Managing Ankylosing Spondylitis Flares: When to Call a Doctor
Is it time to get in touch with your doctor?
Ankylosing spondylitis—an inflammatory arthritis that affects the spine—may have periods of time where symptoms worsen. These are called flares. Managing ankylosing spondylitis flares is a crucial part of your treatment regimen, so it’s important to include your doctor in that conversation.
“I don't think there's any time when your doctor should not be alerted to the fact that your symptoms are more severe and that you're not feeling well,” says Anca D. Askansase, MD, MPH, rheumatologist at Columbia University Irving Medical Center. “It may be just as simple as a phone call and a reassurance, or it may be more complicated.”
The Risk of AS Flares
Your flares are not just a time of worsened symptoms. They’re a time when disease activity is worse, which makes your joints more vulnerable to long-term damage.
“The time of flare is a time of worsening inflammation. All bouts of inflammation can lead to damage. The quicker we quench the inflammation, the less likely the damage will accumulate,” says Dr. Askansase.
With AS, the main concern is spinal fusion. This is when AS inflammation becomes so severe that vertebrae fuse together over time, forming a rigid and immobile spine. Frequent and unmanaged flares are a sign that your treatment may not be working, and your risk for spinal fusion may be higher.
Is It a Flare?
Part of managing your flares is being able to recognize them. Dr. Askansase describes it as a “change from your baseline.”
“You were fine. You maybe had a little pain. But all of a sudden, that pain is now much higher, much more intrusive in your life than before,” she says. That change is a flare.
Key signs of a flare include:
- Sudden and unexplained worsening of pain
- Increased stiffness, especially in the morning
- Decreased mobility
- More limitations in your activity and function
Think you’re having a flare? “Please come in. Let's reevaluate the blood work [and] X-rays. Let's see what the change is,” says Dr. Askansase. “Work with your doctor. It's the partnership that will take you through to the other side of the flare.”
Dr. Askanase is a rheumatologist specializing in lupus, Sjogren's syndrome, and vasculitis at Columbia University Irving Medical Center. She is the founder and clinical director of Columbia's Lupus Center and the Director of Rheumatology Clinical Trials.
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(peppy acoustic guitar music)
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I don't think there's any time when your doctor
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should not be alerted to the fact
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that your symptoms are more severe
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and that you're not feeling well.
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(peppy acoustic guitar music)
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Ankylosing spondylitis is a disease of the axial skeleton.
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It's the spine and the sacroiliac joints,
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the big joints in the middle of the pelvis.
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The skeleton of the core is inflamed.
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A flare is a change
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in the activity of the disease, so you were fine,
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you maybe had a little pain, but all of a sudden,
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that pain is now much higher,
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much more intrusive in your life than before.
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So a flare is a change from your baseline.
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Out of the blue worsening pain,
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decreased mobility, increased stiffness are all signs of flare.
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The time of flare is a time of worsening inflammation.
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All bouts of inflammation can lead to damage.
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The quicker we quench the inflammation,
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the less likely that damage will accumulate.
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Working with your doctor to keep flares under control,
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be it by understanding that you might need
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a different anti-inflammatory nonsteroidal,
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or a different steroidal,
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or even a different disease-modifying drug,
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or a different biologic.
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Work with your doctor. It's the partnership
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that will take you through to the other side of the flare.
- Axial spondyloarthritis. Arthritis Foundation. (Accessed on September 14, 2020)
- Clinical manifestations of axial spondyloarthritis (ankylosing spondylitis and nonradiographic axial spondyloarthritis) in adults. Waltham, MA: UpToDate, 2020)
- DMARDs. Arthritis Foundation. (Accessed on September 14, 2020)
- Treatment of axial spondyloarthritis (ankylosing spondylitis and nonradiographic axial spondyloarthritis) in adults. Waltham, MA: UpToDate, 2020)