Step 1: Check in with your rheumatologist.
“Patients with psoriatic arthritis will usually have disease flares,” says Nicola Kim Berman, MD, rheumatologist based in New York. “They might feel fine for a few weeks … and then develop what’s called a flare, [which means] your disease is acting up again and you’ll get swelling in your joints.”
During a flare, it’s important to take steps that will reduce not only your pain and stiffness, but also the inflammation to prevent complications of PsA, such as joint deformities. Thus, when a flare occurs, contact your doctor.
Your doctor will first make sure that what you are experiencing is actually a flare. Some flares can mimic other problems, including viral or bacterial infections that need treatment, especially if you’re taking immunosuppressive medications.
Additionally, doctors may prescribe different medication during a flare than what you would normally take for your day-to-day treatment plan for PsA. “They can prescribe you something to calm down the flare, particularly if you are uncomfortable, can’t go to work, or can’t carry out your activities of daily living,” says Dr. Berman.
These medications—which include steroids and nonsteroidals—are effective at treating a PsA flare, but they’re not ideal for long-term, everyday use. One reason for that is they can worsen psoriasis symptoms, such as red, flaky, scaly plaques on the skin.
But not all flares are created equal. Some mild flares can simply be treated with over-the-counter anti-inflammatory medicines, such as ibuprofen, according to Dr. Berman. However, severe flares that affect multiple joints to a great extent usually require medical intervention, like steroid injections.
Along with medications, you may need to pay attention to your daily habits to prevent and manage flares. “Living a healthy lifestyle to reduce in the inflammation in your body is important,” says Dr. Berman. The following habits may trigger or worsen PsA flares, according to Dr. Berman:
High, unmanaged stress
Lack of sleep
Lack of exercise
To lessen the impact of a flare, learn more about daily habits to manage PsA inflammation here.
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A lot of people who take
their medication correctly, and
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live a healthy lifestyle, and
see their doctor regularly, and
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really focus on controlling and caring for
their condition, do very very well.
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00:00:21,053 --> 00:00:22,915
When you have psoriatic arthritis,
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it is important to stay on your biologic
therapy as directed by your doctor.
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If you stop your medication,
you can develop flares, and
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then you'll have to restart it again.
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The problem with doing that, we do
sometimes find that it can stop working.
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Seek medical advice when
you develop a flare.
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Firstly, to find out in
fact whether it is a flare.
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If you're on biologic therapy,
your risk of infection is higher, and
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a lot of infections can actually
mimic an inflammatory arthritis.
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If missed, this can be potentially
fatal if you're immunosuppressed.
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Medications that you would take in the
setting of a flare are oral prednisone, or
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taking some ibuprofen, however,
these can exacerbate your psoriasis.
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If you see your rheumatologist and
you have one or two joints involved,
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sometimes you can just have these joints
injected with steroids, and that shouldn't
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exacerbate your psoriasis, because if
you just inject your joints alone,
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a lot of it doesn't absorb
into your bloodstream.
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Certain flares, if you have enough pain
and swelling in your joints that it's
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limiting you from getting through
your daily activities, or
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if it's involving the major weight-bearing
joints and your sacroiliac joints,
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your axial spine, or say your knees,
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then some people might have to go to
the hospital to receive IV steroids.
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Living a healthy lifestyle to reduce the
inflammation in your body is important.
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Stress and lack of sleep can
certainly lead to flares.
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Poor diet can lead to flares, as can lack
of exercise and a sedentary lifestyle.
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alcohol are also pro-inflammatory.
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The problem with any long-standing
inflammation is that it can lead to
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It's important in the setting of
a flare to contact your doctor.
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There's been a lot of advances
in psoriatic arthritis, and
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our ability to treat these
conditions has very much so
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the better in the last couple years.
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Managing psoriatic arthritis flares. Atlanta, GA: Arthritis Foundation. (Accessed on May 15, 2019 at https://www.arthritis.org/about-arthritis/types/psoriatic-arthritis/articles/managing-psa-flares.php.)
To treat or not to treat? Managing PsA flares. Portland, OR: National Psoriasis Foundation, 2016. (Accessed on May 15, 2019 at https://www.psoriasis.org/advance/treat-or-not-treat-how-manage-psoriatic-arthritis-flares.)