Your guide to preventing psoriatic arthritis flare-ups, from medication and symptom tracking to lifestyle changes

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.

                                                                                                                      Getty Images

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.

https://mcpress.mayoclinic.org/psoriatic-arthritis/your-guide-to-preventing-psoriatic-arthritis-flare-ups-from-medication-and-symptom-tracking-to-lifestyle-changes/ 

How Do You Manage Holiday Stress With Psoriatic Arthritis?

From healthcentral.com

By Meaghan Quirin

It starts with setting realistic expectations for the season 

For me, managing holiday stress with psoriatic arthritis (PsA) really comes down to protecting my energy: physically, emotionally, and socially. The holidays can be so joyous, but they can also be exhausting. Between navigating endless to-do lists, family dynamics, colder weather, travel, and packed calendars, it’s a time of year that can push my body and nervous system past their limits pretty quickly if I’m not intentional about how I move through it.

I’ve learned to start by setting realistic expectations. I used to say yes to everything, every invitation, every tradition, every last-minute errand because I didn’t want to let people down or miss out. But now I’m much more honest with myself about what I actually have the capacity for. I ask: What matters most to me this season? What can I let go of? That alone takes so much pressure off.

I also try my best to plan ahead in ways that reduce the chaos. I spread things out over a few weeks instead of cramming errands and prep into one weekend. I look at what else is on my calendar before committing to anything new, and I make sure to block off time for rest, especially if I know something will require more energy or recovery, like travel or a family gathering.

Comfort is another big part of how I get through the season. I’ve let go of trying to look perfectly put together in ways that don’t actually feel good. These days, I’m prioritizing warm layers, soft clothes, supportive shoes and whatever else helps me stay grounded and comfortable in my body. If that means showing up to the holiday party in sneakers and carrying heat packs in my bag, so be it.

Emotionally, I try to give myself space to feel whatever’s coming up. The holidays can stir up grief and frustration of not being able to participate the way I want to. I don’t force myself to be cheerful if I’m not feeling it. But I also try to stay open to small moments of joy and connection, even if they don’t look like I envisioned. Some years, that means new traditions, or quieter ones; it’s saying no to protect my peace and not feeling bad about it.

More than anything, I remind myself that I don’t need to earn rest or prove anything to anyone. Living with PsA means I already have to be mindful of how I use my energy all year long, but during the holidays, I double down on that to avoid stress and burnout. It’s not about doing everything. It’s about doing what matters, in a way that is mindful of how I feel!

https://www.healthcentral.com/condition/psoriatic-arthritis/how-do-you-manage-holiday-stress-with-psa?ap=nl2060&rhid=67ec2b8321f52bf01b0cca01&mui=&lid=141093361&mkt_tok=NTQxLUdLWi0yNDMAAAGefpBusLjyFe7YrljxI-BfpeWftzUtbI_jKvnM0nxzjSfnV3VgdM7Tkf7nAbudJms7BQwBBuxBEDGU80WbLuOnSkx_d4YCS9xdvxfenoZG2k-xeW4 

Orthopaedic surgeon explains why arthritis becomes more painful in winter

From hindustantimes.com

It is totally valid to dread winters if you have arthritis, since the colder months don't go easy on the bones. Dr Vaish shares 5 ways you can manage pain

For many people living with arthritis, winter is far from magical. Cold temperatures, falling barometric pressure, and reduced sunlight can intensify joint stiffness and pain, making flare-ups far more challenging to manage. Understanding why this happens - and how to ease the discomfort - can make the colder months much more bearable. 

                                                        According to Dr Vaish, cold temperatures can make your joint pain worse. (Pixabay)

Dr Abhishek Vaish, consultant orthopaedic surgeon, joint replacement and sports injury specialist from Indraprastha Apollo Hospital and Healing Touch Clinic, Okhla, New Delhi, told HT lifestyle, “Those with arthritis are harder hit by these chilly waves. As the temperature drops, the capillaries narrow, causing stiffness, joint swelling, and weariness. Additionally, their joints respond to an accumulation of pro-inflammatory chemicals, which complicates the situation.”

Why does this happen?

The following are a few causes of arthritis flare-ups during winter, as outlined by Dr Vaish:

• Winter increases the sensitivity of the pain receptors.
• Joint discomfort results from the air pressure dropping. When pressure drops, tissues swell, causing tension to accumulate between joints, resulting in discomfort.
• Colder temperatures cause greater muscular spasms, which exacerbates joint pain and stiffness.
• The cold decreases blood flow to the hands and feet, intensifying arthritic discomfort.
• Vitamin D levels drop throughout the winter months due to decreased sunlight, which also weakens bones and joints.
• 
  

Ways to reduce pain

Dr Vaish outlines five effective tips to lessen pain during the colder months.

1. Staying warm

Dr Vaish notes that the most effective way to ease the pain is to stay warm, ideally in a temperature-controlled environment that shields you from the cold. He elaborates, “It is obvious that staying indoors in an environment with proper temperature control is the best method to prevent the cold. However, layering warm clothing made of quick-drying fabrics like wool is one of the greatest strategies to prevent cold weather aches and pains if you must go outside. Wearing long underwear could also help keep your lower extremities warm if you have arthritis in your hips or knees. Keep your feet and hands warm as well! Extra warm socks and a nice pair of insulated gloves can be helpful. You can also spend some time in a warm bath if you arrive home with joint ache from the cold.”

                                                    Dr Vaish highlights that staying warm is the best way to prevent pain. (Pexel)

2. Remain active and preferably indoors

According to the orthopaedic surgeon, one of the most effective ways to prevent arthritis discomfort is through regular exercise - a habit that also supports overall wellbeing. Dr Viash notes, “Regular exercise helps to increase muscle strength, flexibility, and energy levels, all of which can assist to lessen joint discomfort. Your joints will be least stressed by low impact exercises.” He recommends the following exercises:

• Yoga
• Elliptical trainers or indoor cycling machines
• Aerobics
• Strength training
• Walk or run on treadmills or cushioned indoor tracks

If you've never exercised before, Dr. Vaish recommends, “You should start off slowly. Start out by exercising for about two to 10 minutes, twice daily. Rest well in between workouts. You can lengthen and intensify your workouts as you become more accustomed to your new pursuits.”

3. Use compression gear

The orthopaedician emphasises that compression gear is among the most effective tools for easing joint pain in people with arthritis. He explains, “For years, compression clothing such as arm sleeves, gloves, and socks has helped to ease joint pain. These things aid in boosting circulation, which has been proved to alleviate arthritis discomfort. Compression clothing can trap heat, acting as an additional layer to keep your hands and legs warm throughout the harsh winter months.”

4. Omega-3 fatty acids and vitamin D

Eating foods rich in vitamin D and omega-3s can strengthen bones and help reduce discomfort. But in winter, limited sun exposure lowers the body’s vitamin D production, leaving those with already low levels more prone to pain.

Dr Vaish recommends, “Adults should consume between 20 and 50 ng/mL of vitamin D daily. Consume meals high in omega-3 fatty acids, which are rich in vitamin D, such as salmon or mackerel. There are several items on the market that have been fortified with omega-3 fatty acids and vitamin D, such as milk and cereals. To enhance your consumption, you can also take fish oil and vitamin D pills. In fact, a teaspoon of cod liver oil can supply all of your daily needs for vitamin D.”

5. Keep a healthy weight

Dr Vaish stresses that maintaining a healthy weight is crucial for preventing aching joints, as excess load places unnecessary strain on them. He states, “According to studies, brown adipose tissue, which emits pro-inflammatory chemicals that might harm joints, is more common in individuals with high body mass indices (BMIs). Additionally, autoimmune disorders like rheumatoid and psoriatic arthritis can be brought on by inflammation. Additionally, obesity has been associated with a rise in knee arthritis cases. The greatest strategies to maintain a healthy weight are through a nutritious diet and an active lifestyle.”

Note to readers: This article is for informational purposes only and not a substitute for professional medical advice. Always seek the advice of your doctor with any questions about a medical condition.

https://www.hindustantimes.com/lifestyle/health/orthopaedic-surgeon-explains-why-arthritis-becomes-more-painful-in-winter-shares-7-strategies-to-ease-discomfort-101763896440526.html

Science Reveals 3 New Ways to Relieve Knee Arthritis Pain

From webmd.com

Although joint damage is permanent, new research suggests promising ways to ease knee arthritis pain and possibly slow its progression 

If knee arthritis were a growth stock, you’d want to own a few shares.

Fifty percent of adults in the U.S. will develop knee osteoarthritis, which happens when the cartilage in the joint wears away and the bones rub more closely against one another. Once you have it, you can expect to live with it for 26 years, on average. 

While the damage can’t be reversed, new research offers promising ways to mitigate the pain and perhaps even slow the disease’s progress by targeting what drives it — things like body weight and mechanical load. 

Three recent studies exemplify the trend. 

1. Consider Weight Loss Drugs

Excess body weight has long been linked with increased knee arthritis risk. People with obesity have higher rates of knee arthritis, get diagnosed younger, and experience more pain and physical limitations. 

“Just telling people ‘go lose weight’ is not going to work,” said Elena Losina, PhD, a biostatistician and professor of orthopaedic surgery at Harvard Medical School.  

In a recent study, Losina’s research team created a model to project the cost effectiveness of five weight loss treatments for people with both obesity and knee arthritis: 

• Diet and exercise
• Tirzepatide (Mounjaro, Zepbound), a type of weight loss drug called a GLP-1 agonist
• Semaglutide (Ozempic, Wegovy), another GLP-1 medication
• Gastric sleeve surgery
• Gastric bypass surgery

The model, which was based on a method called a Monte Carlo simulation, weighed each treatment’s price tag against its projected long-term impact on quality of life. For example, the more weight someone loses, the more pain relief they should experience, along with fewer movement limitations and a lower risk of health problems like type 2 diabetes and heart disease. 

Myths and Facts: Using a GLP-1 for Weight Loss

The study found that tirzepatide gave people more years of healthier life than semaglutide, diet and exercise alone, or the “usual care” for obesity and arthritis (which may mean no treatment beyond monitoring symptoms). Semaglutide could still be cost-effective for some patients, the study found, but tirzepatide was rated as the best nonsurgical option overall. 

For people with a BMI of 35 or above, gastric bypass surgery scored highest. It produced the best results and cost less over a person’s lifetime than either of the medications, partly because surgery is a one-time cost rather than an ongoing expense.

“Bariatric surgery has very high efficacy in terms of weight loss for a very long time,” Losina said. But it’s a drastic procedure, with all the risks that entails. That’s why most people who have the choice opt for medication over surgery.

Since the study came out, the U.S. government announced an initiative to reduce the cost of GLP-1 medications — “an exciting development,” Losina said. 

Still, exercise remains the cheapest treatment option, and a second new study may help make it less painful.  

2. Change the Way You Walk 

Exercise is the most commonly recommended treatment for knee arthritis, and walking is the most commonly recommended type of exercise. 

But the repetitive stress of walking — never mind running, basketball, or tennis — can sometimes worsen knee pain.

Arthritis typically begins in the medial compartment of the knee — the part closest to the other knee. 

Medial arthritis is three times more common than lateral arthritis, on the outer part of the knee. That’s because, when you walk, 70% of the compressive force lands on the medial compartment. 

The way you walk can make the problem worse by shifting even more of that stress to the inside of the knee.  

But a recent experiment from researchers at Stanford and the University of Utah showed that gait changes could help patients with medial compartment arthritis shift some of that force to the outside of the knee, reducing pain and making exercise a more viable option.

Participants took a gait retraining program where they learned to turn their toe in or out when landing and pushing off, whichever put less pressure on the medial compartment. 

Most of them (82%) were trained to turn their toes in slightly — by 5 or 10 degrees — when they walked. The rest were trained to turn their toes out. 

After six weeks, all of them reported mild to moderate reductions in walking-related pain. After a year of maintaining the modified gait, their pain had improved even more. 

The Stanford protocol relies on experts and special equipment, so it can’t be replicated at home. But you can talk to your health care provider about making small changes to the way you walk. A physical therapist may be able to assess your gait to reduce pressure on your knee. 

Fortunately, there is an exercise program that requires only internet access and a little floor space.

3. Try a Free Tai Chi Program  

Physical therapist Kim Bennell, PhD, has been studying musculoskeletal injuries for three decades. 

In recent years, she and her research team at the University of Melbourne in Australia have increasingly focused on exercise, as it’s the most effective nonpharmaceutical, nonsurgical arthritis treatment.

One continual challenge: too many barriers to exercise for the people they were trying to help. 

Some live in remote areas without access to facilities or coaching. And some who live in cities and suburbs either don’t have transportation, aren’t mobile enough to get to a facility, or can’t afford to join a gym or pay a trainer.

“So we decided to design and test unsupervised programs that we could offer free,” said Bennell, a professor at the university’s Centre for Health, Exercise, and Sports.

Her team’s most recent study featured an online tai chi program designed for adults with knee arthritis. Participants were given access to a series of 45-minute tai chi videos, led by one of the study’s co-authors, and instructed to do three 45-minute sessions per week. 

After 12 weeks, 73% of the participants reported a clinically meaningful reduction in knee pain while walking, along with improvements in physical and mental well-being. 

This is the third online exercise program Bennell’s team has created for knee arthritis patients. The first was a six-month strength program, published in 2021. That was followed by a three-month yoga program in 2022. 

All three are free to access for anyone who wants to try them. So far, Bennell said, they’ve had 60,000 users from 120 countries.

“The tai chi program seemed to give better results for pain, compared with the yoga program,” Bennell said. Research shows tai chi can improve strength, mobility, balance, and endurance, which may lead to more controlled movement patterns, with better joint stability. The strength program was similar to tai chi in terms of pain reduction. 

Arguably the most important factor for the program’s success: “Participants did report high satisfaction with all three programs and were highly likely to recommend them to others,” Bennell said. 

https://www.webmd.com/pain-management/knee-pain/news/20251119/science-reveals-3-new-ways-relieve-arthritis-knee-pain