Psoriatic arthritis flare up

Contents

Understanding Moderate to Severe Psoriatic Arthritis Flare-Ups

Every person has their own unique experience with psoriatic arthritis flare-ups. Something may cause a flare-up in one person but not in another. That’s why it’s important to track and log the triggers that set off your symptoms. Show the log to your doctor. Finding a link or pattern between certain activities and your psoriasis flare-ups can help control your outbreaks.

Common psoriatic arthritis triggers include the following.

Skin trauma or injury: This might include cuts, bumps, bruises, scratches, scrapes, or infections. Prevent injuries by being careful when cooking, gardening, nail trimming, and shaving. Wear gloves and long sleeves when doing an activity that could potentially cause injury.

Dry skin: Dry skin can cause a flare-up. Aim to keep skin hydrated with moisturizing lotions and creams.

Sunburn: While sunshine is good for psoriasis, getting sunburned is not. Always carry a hat and sunscreen.

Stress: Relaxation and stress reduction tactics such as yoga and meditation can alleviate stress and anxiety. Consider joining a psoriasis support group.

Alcohol: In addition to potentially causing flare-ups, alcohol can interfere with the effectiveness of certain medications.

Climate: Cold, dry weather that sucks the moisture out of your skin can worsen symptoms. Drying heat units also strip moisture from your skin. Additionally, the season’s lack of sunlight can trigger flare-ups (sunshine may improve psoriasis). Minimize your time spent in the cold and use a humidifier at home to add moisture to the air.

Certain medications: Drugs that can worsen psoriasis include antimalarial drugs, certain beta blockers that treat high blood pressure and some heart conditions, and lithium, which is prescribed for some psychiatric disorders. These medications get in the way of your body’s autoimmune response and can cause a flare-up. If you take these medications, find out if they can be substituted. Always let your healthcare providers know that you have psoriasis before starting any new medications.

Excess weight: Extra pounds can stress joints. Additionally, psoriasis plaques can develop in skin folds. People with psoriasis are at a higher risk of cardiovascular disease, which can be triggered by an unhealthy weight. Talk with your doctor about a diet and exercise plan.

Smoking: Quitting might help clear your skin (and it’s good for your overall health anyway).

Gluten: Research has found that this protein, which is found in some grains including rye, wheat, and barley, can aggravate psoriasis symptoms.

Common infections: Thrush, strep throat, and upper respiratory infections are all potential triggers for a flare-up. See a doctor for treatment if you think you have one of these health conditions.

Psoriatic Arthritis Flare-Ups: Exactly What to Do When You Get One

“You could fry an egg on it” is how one patient with psoriatic arthritis (PsA) described her skin flare in a 2015 study. Affecting up to one-third of people with the inflammatory skin condition psoriasis, psoriatic arthritis is a double-whammy that has the hallmarks of both psoriasis (skin rashes) and inflammatory arthritis (joint pain). These painful symptoms may increase at certain times, called flares or flare-ups.

Science hasn’t come as far in understanding psoriatic arthritis flares as it has with other types of inflammatory arthritis, such as rheumatoid arthritis.

“Flares are one of the toughest things to pin down because there’s no real set definition a flare, which could mean different things to different people,” says Elaine Husni, MD, MPH, a rheumatologist at Cleveland Clinic. Because of this, it can be hard for patients — especially those recently diagnosed with psoriatic arthritis — to know when it’s happening.

“The line between an official ‘flare-up’ and the normal waxing and waning of symptoms is definitely a difficult and confusing determination for many patients to make,” says occupational therapist Cheryl Crow, MOT, OTR/L, an adjunct faculty member of the Occupational Therapy Assistant program at Lake Washington Institute of Technology and an American Occupational Therapy Association spokesperson. “At the most basic level, a flare-up is a period of acutely worsening symptoms; however, for psoriatic arthritis, the symptoms may differ from patient to patient.”

What actually triggers a PsA flare in the body is also largely unknown. “We wish we knew — if we knew we could stop the flares,” Dr. Husni says. In addition, triggers can vary widely from person to person and even change throughout your life, Crow says. More research on psoriatic arthritis flares is sorely needed, but here’s what we know so far.

Symptoms of a Psoriatic Arthritis Flare

Joint pain and swelling

As with other types of inflammatory arthritis, an increase in joint problems may signal a flare is coming on. “Sometimes the joint swells, it gets more red, it gets more achy,” says Dr. Husni.

Skin rash

Fortunately (or unfortunately), psoriatic arthritis flares sometimes come with a “visual clue,” says Dr. Husni. “A skin flare would be an increase in skin symptoms, so thicker, redder plaques forming in new areas after having a period of being quiet,” she says. “Sometimes it’s helpful to have multiple organ systems affected to give you clues of what might be happening.”

But to make thing more complicated, Dr. Husni says that joint flares and skin flares in psoriatic arthritis are often separate. “They probably do flare at different times — but for some people they do flare at the same times, so it’s really variable, which makes the flare even harder to define,” she says.

Fatigue and mental problems

The 2015 study on PsA flares in the journal Rheumatology also found invisible symptoms such as fatigue and depression. “Some people say in addition to the joint and skin symptoms, you can also feel more tired or it might be more difficult to concentrate, but it’s unlikely that a flare occurs without the skin and the joint symptoms,” Dr. Husni says. “So if you’re all of a sudden feeling really depressed and there are no changes in your joints or your skin, it may be hard to blame it directly on a flare, although it still could be part of the disease process.”

Lasts at least a few days

Dr. Husni also says that a psoriatic arthritis flare usually doesn’t go away after an hour or two. “If you get better right away we don’t really consider that a flare, which usually lasts over a couple of days or a week,” she says. But, if the symptoms are really severe, you should still call your doctor even if it’s only been a short time. “There’s no magic number of days or hours — it’s more of how it affects your activities of daily living,” Dr. Husni says.

Causes of Psoriatic Arthritis Flares

Stress

Stress is one of the most common triggers for flares. (Of course, just having a chronic illness is stressful in itself.) “I have a patient with four kids who gets a flare every time school starts up again,” Dr. Husni says. “So we make sure we have a plan in place a couple of weeks before her kids start school.”

Injury or Illness

Skin infections or injury can cause an eruption of symptoms at the site. Getting sick can also bring on a flare, as can pushing yourself too hard. “Sometimes people have a cold and that triggers it — and then in addition they can’t take their immunosuppressant medicationuntil they get better,” Dr. Husni says. Learn more about how to care for your skin with psoriatic arthritis.

Not taking meds on time

Even if you feel fine, it’s still important to take your medication as prescribed to prevent psoriatic arthritis from flaring up again. “Sometimes people miss some medication doses and they flare,” Dr. Husni says. “Then we look back with the patient to figure out why and they say, ‘Oh, I was a little late taking it.’”

Unhealthy lifestyle

Dr. Husni says smoking, eating fried or sugary foods, and being overweight can cause your psoriatic arthritis symptoms to become worse.

How Psoriatic Arthritis Flares Are Diagnosed

Because PsA flares don’t 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: what’s 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 — it’s 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 it’s most clear in retrospect.” You can use our ArthritisPower app to track your symptoms and disease activity and share your results with your doctor.

How Psoriatic Arthritis Flares Are Treated

Adjust medications

There are two ways to treat flares: pharmacologic and non-pharmacologic, says Dr. Husni. “It depends on the severity of the flare. Sometimes your doctor will add a little medication for you for that flare until you get better and then go back to your normal treatment,” she says. “Or if that’s the third flare in three months, then I might have a talk about changing medications; but I don’t usually do it on the first flare.”

Reduce activity

Non-medical short-term treatments should be put in place as well. “Immediately we usually recommend activity modification: You have to destress and deactivate your life for a couple days,” Dr. Husni says. “It doesn’t mean you become a couch potato, but you look at your schedule and develop strategies — this might not be the time to volunteer for that event.” In addition, she says to immediately start to get enough good sleep, if you’re not already.

Manage pain

You can also use home remedies to ease pain during a flare. “You can use what we call ‘modalities’ for pain management, which include hot or cold packs depending on the advice of your medical team — the general recommendation is to use cold for acutely inflamed joints and heat for stiffness,” Crow says. “Additionally, if you are having a lot of pain in a specific joint or area, you might benefit from a splint or other specific assistive device which can be recommended by an occupational or physical therapist.”

How to Prevent Psoriatic Arthritis Flares

Identify your triggers

As you become more familiar with your disease patterns, you can identify what’s bringing on the flare and take measures to address it. “If your trigger is stress, then you can invest in stress management strategies such as seeing a counselor or therapist or taking a mindfulness class,” Crow says. “If your trigger is getting a virus, you can boost your infection control measures; most patients who are on immunosuppressants for PsA understand they should wash their hands, but many forget the other small steps they can take to avoid illness, such as not touching their face and eyes. If your trigger is skin lesions or other skin traumas, then doing your best to avoid those would be very beneficial.”

Modify your lifestyle

For an overall reduction in psoriatic arthritis symptoms, Dr. Husni says to make sure you’re living a healthy life: stop smoking, cut back on alcohol, eat heathy, exercise and lose weight. “Weight is really hard to talk about, but it can really help the joints when you have decreased weight,” she says. “It’s like carrying a 10-pound book bag around with you all the time — when you don’t have to do it you feel so much better.”

With eating habits, Dr. Husni says it’s most important to consume nutrient-dense foods, rather than going on a “pop culture” diet like gluten-free. “If there are certain foods that trigger you then you should avoid them, but we always recommend a very colorful plate and to put a variety of non-processed foods on the table,” she says.

Employ some life hacks

Crow also advises taking shortcuts that can make living with PsA flares easier. “These life hacks can help minimize fatigue or joint pain,” she says. “If your joints hurt, you can change the stuff you are using in your daily life; for example, if your hands hurt, you can use a wide-grip fork while eating. You can also change how you interact with stuff, such as choosing to have grocery delivery rather than exerting the energy required to go to the store and bag all the items yourself.”

Take care of your mental health

Managing the mental aspect of psoriatic arthritis is an important treatment component as well. “People with psoriatic arthritis are at a greater risk of anxiety and depression than the general population, and flare-ups are difficult for many to cope with,” Crow says. “Whatever you can do to invest in your mental health is likely a wise choice.”

Call your doctor

As you become more familiar with your flares, you can work out a plan with your doctor for when you can self-manage and when you need to call, Dr. Husni says. But when it doubt, it’s better to reach out. “Patients with chronic diseases tend to get habituated to pushing through pain, and sometimes are tempted to wait a long time before checking in with their doctors,” Crow says. “It’s often harder to control a flare-up once it’s gotten really severe, so checking in proactively is usually advised.” Even for established patients, a flare after not having one for a while may signal a progression of the disease, so it’s best to check in.

Get to know your disease

The positive news is, living with PsA can become manageable as you figure out how it affects you. “If the disease is new to you or early to you, flares are much more uncertain and scary,” Dr. Husni says. “Once you’ve had it for a longer period of time, flares become a lot less scary. This is a good time to have psoriatic arthritis because there are a lot of treatments available, more than we ever had before.”

Keep Reading

  • You’re Much More Likely to Hit Remission in Psoriatic Arthritis with This Kind of Treatment Plan
  • 7 Ways Psoriatic Arthritis Can Change Your Nails (and What You Can Do to Avoid It)
  • ‘The Best Advice I Ever Got for Managing Psoriatic Arthritis:’ 17 Tips from Patients

A guide to Psoriatic Arthritis

In summary points to remember when seeing your doctor:

Ask about your medicines:

  • What does the medicine do?
  • How long will I need to use it?
  • How and when should I take it?
  • Should I avoid any foods, drinks, activities, medicines when I am taking the medication prescribed?
  • What are the possible side-effects and risks – and what should I do if they happen?

What ages does this affect?

Psoriasis and psoriatic arthritis are not discriminatory, attacking any age group and any gender.

Are there any diets that can help with my arthritis?

Be wary about following fad diets especially if the diet recommends stopping your tablets in order to try the diet. Don’t do this without telling your doctor. Sometimes the diet can help reduce the need to take some of your tablets but unfortunately this is rare. Cod liver oil and other marine (sea water) fish oils may reduce the amount of anti-inflammatory drugs needed to control joint inflammation and therefore may be worth a try. There is no evidence that glucosamine or chondroitin help with this condition.

Can being overweight make the condition worse?

If you are overweight, you need to follow a weight-reducing diet because of the extra strain this puts on your leg joints and back.

Does alcoholic drink affect the condition?

Check with your GP or consultant as some drugs may be affected by alcohol consumption. Following alcohol guidelines is always a wise choice.

Complementary and alternative therapies

Many complementary therapies, such as reflexology, reiki, indian head massage, aromatherapy and pilates are unproven in the treatment of psoriatic arthritis. However, they are unlikely to do any harm and may improve your general well being and how you feel about yourself. If you are going to try complementary and alternative medicine (CAM) then consult your healthcare provider.

Can I get pregnant if I have psoriatic arthritis?

Psoriatic arthritis will not in itself affect your chances of having children or carrying a successful pregnancy. For a woman who becomes pregnant, the arthritis often improves during the pregnancy. However, the arthritis may worsen after the child has been born. It is also worth remembering that looking after small babies is hard work and even harder if you have painful joints. Would-be mothers with psoriatic arthritis should therefore try to get plenty of help with childcare. Sexual intercourse may be painful, particularly for a woman whose hips are affected. Using different positions can help. It may help to discuss this with a member of the rheumatology team.

Will the treatments affect my pregnancy?

Some of the drug treatment given for psoriatic arthritis should be avoided when starting a family. For instance, sulphasalazine can cause a low sperm count (this is not permanent) and methotrexate should not be taken by couples trying to conceive. If you are considering starting a family you should discuss your drug treatment with your doctor.

If you are of childbearing age, either male of female and have not considered starting a family, but would like to in the future, you should always make this clear to your doctor. This may have a significant bearing on the treatment options made available to you. There are risks and side-effects with certain medications that may interfere with conception or pregnancy – discuss this fully with your doctor, it is important that both parties know the correct facts about your intentions for the future so as to avoid delays in conception or other facts that could influence your future decisions.

Will I be offered counselling for my condition?

Since 2010, talking therapies which include counselling, cognitive behavioural therapy (CBT) and psychotherapy have been made more widely available within the NHS for a variety of conditions. If your GP or another healthcare professional thinks that you will benefit, and refers you to a qualified counsellor, it may be free of charge.

Should I exercise; can I still do sporting activites?

It is hard to generalise on how much exercise is best – no two people are the same. However, inflammation can cause generalised tiredness and you may find you need to take more rests than usual. On the other hand, inflammation also causes muscle weakness and stiff joints and it is very important to keep exercising the joints to stop them becoming weaker and losing function. It is a question of finding the right balance for yourself but remember not to neglect either rest or exercise when you are trying to help your disease.

What should I avoid, will it affect my lifestyle?

There is no reason why you should avoid any activity that you previously enjoyed, but remember that there may be times when you do feel unable to complete a task, or your arthritis is in a ‘flare’.

Relationships

Sometimes it can be hard for those close to you to understand how psoriatic arthritis affects you. They may get angry with you or feel frustrated, but in any relationship there is a need for ‘give and take’ and discussing your feelings might help.

Will having psoriatic arthritis affect my work and career prospects?

There shouldn’t be any reason why you cannot continue to work, employers cannot legally discriminate against you because you have psoriatic arthritis, and may need to adapt your work to suit your condition

How can I reduce the cost of monthly prescriptions?

Having psoriasis and/or psoriatic arthritis can cost you a small fortune each month, having regular prescriptions. You can reduce your outgoings on prescriptions by having a pre-paid prescription card.

Are there benefits I can claim?

The best place to find out all the latest information is by visiting the Direct Gov website, where you will find out what you have to do to make a claim.
Can surgery help improve my mobility in my wrists, finger joints, back etc?

Surgery is not often needed in psoriatic arthritis, although sometimes operations are necessary to repair damaged tendons and in more severe cases joints may need to be replaced. However, if psoriasis is present in the skin around the affected joint some surgeons are wary about performing a surgical procedure.

Is there a cure?

No, there is no cure for either psoriasis or psoriatic arthritis. Although, there are many who proclaim to have a cure, you should treat these claims with firm scepticism.
Today there is much more known about the mechanisms that lead to inflammation in other conditions and it is likely advances in science will lead to much more effective treatments with fewer side-effects.

Is there any research?

There is a great deal of research looking at the causes and treatments of both psoriasis and psoriatic arthritis.

Psoriatic Arthritis Flare-Up? 5 Ways to Get Symptom Relief

Applying heat or ice to the affected joint can help relieve pain. Suwannee Ngoenklan/

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Psoriatic arthritis, which can attack joints anywhere in the body, affects everyone differently. Some people experience pain and stiffness in the hands, wrists, or elbows, while others feel stiffness in the feet, spine, hips, or shoulders. Psoriatic arthritis can also occur in a combination of these joints, according to the National Psoriasis Foundation (NPF). The intensity of symptoms during a flare-up also varies from one person to the next, making psoriatic arthritis a uniquely individual experience.

While medications help keep symptoms under control, flare-ups can’t always be avoided. Spotting the signs of a flare-up quickly and knowing how to manage the symptoms can help ease your discomfort.

What Causes Psoriatic Arthritis Flare-Ups?

A psoriatic arthritis flare-up can be triggered by a variety of factors. Your immune system may be activated by stress, infections such as HIV or strep throat, a physical injury, or smoking, to name just a few potential causes, says Petros Efthimiou, MD, a professor of clinical medicine and rheumatology at NYU Langone Health in New York City.

When that happens, your joints might start to feel swollen, tender, and stiff, and you might develop areas of tendonitis or swelling of an entire finger or toe, says Theodore Fields, MD, a professor of clinical medicine at Weill Cornell Medical College and attending rheumatologist at Hospital for Special Surgery in New York City. But it’s also possible that you won’t have swelling during a flare-up. Your main symptom might be fatigue, Dr. Fields adds.

It’s important to be in tune with how you feel every day so you can recognize the signs of a flare-up and alert your doctor right away. “We have many medications that can help stop the progress of psoriatic arthritis and dramatically ease symptoms,” Fields explains. The sooner you address symptoms, the faster you can get relief and prevent potential joint damage.

Easing Symptoms of Psoriatic Arthritis Flare-Ups

To deal with psoriatic arthritis symptoms during a flare-up, take these steps:

1. Decrease pain and stiffness

For occasional discomfort, Fields says, nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen can be beneficial. Ask your doctor about increasing the dose during a flare-up. You can also try heat or ice at the source of discomfort, Fields says. If pain persists, he adds, your doctor may recommend prescription pain medication or a steroid injection at the affected joint.

2. Incorporate arthritis-friendly exercise

Proper exercise is essential for keeping joints and tendons loose, strengthening muscles, and maintaining a healthy weight, says the NPF. During a flare-up, try gentler exercises, such as walking, swimming, or yoga. If your condition is keeping you from exercising, work with a physical therapist to help you get moving again.

3. Reduce stress

Not only is stress a psoriatic arthritis trigger, but it can also make you more sensitive to pain, the NPF reports. A report published in 2015 in the American Journal of Public Health Research suggests that taking several deep breaths and letting go of tension will help you regain calm. You can also try stress-relieving techniques such as guided imagery, suggests the National Center for Complementary and Integrative Health.

4. Get extra rest

Sleep disorders such as insomnia and obstructive sleep apnea are more common in people with psoriatic arthritis and psoriasis, the NPF reports. To improve sleep quality, the NPF recommends practicing good sleep habits, such as going to bed early enough to get adequate sleep, and stress-reduction techniques to help you sleep well. Sometimes even getting extra rest may not resolve this level of fatigue, but giving your body time to recover from pain and inflammation may be beneficial since fatigue can be related to severity of inflammation, according to a 2018 study published in the journal Reumatologia.

5. Consider using assistive devices

Your doctor may recommend various devices to provide additional support for an affected joint. A splint can be used to hold a joint in the best position for improved function or to relieve pain and swelling. If foot or heel pain are concerns, foot orthotics such as shoe inserts or pads, may provide relief and improve your gait. Talk to your doctor about your specific symptoms.

What About Managing a Psoriasis Flare-Up?

Controlling psoriasis is key to managing psoriatic arthritis flare-ups. While psoriatic arthritis and psoriasis are two separate conditions, 85 percent of people with psoriatic arthritis have psoriasis before developing the joint disease, according to the NFP. The severity of one disease does not dictate the severity of the other, so your treatment should be individualized.

“Some patients have severe psoriasis and mild arthritis, and the treatments are guided by the skin problem,” Fields says. “Some patients have severe arthritis and not such severe skin problems, in that case, the arthritis will determine the therapy.”

Here are some ways to address psoriasis symptoms during a flare-up:

  • Moisturize. During a flare-up, locking in moisture is the first step to relieving the itch, according to the NPF. “Have a good skin care regimen, especially in dry weather,” says Delphine Lee, MD, PhD, director of the Dermatological Center for Skin Health at Providence Saint John’s Health Center in Santa Monica, California. “Furthermore, in winter months you may flare and should see a board-certified dermatologist for topical or systemic prescription medications if itching is not relieved with your usual regimen.” Apply a rich moisturizing cream or ointment to retain moisture and fight the itch.
  • Avoid skin injury. “Psoriasis can develop at sites of trauma or skin injury,” Dr. Lee cautions. When you are experiencing a flare, protect your skin from chafing and additional irritation by wearing soft, breathable cotton fabrics, the NPF recommends.
  • Address the stress. Stress worsens all symptoms during a flare-up, according to the Arthritis Foundation. Keeping a journal is one way you can release some of the stressful feelings you may be dismissing. You can also look over recent journal entries during a flare-up to identify stress triggers. Consider sharing your findings with a professional therapist who understands the emotional impact of psoriasis and who can help you better manage your stressors.

Additional reporting by Brian P. Dunleavy

The Flare-Up and Remission Cycle With Psoriatic Arthritis

Psoriatic arthritis (PsA) is a chronic, inflammatory disease that can wax and wane, with periods of time with more painful and debilitating symptoms and other periods with milder symptoms or remission. The times of worsened symptoms from PsA are often called “flares” or “flare-ups.” Some people have more continuous symptoms.1

There are different explanations in the scientific literature regarding what is considered a flare, with varying descriptions incorporating some to almost all aspects of PsA. A recent qualitative study conducted with PsA patients explored the patients’ perspective on what it means to have a flare. At the time of interviews, approximately one-third of the patients reported themselves to be in a flare state. Nine main overarching characteristics were identified with respect to flares:

  • Physical symptoms
  • Fatigue
  • Loss of normal function
  • Psychological symptoms
  • Social withdrawal
  • Triggers
  • Timing
  • Management of pre-flare
  • Management of flare

These themes are overlapping and illustrate the significant impact flares can have on a patient’s life.2

Symptoms of a psoriatic arthritis flare

Physical symptoms reported by patients as characteristic of a flare included pain, heat, stiffness, swelling, and psoriasis lesions on the skin. Symptoms are often experienced in multiples or combinations.2

Fatigue

Patients often report significant fatigue during a flare, which may appear as extreme tiredness, difficulty keeping eyes open, or flu-like symptoms. Patients also report symptoms such as lack of motivation and loss of appetite in conjunction with fatigue.2

Loss of normal function

During a flare, patients report a noticeable loss of normal functions, including ones associated with daily tasks of grooming, shopping, and other activity.2

Psychological symptoms

Psychological symptoms experienced by patients during a flare include frustration, depression, embarrassment, and fear. These are exacerbated by fatigue and the loss of normal function.2

Social withdrawal

Patients noted that during a flare, they experience significant social impact. In addition to the physical and psychological symptoms, patients report not wanting physical contact and withdrawal from social activity.2

PsA flare triggers

Patients note that there are particular triggers for flares, such as weather changes or physical exertion.2

When do psoriatic arthritis flares occur?

The theme of timing in the patient interviews related to the duration of the flare, which is variable. Patients reported knowing, by their symptoms and the severity of those symptoms, if the flare would be short-lived or a longer duration.2

What are early warning signs of a flare

Patients reported noticing when a flare was coming on, and this could be seen more clearly in patients who had had PsA for a longer time, indicating the understanding that comes with experience. Those patients with shorter disease duration were more likely to describe their flares as appearing with no warning. Once recognized as a pre-flare state, patients reported strategies for managing the pre-flare, adapting their activity level and lowering stress.2

What are ways to manage symptoms of a flare?

Management of flares involves self-medication, self-help techniques, resting, seeking medical attention, avoiding certain activities, or alternatively, just continuing on. As people live with PsA and begin to learn their body’s signs of a pre-flare state, they learn to self-manage and, in many cases, can avoid the full flare.2

Psoriatic Arthritis: Which Foods are Triggers and Which are Suppressants?

Hugh Duckworth MD

Doctor of Medicine (M.D.) in 1984 from University of Tennessee School of Medicine

Oct 27, 2018 5 min read

What is Psoriatic Arthritis

You’ve likely heard of psoriasis. And you’ve likely heard of arthritis. But, have you ever heard of psoriatic arthritis? If you haven’t, you should. It’s one of the most common types of arthritis, right behind osteoarthritis and rheumatoid arthritis. Although all three types of arthritis have overlapping symptoms, one of the most distinguishing characteristics of psoriatic arthritis is that 85% of individuals living with this disease also have psoriasis.

Equally affecting men and women, psoriatic arthritis most often has an onset in adults between the ages of 30 and 50. While juvenile psoriatic arthritis can occur, it is far less common. Does this mean if you have psoriasis that you will also develop psoriatic arthritis? Not necessarily, but your chances do increase significantly. Around 30% of individuals who experience psoriasis will go on to develop psoriatic arthritis.

50% 50% of Individuals with Psoriatic Arthritis are Male

The symptoms of psoriatic arthritis include the classic joint pain and inflammation. But, individuals living with the disease may develop problems such as tendonitis, generalized fatigue, dactylitis (finger pain and swelling), heel pain, back pain, nail pitting, and reduced joint mobility. While there are five different types of psoriatic arthritis, the most common type affects joints asymmetrically. In contrast, rheumatoid arthritis typically affects joints symmetrically; that is, the same joints on both sides of the body.

The most common type of treatment for psoriatic arthritis is the use of NSAIDs and DMARDs. However, individual diet is also gaining attention as a possible trigger and/or suppressant for psoriatic arthritis symptoms.

What Foods Should I Eat?

When it comes to psoriatic arthritis, many of the foods on the “good list” are the same types found on other types of healthy diet lists such as for heart health, diabetes, and cancer. Many of these foods have the effect of decreasing inflammation. Naturally, since joint inflammation is a major symptom of psoriatic arthritis, these types of foods are beneficial for people who have this disease.

What should you eat to decrease inflammation? As a starting base, your diet should include:

  • Vegetables
  • Fruits
  • Fish
  • Beans
  • Nuts and seeds
  • Legumes

When cooking, use healthy oils, such as extra virgin olive oil or avocado oil. Great herbs to use include ginger and turmeric, which are also noted for their anti-inflammatory properties.

Many of the foods listed for helping to improve psoriatic arthritis are ones with anti-inflammatory and antioxidant properties. The following list of foods are known for just that.

  • Avocado: This fruit is one of the best healthy fats out there. Avocados are high in potassium, beta-carotene, and Vitamins C, E, and K.
  • Greens: Leafy greens, including collards, spinach, kale, Swiss chard, and beet greens are great anti-oxidant and Vitamin K boosters.
  • Fatty fish: Anti-inflammatory omega-3 fatty acids are the key in fatty fish. Try trout and salmon as part of your psoriatic arthritis diet.

  • Green tea or Matcha: The catechins in tea are the antioxidant powerhouses that reduce inflammation. Matcha is a powdered form of green tea mimicking the same antioxidant and anti-inflammatory properties as the traditional tea leaves that are steeped in water.

What are Foods that Trigger Psoriatic Arthritis Symptoms?

Now that you know what you should be eating, let’s talk about what you should be avoiding if you are living with psoriatic arthritis. While the above list of foods are noted for their anti-inflammatory properties, there are foods that are known for just the opposite. That is, they are known to cause inflammation. Naturally, these are just the types of foods you should avoid if you are living with psoriatic arthritis.

Saturated fats, sugar, alcohol, and simple carbohydrates are all triggers for psoriatic arthritis symptoms to flare up. They’re also key factors in weight gain and obesity. As your weight increases, the stress on your joints also increases, so it goes hand in hand that keeping your weight down is beneficial for managing psoriatic arthritis.

What’s on the “bad food list” for individuals living with psoriatic arthritis?

  • Processed meats (e.g., hot dogs, sausages, bacon)
  • Alcohol
  • Sugary drinks
  • Processed foods (e.g., packaged cakes, cookies, and other similar snacks)
  • Soda
  • White bread
  • White rice
  • Candy
  • Fried foods

Similarly, the foods on this list are ones that you would find on many lists for “foods to avoid.” It is only natural that our bodies do well with more nutrient-dense foods than ones that are processed, enriched, and full of sugar.

What are Beneficial Diet Plans for Psoriatic Arthritis?

You’re no stranger to the fact that there are multiple diet plans in the market. These include fad diets, low-carb diets, heart healthy diets, lemonade diets, juice diets, and the list goes on. Is there a specific diet plan for individuals living with psoriatic arthritis to follow? There are several, actually.

  • Paleo diet: Also known as the “Caveman Diet,” the Paleo diet avoids grains, nuts, processed foods, and dairy. Key staples of the Paleo diet include fish, eggs, meat, fruits and vegetables (typical foods that cavemen used to eat). The benefits of this type of diet for individuals living with psoriatic arthritis is that the main staples of the Paleo diet can reduce swelling often caused by processed and sugary foods and dairy.
  • Anti-inflammatory diet: One of the most prevalent symptoms of psoriatic arthritis is joint inflammation. Eating foods with anti-inflammatory properties can reduce swelling. Fatty fish, leafy greens, and a variety of fruits (e.g., blueberries) are great food choices for less inflammation.
  • Weight loss diet: To lose weight, you need to limit your intake of carbohydrates, sugars, and fats. Keeping your weight down keeps pressure off of your joints. Additionally, individuals who are overweight tend to have more severe forms of arthritis and are more prone to develop psoriatic arthritis.

  • Mediterranean diet: The Mediterranean diet consists of consuming extra virgin olive oil, fish, grains, fruits and vegetables. Extra virgin olive oil is the star of this diet – and is known for its anti-inflammatory properties and omega-3s.
  • Gluten-free diet: Eating a diet free of gluten may help with psoriasis symptoms. Over 25% of individuals who have psoriasis show sensitivity to gluten, a protein found in barley and wheat. Gluten is used in a large variety of processed foods, which are not the healthiest. Eating a gluten-free diet encourages the consumption of more fruits and vegetables, and less processed products.

Supplementing Your Diet

In addition to eating healthy foods, you can use a variety of natural remedies to treat psoriatic arthritis. Many of these are food-based.

  • Ginger: a natural anti-inflammatory; you can eat ginger in your everyday cooking or take supplements.
  • Capsaicin: blocks pain receptors to reduce pain; capsaicin has been known to decrease the occurrence of psoriasis.
  • Turmeric: similar to ginger, turmeric has great anti-inflammatory properties; the curcumin in turmeric is the key ingredient to reduce swelling and inflammation in the joints.

  • Apple cider vinegar: a great natural agent to reduce psoriasis flare-ups, especially scalp psoriasis.
  • Fish oil: rich with omega 3s, fish oil supplements can minimize the swelling and inflammation in the joints caused by psoriatic arthritis.
  • Boswellia: known more commonly as Indian frankincense, Boswellia contains anti-inflammatory agents to reduce joint inflammation and swelling when taken in capsule-form.
  • Boxberry: Native Americans have chewed on the leaves of boxberry for centuries as an anti-rheumatic agent.

Whether eating a diet free from inflammatory triggers or eating a diet rich in antioxidants and anti-inflammatory agents, what you’re eating on a daily basis can affect your psoriatic arthritis symptoms. Supplement a good diet with drug therapies and lifestyle changes, such as adequate exercise and rest, and you can improve your quality of life exponentially while living with psoriatic arthritis.

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