Managing Flares in Psoriatic Arthritis

Psoriatic Arthritis
What is psoriatic arthritis?
Psoriatic Arthritis
 Arthritis is inflammation of joints
 Psoriasis 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 psoriasis
 Skin 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
Synovial fluid lubricates the
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
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”
Which joints are affected?
 Psoriatic arthritis is very
 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
Types of Psoritatic Arthritis
 Spondyloarthritis
“Spondylo” means spine
Back pain is the main
Types of Psoritatic Arthritis
 Distal Interphalyngeal
Joint predominant
Rare pattern affecting
joints at ends of the
 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 psoriasis
 Inflammation of eye
“conjunctivitis” or “iritis”
 Tiredness
What is a flare?
What is a flare?
 Psoriatic arthritis is a chronic relapsing remitting
 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
What is a flare?
 A flare means that there is more inflammation and
symptoms are worse
 A flare may involve one joint or several joints
 Affected joints become painful and swollen
 Tendons and ligaments may be inflammed
What is a flare?
 A flare may be short or may last a few weeks
 Flares can occur following an infection, surgery or
often for no apparent reason at all
 They 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
 Relieve Symptoms of pain and stiffness
 Help things to settle down and reduce the length of
the flare
 Help 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
 E.g. Cold initially when swelling most intense and
then heat to soothe when settling down but still
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 properly
 Joints should not be totally immobilised
 Splints 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 needed
 During a flare they can be taken regularly
 Anti-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
Preventing damage: Rest vs Activity
 Exercise is beneficial for many reasons:
 Improve strength and muscle tone –helping to
protect joints
Maintain joint movement
Maintain weight – reducing pressure on joints
Improve fitness and reduce risk of cardiovascular
Ease 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?
 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 are powerful anti-inflammatories and can
help settle a flare quickly
 They can be given into a joint, into the muscle or as a
 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 often
 Can cause flare when stopped
 If reduced slowly can take a long time to be able to
Who to contact if you need
more help or advice?
Need more help?
 If symptoms aren’t improving or struggling to
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
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
Any Questions?
The End

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