Most treatment plans for psoriatic arthritis rely on a combination of analgesic drugs to manage pain during flares and disease-modifying therapies to help achieve and maintain remission.
Psoriatic arthritis is a painful, inflammatory joint condition that affects up to 30% of people with psoriasis. As with psoriasis, psoriatic arthritis occurs when the immune system mistakenly attacks the body’s own tissues, leading to tissue damage, inflammation, and pain.
This article takes a closer look at what causes psoriatic arthritis flares and the steps people can take to prevent them. It also provides tips on how to manage pain during these periods.
A psoriatic arthritis flare is a period of worsening symptoms that occurs between extended intervals of well-controlled disease. Although it is normal for the symptoms of psoriatic arthritis to fluctuate over time, flares tend to involve more severe symptoms that last for longer periods — anywhere from a few days to a week.
Psoriatic arthritis looks different for everyone, and so do flares. Some of the symptoms that people may experience during a psoriatic arthritis flare include:
- joint pain or stiffness
- swelling in the joints, fingers, or toes
- skin or nail changes
- fatigue or difficulty concentrating
- difficulty sleeping
- anxiety or mood changes
- digestive symptoms
A person may experience just one or many of these symptoms at the same time, making it difficult to tell when a flare is happening. Staying attuned to their symptoms, possibly by using a symptom tracker, can help people with psoriatic arthritis determine when a flare is happening. With this knowledge, they can better manage the symptoms.
Psoriatic arthritis flares occur due to higher disease activity, meaning increased inflammation in the joints and skin. Some possible triggers of psoriatic arthritis flares include:
- physical or emotional stress
- injury or illness
- interrupting or discontinuing psoriatic arthritis medication
Pain management during flares is an important component of psoriatic arthritis treatment. Here are five ways in which people with psoriatic arthritis can help control or reduce their pain during a flare.
Use pain medications
Medications to reduce pain are a cornerstone of psoriatic arthritis treatment. The types that people most commonly use to treat pain in psoriatic arthritis are oral nonsteroidal anti-inflammatory drugs (NSAIDs) and injectable or oral corticosteroids.
Corticosteroids work quickly and tend to provide longer-lasting relief than NSAIDs. However, oral corticosteroids can actually trigger flares if a person takes them for too long. A healthcare professional will help determine the most appropriate pharmaceutical treatment plan based on the severity of the person’s symptoms.
A person may find that limiting their activity helps them manage the physical and psychological stress that worsens psoriatic arthritis pain. During flares, people should be mindful of the strain that they place on their body. This may mean forgoing certain activities or adapting them to be easier on the joints.
Use orthotic devices
Orthotic devices are devices that help stabilize and align joints to reduce pain. These may include:
- orthotic gloves
- insoles or orthopedic shoes
- elastic bandages or taping
These types of devices
Use cold therapy
The results of a
Research has also shown that local cold therapy can reduce inflammation and pain severity and improve range of motion in other forms of inflammatory arthritis, including rheumatoid arthritis.
Taking a cold shower or applying an ice pack to the affected joint or joints may help control inflammation and reduce pain during a psoriatic arthritis flare.
Anecdotal evidence suggests that acupuncture may help people with other forms of inflammatory arthritis manage pain, but evidence to support its role in treating psoriatic arthritis is lacking.
There is also a risk that this therapy will lead to psoriatic patches forming in the areas around the injection sites.
Anyone who is interested in acupuncture for pain management should discuss the potential risks and benefits with a healthcare professional.
The best approach to minimizing the pain associated with psoriatic arthritis flares is to prevent them from happening in the first place. Although it is not possible to prevent all flares, people can take certain steps to help reduce the likelihood of pain in psoriatic arthritis.
Adjust the treatment plan
It is impossible to prevent every flare, but if they are happening frequently, a rheumatologist may want to adjust a person’s current treatment plan. This may involve changing the dosage or type of medication or adding a new medication to the current regimen.
Try a psoriatic arthritis-friendly diet
Many people with psoriatic arthritis find that food can trigger their flares. By identifying and avoiding these foods, they can reduce the likelihood of a flare.
Research also suggests that adherence to certain diets, such as
These effects may be related to the anti-inflammatory properties of the diets. Alternatively, the diets may help by supporting weight management, as excess body weight can increase the likelihood of more severe psoriatic arthritis symptoms.
Before making any changes to their diet, a person should consult a healthcare professional to discuss safe and beneficial adjustments.
People may wish to try various types of exercise, such as:
- aerobic exercise
- strength and resistance training
- yoga, tai chi, or qi gong
Pain management is a key aspect of psoriatic arthritis treatment, and it is especially important during painful flares. A combination of medications and nonpharmaceutical options are available to help with pain management during psoriatic arthritis flares. A variety of lifestyle changes can also help improve disease control and prevent flares from occurring.
Anyone experiencing severe or frequent flares should consult a rheumatologist, who can advise them on how to reduce the effects of the disease.