Understanding Moderate to Severe Psoriatic Arthritis Flare-Ups

Psoriatic arthritis is a chronic, inflammatory condition. It affects the joints and areas where tendons and ligaments attach to bones.

In psoriatic arthritis, the immune system overreacts and attacks healthy joints. This can lead to pain, inflammation, swelling, and stiffness.

Symptoms of psoriatic arthritis can vary from person to person. They may range from mild to severe.

Your symptoms may come and go. During a flare-up, you may experience a sudden worsening of symptoms.

Joint pain and swelling

Psoriatic arthritis can cause joints to become painful, swollen, tender, and warm to the touch. It may affect joints on one or both sides of your body.

Joints in the fingers, wrists, ankles, and knees are most often affected.

Stiffness

Joints affected by psoriatic arthritis can become stiff and difficult to move. This can reduce your range of motion.

Joint stiffness is often worse in the morning or following periods of inactivity.

Swollen fingers or toes

Some people may experience painful, sausage-like swelling of an entire finger or toe. This is called dactylitis.

Fatigue

Fatigue is a feeling of constant tiredness or lack of energy that can interfere with daily activities. If you have psoriatic arthritis, your body releases proteins called cytokines that cause inflammation and can contribute to fatigue.

Other causes of fatigue in psoriatic arthritis may include:

• pain
• sleep disturbances
• certain medications
• psoriatic arthritis–related conditions, such as depression or fibromyalgia

Inflammation of the entheses

About half of people with psoriatic arthritis experience enthesitis. It causes inflammation, tenderness, and swelling in one or more entheses. These are the areas where tendons or ligaments connect with a bone.

Enthesitis commonly affects the bottom of the foot and the back of the heel.

Lower back pain

A condition called spondylitis can cause inflammation in the joints of the spine. This can lead to pain and stiffness in the lower back, neck, and hips.

Skin plaques

People with psoriatic arthritis may develop skin plaques characteristic of psoriasis. These are scaly, raised, and inflamed patches of skin. They’re often found on the elbows, knees, and scalp.

Plaques may appear red on lighter skin tones and purple or brown on darker skin tones.

Nail changes

Nails may crumble or become pitted. They may also separate from the nail bed.

Eye inflammation

Psoriatic arthritis can increase your risk of uveitis. This is an inflammatory eye condition that can cause eye pain, eye redness, and blurred vision.

Every person has their own experience with psoriatic arthritis flare-ups. Something may cause a flare-up in one person but not in another.

Finding a link or pattern between certain activities and your psoriatic arthritis flare-ups can help you identify and avoid your triggers. You may want to keep a log of your triggers and symptoms that you can share with a doctor.

Common psoriatic arthritis triggers include:

Skipping or stopping psoriatic arthritis medication

Taking your psoriatic arthritis medication as prescribed can help ease symptoms and prevent flares. If you’re having trouble sticking with your current medication, speak with your doctor about changing or adjusting your treatment plan.

Stress

Stress triggers the release of chemicals that set off your immune system’s inflammatory response, according to the Arthritis Foundation. It can also make your psoriatic arthritis pain feel worse.

Practicing relaxation and stress reduction techniques, such as yoga and meditation, may help ease stress and anxiety. You may also consider joining a psoriatic arthritis support group or talking with a mental health professional.

Certain medications

Drugs that can worsen psoriatic arthritis include:

• antimalarial drugs
• certain beta-blockers that treat high blood pressure and some heart conditions
• lithium, which is prescribed for some mental health conditions

These medications get in the way of your body’s autoimmune response and can cause a flare-up. If you take any of these medications, you can ask your doctor about potential substitutions.

Always let your doctor know that you have psoriatic arthritis before starting any new medications.

Overweight or obesity

Having overweight or obesity can:

• put stress on joints
• increase disease activity
• increase the risk of heart disease
• impair how well certain psoriatic arthritis medications work, according to a 2018 study

If your doctor says you may benefit from losing weight, talk with them about diet, exercise, and other lifestyle strategies that may help.

Common infections

Common infections like thrush, strep throat, and upper respiratory infections are potential triggers for a flare-up. If you think you have an infection, talk with your doctor about your treatment options.

Alcohol

Alcohol may increase inflammation in the body, potentially leading to flare-ups. It can also interfere with the effectiveness of certain psoriatic arthritis medications.

Smoking

Smoking cigarettes can increase your risk of psoriasis and psoriatic arthritis. It may make the conditions more severe, too.

Smoking may also make some psoriatic arthritis medications not work as well as they could, and make it harder to stick with your treatment plan, according to a 2018 study.

If you smoke and are ready to quit, talk with your doctor about smoking cessation methods that may help.

Diet

Certain foods and ingredients can cause inflammation and may trigger flares. For instance, research shows that gluten, which is found in some grains including rye, wheat, and barley, can aggravate psoriasis symptoms.

There’s no one diet that’s right for all people with psoriatic arthritis. Talk with a doctor or dietitian about creating a meal plan that works for you.

Skin trauma or injury

Trauma to the skin can cause new psoriasis lesions to appear. This is called the Koebner phenomenon.

Skin injuries include:

• cuts
• bumps
• bruises
• scratches
• scrapes
• burns
• infections

You can help prevent skin injuries by being careful while doing activities such as cooking, gardening, nail trimming, and shaving. Wear gloves and long sleeves when doing an activity that could potentially cause injury.

Dry skin

Dry skin can cause a flare of psoriasis symptoms. Aim to keep skin hydrated with moisturizing lotions and creams.

Sunburn

While sunshine is good for psoriasis, getting sunburned is not. A sunburn can trigger a psoriasis flare.

Whenever you’re outside, even on cloudy days, take steps to protect your skin, such as applying sunscreen and wearing a hat.

Climate

Cold, dry weather that sucks the moisture out of your skin can worsen symptoms. Drying heat units also strip moisture from your skin.

Additionally, a lack of sunlight can trigger flare-ups. Minimize your time spent in the cold whenever possible. Use a humidifier at home to add moisture to the air.

Psoriatic arthritis flare-ups are unpredictable. You can feel fine one day yet experience a flare-up the next.

The length of a psoriatic arthritis flare-up varies from person to person. A flare-up can last for days or months, according to the Arthritis Foundation.

The goal of psoriatic arthritis treatment is to reduce inflammation, ease symptoms, prevent flare-ups, and slow disease progression. Your treatment may depend on disease severity and the number of joints affected.

Medical treatment options for psoriatic arthritis include the following:

• Nonsteroidal anti-inflammatory drugs (NSAIDs) can lower inflammation and reduce pain.
• Disease-modifying antirheumatic drugs (DMARDs) can help slow the progression of psoriatic arthritis and prevent permanent joint damage. Your doctor may prescribe DMARDs if NSAIDs don’t work well for you.
• Biologics are a newer type of DMARD. They target specific parts of the immune system involved in the inflammatory process. Biologics for psoriatic arthritis include:
  • tumor necrosis factor-alpha (TNF-alpha) inhibitors
  • interleukin 12 and 23 (IL-12/23) inhibitors
  • interleukin 17 (IL-17) inhibitors
  • interleukin 23 (IL-23) inhibitors
  • T-cell inhibitors
• Janus kinase (JAK) inhibitors are oral medications that can help ease symptoms and slow disease progression. They interfere with signaling pathways that cause inflammation.
• Immunosuppressants can help rein in your overactive immune system.
• Topical treatments are creams, lotions, ointments, gels, and other products you can apply directly to the skin to ease flares of psoriasis symptoms.
• Steroidscan be injected directly into an affected joint to quickly reduce inflammation.
• Joint replacement surgery repairs or replaces severely damaged joints with artificial ones made of plastic and metal.

You may need to add or change medication during a psoriatic arthritis flare. Work with your doctor to review your current treatment plan and discuss adjustments that may help.

Certain lifestyle strategies can help prevent and manage flares as well as alleviate the muscle weakness and joint stiffness associated with psoriatic arthritis. These strategies include the following:

• Use assistive devices during flare-ups: You can also immobilize certain body parts with the use of splints, braces, orthotics, crutches, or walkers so they can rest.
• Exercise regularly: Exercise can help keep joints flexible, strengthen your muscles, and boost your overall health. Walking, biking, swimming, and yoga are just a few exercises that won’t stress your joints.
• Modify how you perform daily tasks: This can help protect your joints. For example, you can use a jar opener to remove a lid. An occupational therapist may be able to suggest other modifications.
• Apply hot and cold packs when needed: Heat may help loosen stiff joints. Cold packs may help reduce swelling and inflammation.
• Maintain a moderate weight: Your joints will have less strain on them as a result.

There’s no current cure for psoriatic arthritis, and the flare-ups can be painful enough to interfere with your day-to-day life.

But you can help lessen their impact by identifying and avoiding your triggers and taking steps to reduce inflammation associated with psoriatic arthritis.