From mcpress.mayoclinic.org
Living with psoriatic arthritis (PsA) can be frustrating. On top of causing psoriasis — a condition that causes thick, scaly patches to form on the skin — PsA also has classic arthritis symptoms such as joint stiffness, pain and swelling.
“Psoriatic arthritis can present in different ways and affect any joint, including small joints like the hands or feet and, rarely, bigger joints like the knees and shoulders and even the spine,” explains Delamo I. Bekele, M.B.B.S., a clinical rheumatologist and inflammatory arthritis specialist at Mayo Clinic in Rochester, Minnesota.
And just like symptoms of psoriasis, PsA symptoms are often cyclic, meaning they flare up and then calm down. At times, flare-ups may only cause mild joint discomfort. But other times, the pain, swelling and stiffness may be so severe that you have trouble working, moving and completing your daily tasks.
PsA can get worse over time, especially in people who have multiple joints affected, have joint damage or have PsA that doesn’t respond to treatment. Understanding and treating flare-ups — and how to prevent them — can help you protect against joint damage, keep you as mobile as possible and minimize the impact PsA has on your quality of life.
What is a PsA flare-up?
With PsA, a flare-up does not necessarily involve skin symptoms, though for some people it does. Most of the time, “a flare-up means an acute worsening of joint pain, stiffness and swelling in someone who usually has chronic psoriatic arthritis,” explains Dr. Bekele. “This can range from one joint to multiple joints and tendons,” he says.
The length and intensity of a flare-up depends on the person. For some, a flare may be intense and last several weeks, while for others, a flare causes only mild symptoms that linger for a day or two. During a flare, you may notice that a new joint or area of the body is affected.
In rare situations, Dr. Bekele says a flare may involve dactylitis — swelling of the fingers or toes. Dactylitis can give a sausage-like appearance to the fingers and toes. As a result, you may hear this type of inflammation called sausage digits.
While flare-ups can’t always be prevented, there are a few tell-tale signs that can help you predict the onset and severity of a flare-up, including:
- Morning stiffness that lasts more than an hour.
- Visible swelling of joints or tendons.
- Reduced range of motion.
- Pain or tenderness in the joints or tendons.
What to know about preventing PsA flare-ups
PsA is a chronic, lifelong condition. Currently, there aren’t treatments that can cure PsA or completely prevent flare-ups. But there are a number of treatment options that can help protect your joints, manage symptoms and improve your quality of life.
The most effective way to prevent flare-ups is with medication — and the sooner therapy is started, the better protected your joints will be. A range of medications is available for PsA and, depending on the situation, your care team may recommend a pill, an injection or an infusion. Topical medications also can help with your skin symptoms, though you may need to see a dermatologist to get these treatments to apply to your skin.
Your medication options may include:
- Nonsteroidal anti-inflammatory drugs (NSAIDs), which help reduce pain and swelling during a flare. These medicines include ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve), which you can buy without a prescription..
- Conventional disease-modifying antirheumatic drugs (DMARDs), which help prevent joint damage and control joint inflammation by targeting the immune system broadly.
- Biologic DMARDs, which target specific parts of the immune system to control joint and skin inflammation and prevent joint damage. Typically, Dr. Bekele says biologics are used if conventional DMARDs aren’t effective.
- Targeted synthetic DMARDs, which may be prescribed if conventional DMARDs and biologic agents aren’t options or aren’t tolerated. These medicines include Janus kinase (JAK) inhibitors.
Although finding the right PsA medication can take time, Dr. Bekele says the goal is to achieve remission — a time when your PsA is either inactive or minimally active. “We know there’s clear data for people who are in remission that the risk of flare-ups is extremely low, if non-existent,” Dr. Bekele says. Taking medications consistently as prescribed is very important to achieving remission.
In addition to prescribing medications, your care team will likely discuss other lifestyle modifications that can help you prevent flares. You may be told to:
- Minimise stress. Too much stress can trigger an inflammatory response from the immune system, which can make your pain, swelling and skin symptoms worse.
- Quit smoking. As with many other chronic conditions, smoking can make your symptoms worse.
- Maintain a healthy weight. Excess weight can increase production of certain proteins called cytokines that exacerbate PsA symptoms. Also, too much extra weight can make some PsA medications less effective. Working on weight loss can help improve your PsA symptoms and overall health.
- Improve your sleep hygiene. Sleeping can help reduce stress levels and support your overall health.
- Maintain a PsA-friendly diet. Anti-inflammatory diets, such as diets that follow principles similar to those of the Mediterranean diet, can help you manage your symptoms.
- Exercise regularly. Dr. Bekele recommends low-impact activities such as walking and pool-based therapy to keep your joints mobile.
Tracking your flare-ups can help you and your care team identify what seems to worsen your PsA symptoms. Triggers can range from certain foods, such as gluten, to changes in the weather. To get started, consider using the, online psoriatic disease flare guide and symptom tracker, a free product offered by the National Psoriasis Foundation.
What to do for a flare-up
Sometimes — despite your best efforts — flares happen. To best cope with a flare-up, work with your healthcare professional to develop a care plan ahead of time.
For the first step, Dr. Bekele recommends assessing the severity of your symptoms — such as pain level, stiffness and swelling — as soon as you notice them. If you have severe pain, have trouble walking or are unable to perform your typical tasks, call your care team immediately or seek emergency care.
In some situations, your care team may recommend steroid injections. But Dr. Bekele says steroids are used sparingly, as they can worsen joint and cartilage health in the long run and may cause unwanted side effects, such as weight gain or worsening skin symptoms.
If your flare is minimal to mild, Dr. Bekele says you may consider using non-prescription anti-inflammatory medicines, such as ibuprofen and naproxen sodium. Ice, rest and, if possible, time off work also can help you manage your flare symptoms.
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