Psoriatic arthritis, which can attack joints anywhere in the body, affects everyone differently. Some people experience pain and stiffness in the hands, wrists, or elbows, while others feel stiffness in the feet, spine, hips, or shoulders. Psoriatic arthritis can also occur in a combination of these joints, according to the National Psoriasis Foundation (NPF). The intensity of symptoms during a flare-up also varies from one person to the next, making psoriatic arthritis a uniquely individual experience.

While medications help keep symptoms under control, flare-ups can’t always be avoided. Spotting the signs of a flare-up quickly and knowing how to manage the symptoms can help ease your discomfort.

What Causes Psoriatic Arthritis Flare-Ups?

A psoriatic arthritis flare-up can be triggered by a variety of factors. Your immune system may be activated by stress, infections such as the flu or strep throat, a physical injury, or smoking, to name just a few potential causes, says Petros Efthimiou, MD, a rheumatologist with White Plains Hospital Physician Associates in Larchmont, New York.

When that happens, your joints might start to feel swollen, tender, and stiff, and you might develop areas of tendonitis or swelling of an entire finger or toe, says Theodore Fields, MD, a rheumatologist at the Hospital for Special Surgery in New York City. But it’s also possible that you won’t have swelling during a flare-up. Your main symptom might be fatigue, Dr. Fields adds.

Easing Symptoms of Psoriatic Arthritis Flare-Ups

To deal with psoriatic arthritis symptoms during a flare-up, take these steps:

1. Decrease Pain and Stiffness

For occasional discomfort, Fields says, nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil) or naproxen (Aleve) can be beneficial. Ask your doctor about increasing the dose during a flare-up. You can also try heat or ice at the source of discomfort, Fields says. If pain persists, he adds, your doctor may recommend prescription pain medication or a steroid injection at the affected joint.

2. Incorporate Arthritis-Friendly Exercise

Proper exercise is essential for keeping joints and tendons loose, strengthening muscles, and maintaining a healthy weight, according to CreakyJoints . During a flare-up, try gentler exercises, such as walking, swimming, or yoga. If your condition is keeping you from exercising, work with a physical therapist to help you get moving again.

3. Reduce Stress

Not only is stress a psoriatic arthritis trigger, but it can also make you more sensitive to pain. A report published in 2015 found that taking several deep breaths and letting go of tension can help you regain calm. You can also try stress-relieving techniques like massage and acupuncture, advises the NPF.

4. Get Extra Rest

Sleep disorders such as insomnia and obstructive sleep apnea are more common in people with psoriatic arthritis and psoriasis, according to the Arthritis Foundation. To improve sleep quality, try practicing good sleep habits, such as going to bed early enough to get adequate sleep, and stress-reduction techniques to help you sleep well. Sometimes even getting extra rest may not resolve this level of fatigue, but giving your body time to recover from pain and inflammation may be beneficial since fatigue can be related to severity of inflammation, according to a 2018 study.

5. Consider Using Assistive Devices

Your doctor may recommend various devices to provide additional support for an affected joint. A splint can be used to hold a joint in the best position for improved function or to relieve pain and swelling. If foot or heel pain are concerns, foot orthotics such as shoe inserts or pads may provide relief and improve your gait. Talk to your doctor about your specific symptoms.

What About Managing a Psoriasis Flare-Up?

Controlling psoriasis is key to managing psoriatic arthritis flare-ups. While psoriatic arthritis and psoriasis are two separate conditions, 30 percent of people with psoriasis also develop psoriatic arthritis, according to the NFP. The severity of one disease does not dictate the severity of the other, so your treatment should be individualized.

“Some patients have severe psoriasis and mild arthritis, and the treatments are guided by the skin problem,” Fields says. “Some patients have severe arthritis and not such severe skin problems, and in that case the arthritis will determine the therapy.”

Here are some ways to address psoriasis symptoms during a flare-up:

• Moisturize. During a flare-up, locking in moisture is the first step to relieving the itch, according to the NPF. “Have a good skin care regimen, especially in dry weather,” says Delphine Lee, MD, PhD, director of dermatology at the Los Angeles County Department of Health Services and a clinical professor at the UCLA David Geffen School of Medicine. “Furthermore, in winter months you may flare and should see a board-certified dermatologist for topical or systemic prescription medications if itching is not relieved with your usual regimen.” Apply a rich moisturizing cream or ointment to retain moisture and fight the itch.
• Avoid skin injury. “Psoriasis can develop at sites of trauma or skin injury,” Dr. Lee cautions. When you are experiencing a flare, protect your skin from chafing and additional irritation by wearing soft, breathable cotton fabrics, the NPF recommends.
• Address the stress. Stress worsens all symptoms during a flare-up, according to the NPF. Keeping a journal is one way you can release some of the stressful feelings you may be dismissing. You can also look over recent journal entries during a flare-up to identify stress triggers. Consider sharing your findings with a professional therapist who understands the emotional impact of psoriasis and who can help you better manage your stressors.

Additional reporting by Brian P. Dunleavy