symptoms is called a flare or flare-up.
When you feel PsA symptoms returning, it’s important to get a handle on the condition quickly. Treating a flare early may prevent symptoms from becoming severe or interfering with daily life. Here’s what you need to know about living with psoriatic arthritis flares so you can work with your doctor to treat them effectively.
Just as psoriatic arthritis affects people differently, so do flares. But there are some common symptoms to watch out for. Because flares can come up at any time, they can disrupt life significantly. One member told others, “My feet are burning and stinging. Just did a little shopping; that’s all it takes.” Another said, “Psoriatic arthritis makes you feel so tired and drained that you feel like every step is so heavy and tiring.”
During psoriatic arthritis flares, some people have painful, swollen joints, as well as less characteristic symptoms, such as extreme fatigue and rashes. Joint problems and other psoriasis symptoms may happen simultaneously or at different times during flare-ups. Some individuals experience a flare as a general feeling of discomfort before more specific joint pain sets in.
How long a flare lasts varies from person to person and could mean a couple of days or a week. Usually, if symptoms last just a few hours, they’re not considered a flare. However, if the symptoms are severe, contact your doctor, even if the symptoms haven’t lasted that long. The bottom line: No set amount of time defines a psoriatic arthritis flare, but if your daily activities are affected more than usual, it’s time to talk to your rheumatologist.
There are many ways that you and your doctor can work together to manage your psoriatic arthritis flares and limit how many you experience. Some approaches are proactive, meaning they should be done even before PsA flares begin. Taking steps proactively may help prevent or minimize symptoms should a flare-up occur. Proactive treatment can also help you avoid long-term complications, such as joint damage, that can come from not treating the condition.
Other methods for managing psoriatic arthritis flares involve treating symptoms during flare-ups themselves. If your PsA does flare, you’ll need to take steps beyond those you do daily to manage your condition.
If you’ve been diagnosed with psoriatic arthritis, taking the following actions, which include some lifestyle changes, can help you manage the condition, limit the number of flares, and improve your quality of life:
You have many medication options when it comes to the treatment of psoriatic arthritis. Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (sold as Advil and Motrin) or naproxen (Aleve), can help you manage mild to moderate pain and inflammation. Prescription NSAIDs are also available. If a particular joint is causing you pain, corticosteroid injections can help provide immediate, short-term relief.
Systemic treatments can help you manage disease activity and prevent flares from occurring.
Disease-modifying antirheumatic drugs (DMARDs), such as methotrexate (sold as Otrexup, Rasuvo, and Trexall) or biologics, can help manage psoriatic arthritis.
Examples of biologics used to treat psoriatic arthritis include:
The phosphodiesterase 4 (PDE4) inhibitor apremilast (Otezla) or the Janus kinase inhibitors tofacitinib (Xeljanz) and upadacitinib (Rinvoq) may also be appropriate treatment options.
The right medication will depend on the severity of your condition and which therapies you already tried. Your doctor will help you understand your options and which treatment plan may work best for you.
Psoriatic arthritis can have many types of triggers, which vary from person to person. One MyPsoriasisTeam member said, “I find that stress is my main trigger,” while another shared that coffee triggers their flare-ups. The key is to get to know which triggers cause PsA flare-ups for you.
Sometimes, comorbidities (co-occurring health conditions) can trigger a psoriatic arthritis flare. As one MyPsoriasisTeam member shared, “PDD [premenstrual dysphoric disorder] sucks! Stomach impaction makes it flare, which in turn flares the psoriatic arthritis.”
Other times, PsA seems to flare on its own. One member who experienced this wrote, “I have plaque psoriasis, psoriatic arthritis, and psoriatic nails. At the present time, my psoriasis is under control, but my arthritis flares. I just never know when it’s going to happen.”
You may want to keep a diary to track all possible triggers, including foods and the temperature and weather. Logging your psoriatic arthritis symptoms alongside these factors may help you identify what leads to or worsens your symptoms. Once you know your triggers, you can do your best to avoid them or limit their impact on your life.
Consistent exercise benefits your overall wellness and can help reduce flares. Regular exercise can help you stay at a healthy weight for your body, which is important because excess weight or obesity might prevent your medications from working properly. Physical activity can also keep your affected joints working well, help you get good sleep, and reduce your stress levels. All these benefits may stave off psoriatic arthritis flares.
After getting recommendations for specific exercises by a health care provider, one member shared, “The exercises are really helping!”
Sunburn can be a significant trigger for many people with psoriatic arthritis — especially those who also have psoriasis. Their skin may be extra sensitive to the sun, and prolonged exposure may lead to PsA flare-ups, too. When you’re in the sun, wear sunscreen and sun-protective clothing.
Any sort of injury can trigger psoriatic arthritis flares, including skin infections, bumps, and bruises. These injuries might trigger psoriasis flares before arthritis also flares up. Take care to avoid bumping your joints or inflicting another injury.
Stress is a major trigger for many people diagnosed with psoriatic arthritis. Dealing with a chronic illness is tough enough, and life stress can add to the equation. It’s important to look at your life and your schedule and see where and when you might experience extra stress. You and your doctor can develop a plan for what you will do to avoid a flare during those times of anxiety.
Finding effective techniques for reducing your stress levels is key. You may want to try progressive muscle relaxation, biofeedback, meditation, or mindfulness — all have been shown to lower stress. You may also want to speak to a mental health professional about your stress and anxiety.
If you find yourself in the middle of a psoriatic arthritis flare, you can take a few actions to help manage your symptoms at the moment.
Start by decreasing your physical activity. Less activity doesn’t necessarily mean staying in bed or sitting on the sidelines, but you may need to do the minimum instead of pushing yourself. Stepping back may help you lower your stress levels and give your body time to recover.
When psoriatic arthritis flares up, it’s time to talk to your rheumatologist. It’s possible that your medications may no longer be working as effectively, or your body may need more support to get you through this difficult period.
If one type of medication isn’t working, you may need to try another. Ask your doctor for advice — they’ll help you find the right medication while minimizing potential side effects.
Both heat and cold can help relieve symptoms of psoriatic arthritis during flares. Heat helps ease pain and tension by loosening the muscles around joints and increasing flexibility and circulation. Cold, on the other hand, helps reduce inflammation, swelling, and pain.
For hot therapy, the Cleveland Clinic recommends these options:
For cold therapy, apply a gel-filled cold pack, a bag of frozen vegetables, or a baggie filled with ice for 20 minutes at a time.
Don’t let your pain get worse and worse. Talk to a rheumatologist about managing your pain as soon as it begins. Your doctor can advise you on the best medical and at-home treatments to help manage your discomfort. They may even recommend trying a splint or a brace to reinforce painful joints.
MyPsoriasisTeam is the social network for people and their loved ones with psoriasis and psoriatic arthritis. More than 112,000 members come together to ask questions, give advice, and share their stories with others who understand life with psoriatic disease.
How do you manage PsA symptoms during flares? Have you figured out what tends to trigger your flares? Share your tips in the comments below or by posting on MyPsoriasisTeam.
Ariel D. Teitel, M.D., M.B.A. is the clinical associate professor of medicine at the NYU Langone Medical Center in New York. Review provided by VeriMed Healthcare Network. Learn more about him here.
Sarah Winfrey is a writer at MyHealthTeam. Learn more about her here.
