Flare-up and Remission Cycle

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 consider 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:

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

Physical Symptoms of a 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


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


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


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

Management of Pre-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

Management of 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

Written by: Emily Downward | Last reviewed: October 2016.
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