Diagnosis And Treatment For Arthritis Flares
If you think youre going through a flare that hasnt improved after a couple of days, call your rheumatologist or primary care doctor. They will want to monitor how you feel and may want to order imaging and blood tests to see whats going on. They can also prescribe medications to get the flare under control.
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How To Treat An Arthritis Flare
Sometimes arthritis flare-ups cannot be prevented. At this point, all you can do is get through it the best you can. There are some things you can do that may help provide you some relief.
Make a Plan
You should try to have a plan in place for when you are experiencing arthritis flare-ups.
If you have unavoidable activities that cannot be canceled when your arthritis acts up, let the key people involved know what is happening that way, accommodations can be made.
Apply Heat or Cold
You can choose to use a hot or cold compact or a hot/cold cream, whichever better fits your needs. If you are using a heating pad or an ice pack, youll want to apply it directly to the painful area for 15-20 minute intervals throughout the day. For the hot/cold cream, youll need to follow the product instructions and be sure not to overuse the topical treatment.
Rest
When youre already in pain, its essential to get enough rest. You dont want to put more pressure on your inflamed joints.
You may feel like you are getting behind, but your body needs the time to rest to not prolong the pain. Dont push yourself during a flare.
Low-Impact Movement
While you must get plenty of rest during a flare, you have to be careful of being too still.
Its crucial to get in some low-impact movement like going for a short walk or stretching. There are also hand exercises you can do to keep the joints from becoming stiff.
Consult Your Doctor
Mental Health And Symptom Burden
A review of results from 24 studies found prevalence of anxiety and depression in psoriatic arthritis patients1 out of every 3 patients with PsA have mild anxiety and 1 out of 5 had mild depression. These patients reported greater disease activity, which means their mental health status had an impact on their disease.
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Skin Injuries Can Worsen Psoriatic Arthritis Symptoms
Whether it’s a scrape, sunburn, or something more serious, skin damage can trigger flares for people with psoriatic arthritis. A review published in May 2019 in Archives of Medical Science found that surgical incisions can cause psoriatic arthritis or make symptoms worse.
The link between skin injury and psoriatic arthritis flares probably goes back to the immune systems abnormal inflammatory response, says Ogdie-Beatty.
How to avoid this trigger Exercise caution in the sun so you dont get burned and think twice before you get a tattoo. A Finnish survey, published in June 2017 in Acta Dermatovenerologica Alpina, Pannonica et Adriatica, of 90 psoriasis patients with one or more tattoos found that 27 percent experienced an increase in plaques on the tattoo, a reaction known as the Koebner phenomenon among those, 30 percent reported having a psoriasis flare in the weeks after tattooing.
Dont Blame Yourself For Your Ra
That stress can actually contribute to the development of RA. Research has found a correlation between, for instance, post-traumatic stress disorder and RA, the association is unclear. Our understanding of how stress contributes to the development of autoimmune diseases is still relatively crude, says Anca Askanase, M.D., Director of Rheumatology Clinical Trials at Columbia University Medical Center. There does seem to be a connection between big life stressors and RA, but not necessarily everyday stressors like having a bad job. Whats most important to remember: Blaming yourself for your diagnosis is itself stressfuland counterproductive to healing.
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How Psoriatic Arthritis Flares Are Diagnosed
Because PsA flares dont have a set definition, the diagnosis is made in large part through communication with your doctor. The first thing we do is we look at the history: whats been happening before the flare, Dr. Husni says. We want to know what the triggers are for your disease and we want patients to see the connection.
A skin flare is a bit easier to identify, and a diagnosis would be made with a rheumatologist and dermatologist. We work very closely with the dermatologist its important that they are involved in the treatment decision, Dr. Husni says.
PsA flare-ups can be so hard to pin down that both professionals we talked to suggested keeping a brief diary of your symptoms to help your doctor diagnose when they are happening, and why.
I recommend that people keep a symptom diary over time so that they can keep track of the conditions that might have preceded their flares in their lifetime, so that they can respond more proactively in the future, Crow says. Unfortunately often its most clear in retrospect. You can use our ArthritisPower app to track your symptoms and disease activity and share your results with your doctor.
Stay Away From Foods That Make You Feel Worse
The effect of diet on arthritis has been disputed for years. Some claim there is no direct effect, while others claim certain foods increase inflammation and make arthritis symptoms worse. This is likely the most individual tip of all those listed.
If you are aware that certain foods make your arthritis feel worse, steer clear. This will not be the case for every person with arthritis, but if it does apply to you, dont eat foods that trigger inflammation.
- By Robert H. Shmerling, MD, Senior Faculty Editor, Harvard Health Publishing
A new study has raised the possibility that stress may cause autoimmune disease, such as lupus or rheumatoid arthritis, because it found a higher incidence of autoimmune diseases among people who were previously diagnosed with stress-related disorders.
I have patients who heard about this research and are saying, I knew it!
But before we accept a potential link between stress and autoimmune disease, lets look at some details of the study and consider how we define the terms autoimmune disease,stress, and stress-related disorder.
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Explore Pain Management Solutions
PsA flare-ups can be painful, especially in your muscles, tendons, and on scaly skin patches. According to the Arthritis Foundation, people with arthritis who experience high levels of pain are also likely to have anxiety and depression. That, in turn, can make the pain even worse.
Developing a pain management plan with your doctor can come with the added benefit of reduced anxiety. Nonsteroidal anti-inflammatory drugs , available over the counter, may help relieve the pain.
The Mystery Of Autoimmune Illness Continues
Whether stress or stress-related disorders play an important role remains speculative. Even more important is the question of whether any particular treatment of these stress-induced psychological illnesses can prevent autoimmune disease. I look forward to a clinical trial that examines this fascinating possibility.
Follow me on Twitter @RobShmerling
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General Overview Of Molecular Mechanisms Involved In The Pathogenesis Of Psoriasis
Psoriasis is histopathologically characterized by elongated rete ridges, hyperkeratosis with parakeratosis, and dilated vessels in the dermal papillae. These histopathological changes are responsible for the clinical appearance of psoriasis. Therefore, the silvery-white scales are the result of parakeratosis. The lesions are elevated and well demarcated due to the elongation of rete ridges while the erythema is the result of the dilated dermal vessels .
Almost all cell types found in the skin are involved in the pathogenesis of psoriasis. Keratinocytes produce IL-8, IL-12, IL-15, IL-18, TNF-, vascular endothelial growth factor , and platelet-derived growth factor . Dendritic cells produce interferon- , TNF-, IL-20, and IL-23. Th1 lymphocytes secrete IFN-, TNF-, and TNF-, Th17 lymphocytes produce IL-17, IL-21, and IL-22, and the dermal mesenchymal tissue produces keratinocyte growth factor the interaction of all the cytokines and chemokines is extremely complex and results in the amplified proliferation of keratinocytes, angiogenesis associated with the occurrence of dilated capillaries, and the maintenance of inflammation. These processes underlie the occurrence of the psoriasis plaque. A central role in the pathogenetic mechanisms involved in psoriasis is played by TNF- .
Every Day Is Different And I Dont Know What Body I Will Wake Up To
Some days I feel fine other days its a struggle just to get out of bed. A psoriatic arthritis flare doesnt just mean painful joints, for me it also includes brain fog, fatigue, psoriasis flares, difficulty moving, and tender, swollen fingers and toes. This can have a huge impact on my mental health and self-esteem as every day is different, and I dont know what body I will wake up to.
Simple tasks become difficult during flares, and I can lose my train of thought mid-sentence, which makes me feel really self-consciousespecially at work. I worry that people take this as me being rude and not concentrating, but really its just the psoriatic arthritis brain fog and fatigue kicking in. Jude D., 28
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Take Time Away From Oa
We always seem to find time for the things we have to do. But itâs just as important to make time in your schedule for activities you like, such as reading, having coffee with a friend, seeing a movie, or listening to music. Not only will this help reduce your stress level, but it may also help you forget about your arthritis pain.
How many times have you sworn that a storm was coming because your arthritis pain was flaring up? How many times has a bone-chilling cold caused your joints to swell and get inflamed with pain and stiffness?
Winter weather can be especially tough for those who suffer from arthritis, and there could be some truth to the old wives tale that aching joints can be an indicator of a change in weather. In fact, the Arthritis Foundation even cites studies that show lower barometric pressure caused more aches and pains for people in barometric pressure chambers.
Arthritis can be classified as either inflammatory or non-inflammatory. Inflammatory arthritis features inflammatory white blood cells in the joint fluid. Forms of inflammatory arthritis include rheumatoid arthritis, lupus arthritis, gout, and many others. Forms of non-inflammatory arthritis include osteoarthritis, arthritis of thyroid disease, arthritis after injury and many others. Studies have shown that cold weather can affect both inflammatory and non-inflammatory arthritis.
1. Stay warm and layer up
2. Eat a healthy diet
3. Get your stress under control
4. Stay active and exercise
Reducing The Stress Of Psoriatic Arthritis
- Stress can contribute to worse psoriatic arthritis symptoms.
- Stress-management techniques may help to reduce stress-related psoriatic arthritis flare-ups and symptoms.
- Exercise, relaxation techniques, and improved sleep hygiene can help reduce stress.
Stress can create a complicated cycle for people with chronic inflammatory conditions such as psoriatic arthritis. Navigating doctor visits, treatment options, medical bills, and symptoms of a chronic condition can all cause stress. In turn, increased stress levels could worsen psoriatic arthritis symptoms, such as joint pain and fatigue. Managing stress is very important for maintaining a good quality of life, especially if you have a condition like psoriatic arthritis.
Doctors and researchers are working to better understand the connection between stress and conditions like psoriasis arthritis. Scientists are also studying how different stress-reduction techniques could help to decrease psoriatic arthritis features, including joint pain and inflammation. Stress-management techniques provide a practical way to potentially disrupt the cycle between stress and psoriatic arthritis.
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Delivery Might Cause Relapse
If your psoriasis symptoms got better while you were expecting, the improvement may be short-lived. After the baby comes, your hormone levels go into a free-fall and your immune system snaps back to its previous state. For many women, symptoms flare badly a few weeks after delivery.
But some women find that their joints feel better after they have the baby, while others feel worse. Some women with psoriasis get PsA for the first time after giving birth.
Medical Treatment Of Psoriatic Arthritis
Treatment depends on how much pain you are in. You may only need treatment during flare-ups and when you have symptoms. If this is the case, you may be able to stop treatment when your flare-ups subside and your symptoms are less active. Medical treatment for psoriatic arthritis includes the following.
Immunosuppressants can help rein in your overactive immune system.
Nonsteroidal anti-inflammatory drugs can lower inflammation and reduce pain.
Tumor necrosis factor-alpha inhibitors decrease the molecule tumor necrosis factor, which initiates inflammation in the body and leads to morning stiffness, swollen or tender joints, and pain.
Disease-modifying antirheumatic drugs can slow the progression of psoriatic arthritis.
Steroidsmay be injected into an affected joint to quickly reduce inflammation.
Joint replacement surgery repairs or replaces severely damaged joints with artificial ones made of plastic and metal.
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Engage In Regular Physical Activity
Physical activity should not be ignored. Light exercise is crucial in order to maintain good health and prevent the body from becoming stiff.
Simple indoor exercises such as stretching, walking and yoga are enough for patients of arthritis.
Regular massage of the affected area helps to improve the blood flow and makes the immune system stronger and better during the winter season.
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Manage Symptoms During A Psoriatic Flare
- Moisturize: During a flare-up, locking in moisture is the first step to relieving the itch. Create a good skincare routine, especially in dry weather. Moisturizing will help prevent flares and help ease symptoms.
- Utilize assistive devices: Talk to your doctor about helpful assistive devices to provide additional support for an affected joint. They can recommend tools such as wraps, splints, or special inserts to assist with pain.
- Hot and cold therapy: Cold packs can have a numbing effect, which will help dull your pain. Heat can help relieve pain and swelling by soothing sore muscles.
Rheumatologists are experts in the diagnosis and treatment of psoriatic arthritis. With the advent of newer therapies, the majority of patients can live healthy, productive lives.
At Carolina Arthritis, we believe it is imperative for our patients to fully understand their diagnosis and be comfortable with the treatment. While there is no single treatment for psoriatic arthritis that suits everyone, the doctors at Carolina Arthritis are well trained in lessening ongoing symptoms and enhancing a patients quality of life.
If youre ready to tackle your psoriatic arthritis, contact us right away to schedule an appointment.
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Risk Factors And Triggers You Can Influence
You do have some power to curb other risk factors and triggers, including:
Sunburnor other skin injury. Wear sunscreen with an SPF of 30 daily. Sunburn is a sign of injury. Skin damage causes inflammation that can set off psoriatic arthritis symptoms. This is the Koebner phenomenon at work. Cuts, scrapes, and other skin injuries can also lead to a flare.
Stress. Inflammation is also part of your body’s response to stress. Too much stress for too long sends stress chemicals in your system.
Everyone has stress. Itâs important to find healthy ways to manage it, such as exercise and meditation. Also, look for different ways to think about or handle the things that cause you stress. Working with a counselor or taking a stress management class can help with this.
Alcohol. Alcohol promotes joint inflammation. Drinking too much might worsen psoriatic arthritis symptoms. Some people with psoriatic arthritis claim that their symptoms improve when they avoid alcohol.
Cigarettes. Smoking both raises the risk for psoriasis and makes the disease worse. Exactly how cigarettes affect psoriatic arthritis isn’t as clear. There is some evidence that people who smoke don’t respond as well to their psoriatic arthritis medicine as nonsmokers.
Food: Foods like these seem to trigger psoriatic arthritis flares in some people:
Obesity. Inflammation may be the link between psoriatic arthritis and obesity.
What Are The Treatment Options For Psoriatic Arthritis
The aim of treatment for psoriatic arthritis is to control the disease and relieve symptoms. Treatment may include any combination of the following:
Choice of medications depends on disease severity, number of joints involved, and associated skin symptoms. During the early stages of the disease, mild inflammation may respond to nonsteroidal anti-inflammatory drugs . Cortisone injections may be used to treat ongoing inflammation in a single joint. Oral steroids, if used to treat a psoriatic arthritis flare, can temporarily worsen psoriasis. Long-term use of oral steroids should be avoided when possible due to the negative effects on the body over time.
DMARDs are used when NSAIDs fail to work and for patients with persistent and/or erosive disease. DMARDs that are effective in treating psoriatic arthritis include: methotrexate, sulfasalazine, and cyclosporine.
Biologic agents are an important consideration when disease control is not being achieved with NSAIDS or DMARDs. Biologics have been utilized for the treatment of psoriatic arthritis since 2005 and are highly effective at slowing and preventing progression of joint damage. Your healthcare provider will complete additional laboratory tests and review safety considerations before initiating a medication regimen. Gaining good control of psoriatic arthritis and psoriasis is important to avoid increased systemic risks, particularly heart disease.
Exercise
Heat and cold therapy
Joint protection and energy conservation
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Taking Care Of Your Mental And Physical Health In Psoriatic Arthritis
Disease-associated mental stress is a reality that affects disease progression and how bodies responds to treatment, among other things. Anxiety and depression in psoriatic arthritis are recognized comorbidities, and it is important to address these issues to ensure patient wellbeing. Heres why.