Fight the flare

(Editor's note: Portions of this interview were edited for clarity and brevity.)

Q: What can I do to prevent joints from freezing or fusing during a flare?

I would turn to some physical approaches like putting the joint through passive and active range of motion. Passive means that you or someone else is moving the finger or limb around the inflamed joint. You can do it yourself or ask someone else to do it for you, like your spouse. Either way, you put the limb or joint through a small range of motion, which tends to be a little less painful than an active range of motion. 

Q: Is there a connection between seasonal allergies and PsA flares?

The answer is yes. In my experience, a person can get seasonal allergies, feel kind of crummy and have that be a trigger for a flare. But it’s not always the case. Until you’ve actually experienced it yourself, I can’t tell you whether or not your psoriasis or psoriatic arthritis will be flared by those allergies.

Q: Do your recommend exercising during a flare?

We do encourage modest activity. Get up and do some walking, and maybe even once the flare begins to subside, get back into regular exercise. Start slow, stretch and choose low-impact activities like swimming, cycling or walking. I would strongly have you consider something like yoga or tai chi.

Q: I use acupuncture to help with PsA pain. Will it aggravate my psoriasis? I’ve experienced the Koebner effect. 

Acupuncture can help the pain of arthritis. But if you happen to be highly sensitive to physical trauma to the skin and get the Koebner phenomenon, which is when you get a flare of psoriasis where the skin has been traumatized, then that’s possibly a no-go situation for you. 

Q: What types of assistive devices can be helpful for PsA?

Health supply stores and drugstores have things like braces and adaptive aids for all of our everyday activities like writing, cooking and walking. These activities can be helped by use of things like handles for utensils, tools or writing implements. Using canes or wrist and knee bracing is also important.

Q: How can I tell if I’m having a PsA flare?

Flares can be defined in different ways for different people, but it means a worsening or increase of pain, increased stiffness, increased fatigue, malaise (general feeling of discomfort) and difficulty sleeping. Some people say it’s like the flu.

Q: Are there any over-the-counter topical ointments or creams that can be put on the skin to help with the redness and swelling of a PsA flare? 

There are some anti-inflammatory topical agents. Then there are the topical analgesic (pain relief) medications, including, for example, topical lidocaine. Even the old remedies like BENGAY may have some therapeutic benefit for you. A caveat to keep in mind is that most of these topical agents only penetrate slightly through the skin. They don’t really get down into the level of the joint or the tendons. Some of the newer products that are being developed have carriers embedded within them that can improve this situation and allow the topical to reach a deeper level. That’s something that would be worth talking about further with your physician.

Dr. Philip Mease is Clinical Professor at the University of Washington School of Medicine and Director of the Rheumatology Clinical Research Division at Swedish Medical Center in Seattle, Washington. He is co-chair of the National Psoriasis Foundation’s PsA Project Design Committee.

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