While medications help keep symptoms under control, flare-ups can’t always be avoided. Spotting the signs of a flare-up quickly and knowing how to manage the symptoms can help ease your discomfort.
What Causes Psoriatic Arthritis Flare-Ups?
A psoriatic arthritis flare-up can be triggered by a variety of factors. Your immune system may be activated by stress, infections such as HIV or strep throat, a physical injury, or smoking, to name just a few potential causes, says Petros Efthimiou, MD, a professor of clinical medicine and rheumatology at NYU Langone Health in New York City. When that happens, your joints might start to feel swollen, tender, and stiff, and you might develop areas of tendonitis or swelling of an entire finger or toe, says Theodore Fields, MD, a professor of clinical medicine at Weill Cornell Medical College and attending rheumatologist at Hospital for Special Surgery in New York City. But it’s also possible that you won’t have swelling during a flare-up. Your main symptom might be fatigue, Dr. Fields adds. It’s important to be in tune with how you feel every day so you can recognize the signs of a flare-up and alert your doctor right away. “We have many medications that can help stop the progress of psoriatic arthritis and dramatically ease symptoms,” Fields explains. The sooner you address symptoms, the faster you can get relief and prevent potential joint damage.
1. Decrease pain and stiffness
For occasional discomfort, Fields says, nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen can be beneficial. Ask your doctor about increasing the dose during a flare-up. You can also try heat or ice at the source of discomfort, Fields says. If pain persists, he adds, your doctor may recommend prescription pain medication or a steroid injection at the affected joint.
2. Incorporate arthritis-friendly exercise
Proper exercise is essential for keeping joints and tendons loose, strengthening muscles, and maintaining a healthy weight, says the NPF. During a flare-up, try gentler exercises, such as walking, swimming, or yoga. If your condition is keeping you from exercising, work with a physical therapist to help you get moving again.
3. Reduce stress
Not only is stress a psoriatic arthritis trigger, but it can also make you more sensitive to pain, the NPF reports. A report published in 2015 in the American Journal of Public Health Research suggests that taking several deep breaths and letting go of tension will help you regain calm. You can also try stress-relieving techniques such as guided imagery, suggests the National Center for Complementary and Integrative Health.
4. Get extra rest
Sleep disorders such as insomnia and obstructive sleep apnea are more common in people with psoriatic arthritis and psoriasis, the NPF reports. To improve sleep quality, the NPF recommends practicing good sleep habits, such as going to bed early enough to get adequate sleep, and stress-reduction techniques to help you sleep well. Sometimes even getting extra rest may not resolve this level of fatigue, but giving your body time to recover from pain and inflammation may be beneficial since fatigue can be related to severity of inflammation, according to a 2018 study published in the journal Reumatologia.
5. Consider using assistive devices
Your doctor may recommend various devices to provide additional support for an affected joint. A splint can be used to hold a joint in the best position for improved function or to relieve pain and swelling. If foot or heel pain are concerns, foot orthotics such as shoe inserts or pads, may provide relief and improve your gait. Talk to your doctor about your specific symptoms.
What About Managing a Psoriasis Flare-Up?
Controlling psoriasis is key to managing psoriatic arthritis flare-ups. While psoriatic arthritis and psoriasis are two separate conditions, 85 percent of people with psoriatic arthritis have psoriasis before developing the joint disease, according to the NFP. The severity of one disease does not dictate the severity of the other, so your treatment should be individualized. “Some patients have severe psoriasis and mild arthritis, and the treatments are guided by the skin problem,” Fields says. “Some patients have severe arthritis and not such severe skin problems, [and] in that case, the arthritis will determine the therapy.” Here are some ways to address psoriasis symptoms during a flare-up:
Moisturize. During a flare-up, locking in moisture is the first step to relieving the itch, according to the NPF. “Have a good skin care regimen, especially in dry weather,” says Delphine Lee, MD, PhD, director of the Dermatological Center for Skin Health at Providence Saint John’s Health Center in Santa Monica, California. “Furthermore, in winter months you may flare and should see a board-certified dermatologist for topical or systemic prescription medications if itching is not relieved with your usual regimen.” Apply a rich moisturizing cream or ointment to retain moisture and fight the itch.Avoid skin injury. “Psoriasis can develop at sites of trauma or skin injury,” Dr. Lee cautions. When you are experiencing a flare, protect your skin from chafing and additional irritation by wearing soft, breathable cotton fabrics, the NPF recommends.Address the stress. Stress worsens all symptoms during a flare-up, according to the Arthritis Foundation. Keeping a journal is one way you can release some of the stressful feelings you may be dismissing. You can also look over recent journal entries during a flare-up to identify stress triggers. Consider sharing your findings with a professional therapist who understands the emotional impact of psoriasis and who can help you better manage your stressors.
Additional reporting by Brian P. Dunleavy
