About AS flares
People with AS (also called axial SpA) experience times of flare and times when their condition is manageable or settled.
An AS flare can include pain, stiffness, and extreme fatigue. Understanding these features can help you manage them.
Symptoms
Symptoms can include the following:
- Intense, raw pain caused by active inflammation in the tissues around the joints and tendons.
- Dull, achy pain caused by shortening or tightening of muscles or tendons.
- Intense, sharp pain caused by protective muscle spasms.
- Stiffness in the lower back, hips and buttocks or neck, caused by muscles and tendons shortening and tightening. Sometimes this is caused by new bone growth between the joints of the spine and in the pelvis.
Causes
Flares cannot always be controlled, but you may be aware of certain triggers. Understanding these triggers, and avoiding them, can help.
Causes can include the following:
- Random fluctuations in disease activity. This can happen whether or not you are being treated with biologic or other anti-inflammatory medicines.
- Increased emotional stress
- Infection
- Fatigue, caused by the following:
- chemicals released by the body during the inflammation and healing cycle
- muscle tightness and imbalance
- disrupted sleep
- stress from living with a chronic inflammatory condition
- low mood and anxiety.
Flare self-management
Use the pull-down menus for advice on:
- breathing
- movement
- heat and cold
- rest and meditation.
Feelings of panic are common when a flair starts, and they can cause more muscle tension and pain.
If you slow down your breathing, you will allow more air through your lungs, and this will help you relax.
Get familiar with some breathing exercises before you need them (see the example below).
Practice them regularly. This will help your lung health and stress levels.
Breathing exercise
- Place one hand on your chest and the other on your stomach, just above your belly button. Relax your shoulders, allowing them to fall away from your ears. Keep them relaxed.
- Take a slow, deep breath in through your nose.
- Try to keep your chest and top hand still, but allow your belly and lower hand to gently rise.
- Gently breathe out through your mouth, allowing your stomach and lower hand fall.
- Repeat this for 3 breaths, then return to normal breathing.
Keeping moving is one of the best ways to limit the duration and intensity of your flare.
Try to go out for a short walk, even if it is just to the front gate.
Natural daylight helps to lift the mood by releasing endorphins which in turn help people cope with pain.
Gently stretch the areas that tend to tighten up with your AS even if this feels uncomfortable. Stop if you begin to feel intense pain.
First thing in the morning
While you are in bed, your spine, joints and muscles are warm and unaffected by the pull of gravity. Although it is tempting to curl up and go back to sleep in the morning, it is a good idea to start gently moving your joints to alleviate stiffness.
Try a few simple exercises that you can do without aggravating your pain. For example, lie on your back with your knees bent. Gently rock your knees from side to side.
For more gentle exercises, try the NASS website Stretches for your daily life and the NASS YouTube channel.
Getting out of bed
- Try to move in stages so you do not pull on muscles that are already in spasm.
- Move on the out breath. Do not hold your breath while bracing yourself.
- Let your body adjust to each position before moving to the next one.
- Try rolling onto your side, taking your legs off the bed and pushing yourself up into a sitting position.
Hot bath or shower
Warm water helps to relax tight muscles and release joint stiffness. It can also relieve pain.
The jet of warm water from a shower can have a massaging effect and help to soothe sore areas. Soaking in a bath can also be soothing, if you can get in and out safely without causing more pain.
You might like to use a combination of Epsom salts and aromatherapy oils to help you relax and lift your mood.
Heat and cold combination
Sometimes an alternating combination of heat and ice can stimulate blood supply locally to the painful area.
If you are not able to have a shower or bath, try a hot water bottle, thermal heat stick-on pads, wheat bag or heating pad, with an ice pack or bag of frozen peas or cold gel.
- Always place a towel between your skin and the source of heat or cold to prevent skin damage.
- Do not use heat or cold on psoriasis skin patches.
Rest
- Get enough rest.
- Over-exertion can trigger flares. Take time to prioritise and plan out your day.
- Accept that you may not be able to do everything today. Make smaller goals for the day(s) ahead.
Meditation or mindfulness
Guided meditation apps and podcasts can help. Consider mindfulness meditation to help you relax. Visit Versus Arthritis on meditation and mindfulness and how it might help you.
Treatment
Medicines
These include anti-inflammatories and painkillers, which can be obtained over the counter or from your GP, for example ibuprofen, naproxen or celecoxib.
Discuss these medicines with your GP or rheumatology team before you start taking them, as they may not be safe for everyone.
Take your medicine, especially painkillers, as soon as you wake up and realise that you are having a flare.
Anti-inflammatory gels may be applied to inflamed joints locally. Always follow the manufacturer’s instructions. These can be taken in combination with biologics (a type of anti-inflammatory drug).
If you have psoriatic skin lesions, consult your GP or dermatologist for advice on the most suitable cream for your skin.
When to seek further help
If you have tried all of these and your symptoms show no signs of improvement after 7 to 10 days, you may need to contact your rheumatology team
If you experience regular flares, your GP or rheumatology team may decide to review your medicines.
Your symptoms and blood test results will help them assess whether your AS is becoming less controlled or whether you are experiencing pain for other reasons.
More information
NASS (National Axial Spondyloarthritis Society) on:
Contact information
Kingston Hospital Rheumatology Department