It might start with taxing fatigue. Maybe your joints feel a little swollen and stiff, and pain is making it hard to move. Before you know it, you’re in the throes of a psoriatic arthritis (PsA) flare.
Luckily, treatment can help. Your rheumatologist may be able to suggest different options if you’re experiencing symptoms that don’t respond to your usual strategies.
Still, as you sit buried in heat and ice packs, you might wonder if there was something you could have done to avoid this latest bout of worsening symptoms.
When you have psoriasis (PsO), your skin becomes the GOAT of producing new skin cells. Unfortunately, it tends to produce new cells faster than the old ones can flake off. This is the reason behind the dry and irritated lesions that are characteristic of PsO, an autoimmune condition affecting around 8 million Americans.
“Autoimmune” refers to when your immune system cells attack healthy cells in your body. A key feature of autoimmune disease, and the driver of many of its complications, is inflammation.
An estimated 30 percent to 42 percent of people with PsO eventually develop PsA, which includes inflammation from both psoriasis and arthritis.
PsA inflammation can affect a person in various other ways, with issues like:
- Spondylitis. Inflammation of the spinal bones.
- Enthesitis. Inflammation where bone attaches to ligaments, joint capsules, and tendons.
- Uveitis. Eye disease from inflammation in the middle layer of the eye wall (uvea).
- Irritable bowel disease (IBD). Ulcerative colitis (UC) and Crohn’s disease (CD) are two forms of IBD that are sometimes connected to PsA.
- Synovitis. Inflammation in the connective tissue that lines some joints.
- Dactylitis. Swelling of fingers and toes.
Not everyone with PsA has each of these conditions, but if you experience a new or worsening symptom during one of your flares, it’s important to let your doctor know. Early treatment can reduce or prevent long-term damage.
If you’ve been living with PsA for a while, you’ve probably identified some of your triggers. They can be different for everyone: What triggers inflammation flares in some people may have little or no effect on others.
If you’re not sure, consider keeping a log. If you create the habit of tracking known PsA trigger events as they happen in your life, you can connect the dots to see if they cause flares for you.
This is when you don’t want to go viral. Catching a viral or bacterial infection may mean you have to temporarily pause your immunosuppressant medication regimen. This, paired with your immune system taking action to fight your infection, can trigger a PsA flare.
According to the Arthritis Foundation, the bacterial infection strep throat is a common trigger for PsA flares.
Stress impacts health. This applies whether that stress is specific to your life or felt by the population at large, as in the case of the COVID-19 pandemic.
PsA presents a particularly challenging vicious circle because stress and PsA can trigger each other. It can seem like there’s just no getting away from it.
A 2014 study found that more than 70 percent of people with psoriasis listed stressful events as flare triggers. Meanwhile, a 2020 study in Italy found that people with autoimmune arthritis were particularly vulnerable to pandemic lockdown-related psychological distress.
Cold weather and less daylight exposure can intensify PsA symptoms.
Part of the reason might be reduced levels of vitamin D that you’d normally get from sunlight. If you think your psoriasis feels better after some moderate sun exposure (not too much, though), it’s not your imagination.
Research suggests there may be a connection between vitamin D deficiency and psoriasis. In fact, vitamin D intake is linked to a reduction in autoimmune disease in general (not just psoriasis) as demonstrated in a 2022 study of 25,871 participants.
Cold weather, meanwhile, can increase your PsA aches and pains. Lower barometric pressure can cause joints to expand and become painful. Synovial fluid in joints can also thicken in the cold, increasing stiffness.
Physical trauma and mechanical stress can set in motion a cascade of events leading to inflammation in PsA. Examples include:
- heavy object lifting
- having obesity or being overweight
If you’ve experienced a flare after moving to a new house or throwing down deadlifts, mechanical stress is likely the reason.
Taking your medication on time, as prescribed, is one of the ways you can prevent a psoriatic arthritis flare.
Some PsA medications work by calming the immune system overactivity that causes flares. If you’re late taking this medication, its protective effect can wane, leaving you vulnerable to an increase in symptoms.
Sometimes medications to treat other conditions can make your PsA flare up. These include:
- some blood pressure medications
It’s important to speak with the prescribing doctor before you stop taking these medications. It’s also a good idea to ask about potential PsA flares before starting any new prescriptions.
Most people slip up on self-care every now and then. Maybe a busy week has cut into your sleep schedule, or a special occasion has swayed you away from healthy eating.
Unhealthy lifestyle habits are a PsA flare trigger that you can change. Simple strategies like avoiding sugary or fried foods can help. The tougher hills to climb, like quitting smoking and establishing an exercise plan, repay your effort with numerous health benefits including fewer PsA flares.
PsA flare risk factors fall into two categories: those you can’t control, and those you can.
Factors like family history, age, and preexisting psoriasis can all predispose you to develop PsA and its subsequent flares. There’s not much you can do about these circumstances.
But there are risk factors that you may be able to act on, such as:
- adherence to your medication plan
- the range of nutritious foods in your diet
- amount of sleep
- cigarettes and alcohol use
- overweight or obesity
- exposure to cold
- people contact during cold and flu season
Since PsA may affect individuals slightly differently, you may have a flare risk that’s not on the list. What matters is that you can identify it and make helpful changes to protect yourself.
What if you’re taking your medication as prescribed and avoiding triggers but you’re still having a flare? It might be time to change treatments.
There are several ways your rheumatologist can help. They can:
- change your medication dose
- change your medication type
- add an additional medication
Treatment changes should be a collab between your rheumatologist and dermatologist, since what can help your joints may not benefit your skin. Corticosteroids are an example: they can ease arthritis symptoms but cause a psoriasis flare.
PsA is an autoimmune condition, so it’s sensitive to triggers that can cause inflammation. Not everyone responds the same way to each trigger, so it’s important to know which ones affect you.
The good news is that PsA can be managed if you’re proactive about avoiding flares and you follow your treatment plan. Self-monitoring and communication with your care team are two key strategies that can help keep your PsA at bay.