Understanding Moderate to Severe Psoriatic Arthritis Flare-Ups

PsA is a chronic inflammatory condition. It happens when your immune system attacks the healthy joints and areas where tendons and ligaments attach to bones.

Symptoms of PsA may vary from person to person. They could also range from mild to severe and affect different parts of your body:

• Joint pain: PsA may affect joints on one or both sides of your body. The most commonly affected joints are those in your fingers, wrists, ankles, and knees.
• Stiffness: Joints affected by PsA can become stiff, which may reduce your range of motion. Joint stiffness is often worse in the morning or following periods of inactivity.
• Fatigue: A 2020 study found that 44% of participants with PsA experienced fatigue.
• Swollen fingers or toes: Also called dactylitis, this is when you develop painful, sausage-like swelling of an entire finger or toe.
• Enthesitis: Approximately 1 in 2 people with PsA experience inflammation, tenderness, or swelling in one or more entheses. These are the areas where tendons or ligaments connect with a bone, such as the bottom of the foot and the back of the heel.
• Lower back pain: Spondylitis is a condition that may cause inflammation in the joints of your spine. This can lead to pain and stiffness in the lower back, neck, and hips.
• Skin plaques: You may develop scaly, inflamed, and discolored patches of skin on your elbows, knees, and scalp.
• Nail changes: Nails may crumble or become pitted. They may also separate from the nail bed.
• Eye inflammation: PsA may increase your risk of uveitis, which is an inflammatory eye condition.

Several factors may cause PsA flare-ups. These may differ for every person.

Knowing what triggers your PsA symptoms can help you manage and prevent future flare-ups:

• Stress: Stress may trigger the release of chemicals that can set off your immune system’s inflammatory response.
• Skin injuries: Cuts, sunburns, and scrapes may cause new skin lesions to appear. This is the Koebner phenomenon.
• Smoking: Smoking can increase the severity of PsA symptoms and interfere with treatment, according to the National Psoriasis Foundation.
• Infections: Thrush, strep throat, upper respiratory, and other infections may trigger a flare-up.
• Drinking alcohol: Alcohol may increase inflammation in the body, leading to flare-ups. It can also interfere with the effectiveness of some PsA medications.
• Skipping or stopping PsA medication: Interruptions to treatment can trigger flare-ups.
• Taking certain medications: Drugs like antimalarials, beta-blockers, and lithium may ramp up the autoimmune response and thereby lead to a possible psoriasis flare-up.
• Having overweight or obesity: This may put extra stress on your joints, increase PsA activity, and impair how well PsA medication works.
• Dry and cold weather: This weather sucks the moisture out of your skin and can worsen PsA symptoms.
• Eating certain foods: Gluten, dairy products, highly processed foods, and others may trigger PsA flare-ups.

There’s currently no cure for PsA and flare-ups. However, a treatment plan can help:

• reduce inflammation
• ease symptoms
• prevent flare-ups
• slow disease progression

Your treatment plan may depend on the severity of your symptoms and the number of joints affected. Identifying and avoiding your triggers is the first step to reducing inflammation associated with PsA.

A healthcare professional may prescribe some of the following medical treatment options for PsA:

• Nonsteroidal anti-inflammatory drugs (NSAIDs): These help lower inflammation and reduce pain.
• Disease-modifying antirheumatic drugs (DMARDs): These help slow the progression of PsA and prevent permanent joint damage.
• Biologics: Biologics are a newer type of DMARD. They target specific parts of the immune system involved in the inflammatory process.
• Janus kinase (JAK) inhibitors: These are oral medications that can help ease symptoms and slow disease progression. They interfere with signaling pathways that cause inflammation.
• Immunosuppressants: These medications can help rein in your overactive immune system.
• Topical treatments: Creams, lotions, ointments, and gels may help ease psoriasis skin flare-ups.
• Steroids: Steroidscan be injected directly into an affected joint to quickly reduce inflammation.
• Joint replacement surgery: This surgery repairs or replaces severely damaged joints with artificial ones made of plastic and metal.

You may need to add, change, or modify your medication during a PsA flare-up. It’s important to speak with a healthcare professional about how your current treatment plan is working. They’ll help you discuss any adjustments.

Some natural remedies and lifestyle changes may help you prevent and manage flare-ups. They can also help alleviate the muscle weakness and joint stiffness associated with PsA.

Here are some tips to help you manage PsA flare-ups:

• Use assistive devices: These devices can help you move. You can also immobilize certain body parts with splints, braces, orthotics, crutches, or walkers so they can rest.
• Exercise regularly: Exercise helps keep your joints flexible, strengthen your muscles, and boost your overall health. Low impact exercises like biking, swimming, and yoga are exercises that won’t stress your joints.
• Modify how you perform daily tasks to protect your joints: For example, you can use a jar opener to remove a lid or a wide fork to eat. An occupational therapist can suggest other tips.
• Apply hot and cold packs when needed: Heat may help loosen stiff joints, while cold packs can reduce swelling and inflammation.
• Consider eating an anti-inflammatory diet that is high in antioxidants: This kind of diet can manage and prevent PsA flare-ups. According to the Arthritis Foundation (AF), some foods to add to your grocery list include fish, olive oil, nuts, vegetables, and lean protein.
• Maintain a moderate weight: This can put less strain on your joints.

What is the first red flag of psoriatic arthritis?

Some of the first signs of PsA include swelling, tenderness, and pain in one or more joints. You may also experience thick, scaly patches of skin and nail pitting, which are characteristic of psoriasis.

How long does a psoriatic arthritis flare last?

PsA flare-ups are unpredictable. You can feel fine one day yet experience a flare-up the next. According to the AF, a flare-up may last for days or even months.

PsA is a chronic inflammatory condition that typically begins to affect people between ages 30–50 years.

Flare-ups are periods when your symptoms worsen. These can be triggered by things like infections, skin injury, and diet. However, identifying and avoiding your triggers can help you prevent flare-ups.

Speak with a healthcare professional if your PsA is affecting your daily activities. They can help develop a treatment plan that’s right for you.