7 Tips on How to Treat a Psoriatic Arthritis (PsA) Flare-Up

Psoriatic arthritis (PsA) is a lifelong autoimmune condition that can cause inflammation in the skin (psoriasis), joints, spine, and tendons. About 30% of people who have psoriasis also have PsA. 

There is no cure for PsA (yet!), but there are many medications to keep it controlled. The goal of PsA treatment is to find medication that treats all of your symptoms: psoriasis rashes, joint pain, and tendon problems.

Even with great medications, PsA flares sometimes happen. This is when symptoms temporarily worsen. The good news is that learning about what can trigger PsA flares and how to prevent them is one way you can take control of your PsA.

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Below, we explain the signs and symptoms of PsA flares and offer tips on how to treat and prevent them.

What are the symptoms of a PsA flare?

An official definition of a PsA flare does not exist yet, but experts are working together to create one. PsA flares are different for everybody, since everyone has their own version of PsA. When your PsA flares, the symptoms of your PsA will be worse than normal. Sometimes, new symptoms can also occur.  

For example, let’s say you have psoriasis rashes on your elbowsand joint pain when your PsA is not well controlled. During a PsA flare, you could expect to have rashes, joint pain, or both. A new symptom might also show up if the flare is very bad.

Some typical PsA symptoms include:

• Joint pain or swelling

• Worsening of psoriasis rashes — in new areas or areas that have been involved before

• Enthesitis: Tenderness and inflammation at the site where tendons attach to bone, like the back of your heel.

• Dactylitis: Swelling of an entire finger or toe. Also called sausage digit.

• Spondylitis: Inflammation of the sacroiliac joints or the spine. 

• Fatigue

What are triggers of a PsA flare?

A variety of things can trigger a PsA flare. Some triggers you can prevent, but some you can’t. 

The good news is that the most common cause of a PsA flare — missing doses of your medication — is within your control. The best favor you can do for yourself is taking your PsA medications as directed. 

If you are having trouble getting or taking your medications for any reason, talk to your healthcare provider or pharmacist. They can help troubleshoot, problem-solve, or find an alternative medication if needed. If it’s hard for you to remember to take your medications, you could try using a medication reminder app or setting an alarm on your phone.

Aside from missed medication, other causes of PsA flares include:

• Stress

• Lack of sleep

• Infections of any kind (bacterial, viral, etc)

• Smoking

Other things can also trigger psoriasis flares. It is reasonable to avoid psoriasis triggers (like skin injuries and certain foods), too.

Can your diet trigger PsA flares?

Diet isn’t linked to PsA flares specifically, but diet may cause psoriasis flares in some people. No studies prove that diet triggers psoriasis rashes for all people. But, for some folks, certain foods can be triggers. If you know certain foods or drinks worsen your psoriasis rashes, it makes sense to avoid them when trying to prevent PsA flares, too. Eating a healthy diet is also a good idea, since PsA increases the risk of heart disease.  

What can you do to treat a PsA flare?

It’s important to call your provider and let them know you are having a flare. They may need to prescribe a short-course of new medication or change what you’re currently taking. 

Some PsA flares can improve with just 1 to 2 weeks of nonsteroidal anti-inflammatory drugs (NSAIDs) or steroids to stamp out the extra inflammation. Your provider may be able to prescribe these without seeing you in person. But if your flare isn’t getting better after 1 to 2 weeks with these, this could be a sign that your PsA medications aren’t working as well anymore. You should schedule an appointment so your provider can take a closer look. You might need a change in your PsA medications to get things back under control.

There are also some things you can do on your own to feel better sooner:

• Take it easy on swollen and painful joints. Give them time to heal.

• Ice swollen and painful joints. Ice can temporarily decrease warmth, pain, and swelling in joints that hurt the most.

• Take your medications as directed.

• Rest and sleep. This might mean taking some time off of work or asking for extra help from family or friends. 

• Try to focus on decreasing stress levels. This could include self-care, exercise, mindfulness, or a number of other options. 

• Lean on your support system. An arthritis support group can also be a great resource.

What’s the best way to prevent a PsA flare?

PsA flares can make it hard to work, play, and take care of your family. But there are things you can do to decrease your chances of having flares in the future.

To help prevent PsA flares, focus on the following:

• Taking your medications as prescribed

• Stopping smoking

• Stress management

• Getting enough sleep

• Staying up-to-date on recommended vaccines to prevent infections that can trigger flares

• Avoiding known food triggers of your psoriasis rashes, if you have them

Why trust our experts?

Written by:

Samantha C. Shapiro, MD

Samantha Shapiro, MD, is a board-certified rheumatologist and internist with expertise in autoimmune and inflammatory conditions. She founded the division of rheumatology at Dell Medical School at The University of Texas at Austin.

Edited by:

Mandy Armitage, MD

Mandy Armitage, MD, has combined her interests in clinical medicine with her passion for education and content development for many years. She served as medical director for the health technology companies HealthLoop (now Get Well) and Doximity.

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