Am I Having a Flare?

I was talking on the phone with a friend the other day after I had, once again, canceled our plans. Yes, she was empathetic and is a great friend. She has even learned many of the terms that we banter about every day in our psoriatic arthritis community such as flare and biologics.

So she asked, “Are you having a flare?” Hmm, great question. Am I having a flare? I’m not really sure.

Recognizing what a flare actually is

When I was first diagnosed, years ago, I thought that the term “flare” had a very black and white definition. Meaning, you were either having a flare or you weren’t. From that perspective, I believed that pretty much every single day of my life back then was lived in the midst of a flare. But flares aren’t exactly black and white are they?

I’ve had many people ask me, “I feel awful all the time, how do I know the difference?” Well, my dear friends, I get it! The reason that question is so difficult is that, in fact, there is no black and white answer. There is no check yes or no box here.

What symptoms of a psoriatic arthritis flare?

We banter the phrase, “I am having a flare,” often as PsA patients. I suppose when it comes down to it, the definition of a flare definitely changes a bit from person to person. For some, it includes some things that can be seen on the outside, like our plaques and pustules or swelling and stiffness. But for many of us, you can’t see anything on the outside. But, boy can we feel it!

The low level of flares

Flares start at a low level, I call this the slow simmer. It is almost like a simmering pot on the stove. It will exist in the background for hours, days, weeks, and sometimes even months. You can mostly function, but not on any sort of grand scale.

This is pretty much the level I hang out in even if I am doing everything "right.” When you are at the level of a slow simmer, you exist right on the edge of the next flare level. Of course, stress, weather change, or a simple cold will send you over the edge into the next level of a flare.

The middle level of flares

If you find yourself in the middle level of a flare, then you must be sitting right next to me. Because chances are, the middle is where I pretty much live. If you read the previous paragraph, then you know that I find myself in the slow simmer if I manage to do everything “right.” Let’s be honest here people, how often do any of us do everything right? Yeah, that’s what I thought.

The middle is when you want to try and enjoy life. The actual desire is there, but the reality reminds you it's not. In the middle level, you are painfully aware of what you are missing out as the world passes you by. You may squeak a few decently functional hours in a day, but all of your activities and mental functioning is limited. Your life is mostly spent deciding how or when you should use those precious few spoons.

Another way you may recognize yourself in the middle level is that dry shampoo is your new best friend. You don’t have the energy to full-on shower every day, but you sort of care about how you look, so dry shampoo becomes the ultimate go-to product. The middle is all about convenience and conservation. You do what you need to do to get from one day to the next. There is no time or energy for long term planning and grandiose ideas.

The death level of flares

And then there is death level. And yes, it is almost as bad as it sounds. In the death level, you forsake your dry shampoo in exchange for your bed, tub, and couch. Getting through the flare, you don’t have the energy or inclination to care about a whole lot. You need to sleep, but you can’t. And it is at this point, the death level when I give in to the steroids to “try” and snap myself out of it.

Well, am I having a flare?

Which brings us right back around to the first question, “Am I having a flare?” Well, I suppose the short answer is yes, of course. My whole life is a flare. But the real question is, which level?