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The Flare and Remission Cycle of Psoriatic Arthritis

Reviewed by: HU Medical Review Board | Last reviewed: August 2022

Psoriatic arthritis (PsA) is a chronic inflammatory disease that can wax and wane. There can be periods when symptoms are more painful (flare) and periods when symptoms are much milder (remission). Symptoms can even seem to disappear during remission.1

Flares, or flare-ups, of PsA can vary from person to person. They can affect multiple areas of the body or just one area. For example, you could have joint pain along with psoriasis skin symptoms, or you could have only the skin symptoms.2

Symptoms also can change with each flare. They are often unpredictable and can have a big impact on a person’s quality of life.1,2

Symptoms of a PsA flare

Symptoms are often experienced in multiples or combinations. Flares include many physical symptoms, such as:2,3

  • Pain
  • Heat
  • Stiffness
  • Swelling
  • Skin lesions (psoriasis)

Flares can also include invisible symptoms, such as:2,3

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  • Fatigue – Fatigue may appear as extreme tiredness, difficulty keeping your eyes open, or flu-like symptoms. People also report symptoms such as lack of motivation or brain fog along with fatigue.
  • Loss of normal function – During a flare, people often lose the ability to perform some normal functions. For example, daily tasks of bathing, getting dressed, or shopping are much harder and more painful.
  • Social withdrawal and isolation – Many people avoid going out or being social during a flare because the symptoms are too much to bear. This leads to social isolation, which may only make symptoms worse.
  • Anxiety and depression – Psychological symptoms that some people experience during a flare include anxiety, depression, frustration, embarrassment, and fear. These are made worse by fatigue and the loss of normal joint function.

Early warning signs and triggers of a PsA flare

Just like flare symptoms, the early warning signs of a PsA flare can vary widely. You may wake up feeling extra tired, sore, and stiff. Or you may start having blurry vision.3

Certain information can tell you what your unique warning signs and triggers might be. Keep track of your:2,3

  • PsA symptoms
  • Sleep patterns
  • Diet
  • Daily activities
  • Stress levels

Potential triggers may be:2,3

  • Skipping medicine
  • Trauma or injury to the skin or joints (for example, a sunburn or a fall)
  • Stress
  • Unhealthy diet
  • Smoking

By knowing what triggers your PsA flares, you can largely avoid them. This could lead to more periods of remission.2,3

Managing flares

Management of PsA flares means taking care of both your body and your mind. It involves:2,3

  • Taking medicine consistently
  • Managing stress
  • Eating a healthy diet
  • Exercising regularly
  • Resting when you need to
  • Avoiding certain activities that make you prone to triggers
  • Recognizing the early warning signs of a flare

Flares are common in PsA. But as you become aware of the triggers and early warning signs, you can learn to manage your day-to-day activities to reduce your chances of a flare. Take care of yourself, and you may have fewer flares and more periods of remission.