Psoriatic arthritis
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Psoriatic Arthritis. How to manage a flare. What is psoriatic arthritis?. Psoriatic Arthritis. Arthritis is inflammation of joints Psoriasis is a skin condition which causes patches or plaques of red scaly skin.

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Psoriatic Arthritis

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Psoriatic Arthritis

How to manage a flare


What is psoriatic arthritis?


Psoriatic Arthritis

  • Arthritis is inflammation of joints

  • Psoriasis is a skin condition which causes patches or plaques of red scaly skin.

  • Psoriatic arthritis is a type of arthritis which develops in some people with psoriasis

  • Skin psoriasis can be severe or mild, some people just have a family history of psoriasis


A normal joint

  • Movement occurs when muscles pull on tendons

  • Cartilage covers the ends of bone

  • Synovial fluid lubricates the joint

  • Synovium surrounds the joint and makes synovial fluid

  • The outer part of synovium is the capsule which is tough and keeps everything in place

  • Muscles and tendons provide stability


Psoriatic Arthritis

  • Inflammation can occur in the synovium (lining which creates the lubricating synovial fluid) “synovitis”

  • Inflammation can occur in the tendons and/or ligaments “tendonitis” “enthesitis”


Which joints are affected?

  • Psoriatic arthritis is very variable

  • People are affected in different ways

  • Some people have many inflammed joints

  • Some people have just one inflammed joint


Types of Psoritatic Arthritis

  • AsymetricalOligoarticular “oligo” means few

    • Less than 5 joints at one time. E.g. knee and a few joints in the hands


Types of Psoritatic Arthritis

  • Symmetrical polyarthritis “poly” means many

    • Usually lots of small joints. E.g. in hands and wrists


Types of Psoritatic Arthritis

  • Spondyloarthritis “Spondylo” means spine

    • Back pain is the main symptom


Types of Psoritatic Arthritis

  • Distal Interphalyngeal Joint predominant

    • Rare pattern affecting joints at ends of the fingers

  • Arthritis mutilans

    • Rare severe form causing a lot of joint damage


Psoriatic Arthritis Symptoms

  • Joint Symptoms

    • Pain and stiffness. Stiffness usually worse in the morning and after rest. Inflammation causes swelling and redness.

  • Tendon inflammation

    • E.g. Achilles


Other symptoms

  • Dactylitis “Sausage” fingers or toes

  • Nail psoriasis

  • Inflammation of eye “conjunctivitis” or “iritis”

  • Tiredness


What is a flare?


What is a flare?

  • Psoriatic arthritis is a chronic relapsing remitting condition

  • This means it is persistent and sometimes flares up whilst at other times settles down

  • It is difficult to predict for an individual how the disease will progress and how severely they might be affected


What is a flare?

  • A flare means that there is more inflammation and symptoms are worse

  • A flare may involve one joint or several joints

  • Affected joints become painful and swollen

  • Tendons and ligaments may be inflammed


What is a flare?

  • A flare may be short or may last a few weeks

  • Flares can occur following an infection, surgery or often for no apparent reason at all

  • They may develop over a period of hours or days


Can flares be prevented?

  • Goals of treatment are

    • Reduce pain and stiffness

    • Prevent joint damage

    • Minimise disability caused by pain or joint damage


Can flares be prevented?

  • Many patients need long-term medication to control their symptoms

  • Taking these medications should reduce inflammation and flares

  • Even when control is good flares can still occur


What can you do when a flare occurs?


Treatments

  • Relieve Symptoms of pain and stiffness

  • Help things to settle down and reduce the length of the flare

  • Help to prevent damage


What Can You Do at Home?


Helping Symptoms: Heat/Cold

  • Cold – E.g. ice or frozen peas wrapped in a towel - can reduce swelling and relieve pain by numbing the affected joints and by reducing the amount of inflammation causing chemicals being brought to the joint in the blood.


Helping Symptoms: Heat/Cold

  • Heat – E.g. warm towel, heat pack, or warm bath - can help relax aching muscles and relieve joint pain and soreness


Helping Symptoms: Heat/Cold

  • Experiment to find combination that works best for you

  • E.g. Cold initially when swelling most intense and then heat to soothe when settling down but still painful


Helping Symptoms: Splinting

  • Splints may help rest joints at night or hold them in a comfortable position during work or exercise

  • During a flare they may help ease pain in that joint


Helping Symptoms: Splinting

  • Splints should fit properly

  • Joints should not be totally immobilised

  • Splints should be removed periodically to perform gentle exercises to maintain mobility


Helping Symptoms: Painkillers

  • Anti-inflammatories are good at easing pain and stiffness. Many different types are available and each is slightly different.

  • These are often used as needed

  • During a flare they can be taken regularly

  • Anti-inflammatory creams or gels are also available


Helping Symptoms: Painkillers

  • Sometimes extra painkillers are needed e.g. paracetamol or codeine

  • These can be taken regularly during a flare and then stopped


Preventing damage: Rest vs Activity

  • Exercise is beneficial for many reasons:

  • Improve strength and muscle tone –helping to protect joints

  • Maintain joint movement

  • Maintain weight – reducing pressure on joints

  • Improve fitness and reduce risk of cardiovascular disease

  • Ease stress


Preventing damage: Rest vs Activity

  • During a flare when a joint or tendon is inflammed you may need to rest more and modify your activities to prevent additional strain through the joint.


How might a doctor help when a flare occurs?


Painkillers

  • Your GP may be able to prescribe stronger or alternative anti-inflammatories

  • He/she may also prescribe additional painkillers such as paracetamol or codeine


Steroids

  • Steroids are powerful anti-inflammatories and can help settle a flare quickly

  • They can be given into a joint, into the muscle or as a tablet

  • Sometimes when steroids are stopped or wear off skin psoriasis can flare and become worse


Steroids: into a joint

  • If one or two joints are involved in a flare this can be very effective

  • Excess fluid can be drained at the same time which can quickly improve symptoms and joint movement


Steroids: into a joint

  • Depending on the joint involved this could be done

    • At GP practice

    • In injection clinic

    • On day assessment unit


Steroids: into muscle

  • If lots of joints are involved giving an ‘IM’ injection allows it to be slowly absorbed and benefit all joints

  • Comes out of the body gradually over several weeks


Steroids: tablets

  • Used less often

  • Can cause flare when stopped

  • If reduced slowly can take a long time to be able to stop


Who to contact if you need more help or advice?


Need more help?

  • If symptoms aren’t improving or struggling to manage

    • GP

    • Advice line – 01225 428823 & leave a message explaining you have a flare. You will be called back by a nurse specialist. (Not for emergency calls, at busy periods may take up to 48hours)

    • Consultant’s secretary via hospital switchboard – 01225 465941


What next?


What next?

  • Flares are part and parcel of Psoriatic Arthritis

  • If they settle down no further action may be needed

  • If flares are happening frequently or there are persistent symptoms it may be worth reviewing your regular medication at your next appointment


Any Questions?

The End


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