HOW TO MANAGE A FLARE

Psoriatic Arthritis

What is psoriatic arthritis?

Psoriatic Arthritis

Arthritis is inflammation of jointsPsoriasis is a skin condition which causes

patches or plaques of red scaly skin.Psoriatic arthritis is a type of arthritis which

develops in some people with psoriasisSkin psoriasis can be severe or mild, some

people just have a family history of psoriasis

A normal joint

Movement occurs when muscles pull on tendons

Cartilage covers the ends of bone

Synovial fluid lubricates the joint

Synovium surrounds the joint and makes synovial fluid

The outer part of synovium is the capsule which is tough and keeps everything in place

Muscles and tendons provide stability

Psoriatic Arthritis

Inflammation can occur in the synovium (lining which creates the lubricating synovial fluid) “synovitis”

Inflammation can occur in the tendons and/or ligaments “tendonitis” “enthesitis”

Which joints are affected?

Psoriatic arthritis is very variable

People are affected in different ways

Some people have many inflammed joints

Some people have just one inflammed joint

Types of Psoritatic Arthritis

Asymetrical Oligoarticular “oligo” means few Less than 5 joints at

one time. E.g. knee and a few joints in the hands

Types of Psoritatic Arthritis

Symmetrical polyarthritis “poly” means many Usually lots of small

joints. E.g. in hands and wrists

Types of Psoritatic Arthritis

Spondyloarthritis “Spondylo” means spine Back pain is the main

symptom

Types of Psoritatic Arthritis

Distal Interphalyngeal Joint predominant Rare pattern affecting

joints at ends of the fingers

Arthritis mutilans Rare severe form

causing a lot of joint damage

Psoriatic Arthritis Symptoms

Joint Symptoms Pain and stiffness. Stiffness usually worse in the

morning and after rest. Inflammation causes swelling and redness.

Tendon inflammation E.g. Achilles

Other symptoms

Dactylitis “Sausage” fingers or toes

Nail psoriasisInflammation of eye

“conjunctivitis” or “iritis”

Tiredness

What is a flare?

What is a flare?

Psoriatic arthritis is a chronic relapsing remitting condition

This means it is persistent and sometimes flares up whilst at other times settles down

It is difficult to predict for an individual how the disease will progress and how severely they might be affected

What is a flare?

A flare means that there is more inflammation and symptoms are worse

A flare may involve one joint or several jointsAffected joints become painful and swollenTendons and ligaments may be inflammed

What is a flare?

A flare may be short or may last a few weeksFlares can occur following an infection,

surgery or often for no apparent reason at allThey may develop over a period of hours or

days

Can flares be prevented?

Goals of treatment are Reduce pain and stiffness Prevent joint damage Minimise disability caused by pain or joint damage

Can flares be prevented?

Many patients need long-term medication to control their symptoms

Taking these medications should reduce inflammation and flares

Even when control is good flares can still occur

What can you do when a flare occurs?

Treatments

Relieve Symptoms of pain and stiffnessHelp things to settle down and reduce the

length of the flareHelp to prevent damage

What Can You Do at Home?

Helping Symptoms: Heat/Cold

Cold – E.g. ice or frozen peas wrapped in a towel - can reduce swelling and relieve pain by numbing the affected joints and by reducing the amount of inflammation causing chemicals being brought to the joint in the blood.

Helping Symptoms: Heat/Cold

Heat – E.g. warm towel, heat pack, or warm bath - can help relax aching muscles and relieve joint pain and soreness

Helping Symptoms: Heat/Cold

Experiment to find combination that works best for you

E.g. Cold initially when swelling most intense and then heat to soothe when settling down but still painful

Helping Symptoms: Splinting

Splints may help rest joints at night or hold them in a comfortable position during work or exercise

During a flare they may help ease pain in that joint

Helping Symptoms: Splinting

Splints should fit properlyJoints should not be totally immobilisedSplints should be removed periodically to

perform gentle exercises to maintain mobility

Helping Symptoms: Painkillers

Anti-inflammatories are good at easing pain and stiffness. Many different types are available and each is slightly different.

These are often used as neededDuring a flare they can be taken regularlyAnti-inflammatory creams or gels are also

available

Helping Symptoms: Painkillers

Sometimes extra painkillers are needed e.g. paracetamol or codeine

These can be taken regularly during a flare and then stopped

Preventing damage: Rest vs Activity

Exercise is beneficial for many reasons:Improve strength and muscle tone –helping

to protect jointsMaintain joint movementMaintain weight – reducing pressure on jointsImprove fitness and reduce risk of

cardiovascular diseaseEase stress

Preventing damage: Rest vs Activity

During a flare when a joint or tendon is inflammed you may need to rest more and modify your activities to prevent additional strain through the joint.

How might a doctor help when a flare occurs?

Painkillers

Your GP may be able to prescribe stronger or alternative anti-inflammatories

He/she may also prescribe additional painkillers such as paracetamol or codeine

Steroids

Steroids are powerful anti-inflammatories and can help settle a flare quickly

They can be given into a joint, into the muscle or as a tablet

Sometimes when steroids are stopped or wear off skin psoriasis can flare and become worse

Steroids: into a joint

If one or two joints are involved in a flare this can be very effective

Excess fluid can be drained at the same time which can quickly improve symptoms and joint movement

Steroids: into a joint

Depending on the joint involved this could be done At GP practice In injection clinic On day assessment unit

Steroids: into muscle

If lots of joints are involved giving an ‘IM’ injection allows it to be slowly absorbed and benefit all joints

Comes out of the body gradually over several weeks

Steroids: tablets

Used less oftenCan cause flare when stoppedIf reduced slowly can take a long time to be

able to stop

Who to contact if you need more help or advice?

Need more help?

If symptoms aren’t improving or struggling to manage GP Advice line – 01225 428823 & leave a message

explaining you have a flare. You will be called back by a nurse specialist. (Not for emergency calls, at busy periods may take up to 48hours)

Consultant’s secretary via hospital switchboard – 01225 465941

What next?

What next?

Flares are part and parcel of Psoriatic Arthritis

If they settle down no further action may be needed

If flares are happening frequently or there are persistent symptoms it may be worth reviewing your regular medication at your next appointment

The End

Any Questions?