About PsA flares
Psoriatic arthritis flares can affect skin, joints, eyes or cause lower back pain or foot pain.
Symptoms
Symptoms can include the following:
- Swollen fingers and toes. A painful, sausage-like swelling of your fingers and toes.
- Foot pain. Pain at the points where tendons and ligaments attach to your bones. For example, at the back of your heel (Achilles tendinitis) or the sole of your foot (plantar fasciitis).
- Lower back pain. Some people develop a condition called spondylitis. Spondylitis mainly causes inflammation of the joints between the vertebrae (tiny bones) of your spine and in the joints between your spine and pelvis (called Sacroiliitis).
- Nail changes. Nails can form tiny dents (pits), crumble or separate from the nail beds.
- Eye inflammation. Uveitis (inflammation of the middle layer of the eye) can cause eye pain, redness and blurry vision.
- Skin patches. Some patients are prone to patches of psoriasis on their scalp or over their body. These patches may get worse during a flare.
- Fatigue (tiredness). This can be caused by an increase in inflammation and overwhelming symptoms.
Causes
Causes can include the following:
- stress
- injury or Illness
- infection
- a pause in medicine
- unhealthy habits such as smoking or excessive alcohol intake.
Flare self-management
The following can help you self-manage your symptoms.
Cut down on activity
- Prioritise your tasks throughout the day. Try not to do too much.
- Plan your day and take a short rest when you need one.
- Consider mindfulness meditation to help you relax. For more information, visit Versus Arthritis on meditation and mindfulness and how it might help you
Heat or cold
Applying heat or cold to your joints may reduce pain and inflammation. For example, hot or cold showers, a hot water bottle, wheat bag or heating pad, or an ice pack, 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.
- Alternate between using hot and cold for 15 minutes at a time.
- Do not use heat or cold on psoriasis skin patches.
Treatment
Medicines
During a flare, DMARDS (disease-modifying anti-rheumatic drugs) and biologics (a type of anti-inflammatory drug) can be supplemented with non-steroidal anti-inflammatory drugs (NSAIDs). Common NSAIDs include ibuprofen or naproxen.
Discuss this with your GP or rheumatology team before you start taking them, as these medicines may not be safe for everyone.
Pain medicines such as paracetamol or over the counter co-codamol may help.
Some patients see their GP for additional pain management.
Topical treatment
Anti-inflammatory gels may be applied to inflamed joints locally. Always follow the manufacturer’s instructions.
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 dermatologist may decide to review your medicines.
Your symptoms and blood test results will help them assess whether your PsA is becoming less controlled or whether you are experiencing pain for other reasons.
Contact information
Kingston Hospital Rheumatology Department