PODIATRY

What Triggers an Arthritis Flare?

For those of us who have have any type of arthritis, you’ve probably lived through a flare up. During this period of renewed, increased disease activity or worsening symptoms — a time when the medications you normally rely on to control your disease don’t seem to work. The causes of flares vary by disease — so let’s look at the triggers of each. 

Rheumatoid Arthritis 

rheumatoid arthritis in feet
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In rheumatoid arthritis (RA), a flare can be related to natural variations in the processes that cause inflammation. This means flares can vary in intensity, duration and frequency, but they’re usually reversible — if treated promptly. 

For most people, the flare risk increases when treatments are tapered or stopped. Other triggers include overexertion, stress, infection or poor sleep. “Disease-modifying arthritis therapies are NOT cures; they maintain patients (hopefully) in states of low-disease activity or occasionally even remission. But when they are stopped, it is possible for the disease is likely to come roaring back. 

Osteoarthritis 

Since osteoarthritis (OA) is a degenerative disorder and typically it gets worse over time, it may be hard to tell a flare from disease progression. You might have increased joint pain, swelling, stiffness, and reduced range of motion. The most common triggers of an OA flare are overdoing an activity or trauma to the joint. Other triggers can include bone spurs, stress, repetitive motions, cold weather, a change in barometric pressure, an infection or weight gain. As we’ve discussed in previous blogs its time to start considering OA as a disease process that can be influenced or controlled instead of a runaway train.

Psoriatic Arthritis 

Psoriatic arthritis (PsA) is an inflammatory disease that affects the skin and joints. Nearly 30% of people with the skin disease, psoriasis develop psoriatic arthritis. Most people with PsA say a psoriasis skin flare will often precede a flare of arthritis symptoms. 

Common triggers for psoriasis flares include: 

  • Stress 
  • Injury to your skin 
  • Certain medications 
  • Bacterial infections, specifically strep throat 
  • Other possible triggers: allergies, diet, alcohol intake, smoking and weather changes 

According to the article in Rheumatology, their flares were more than an increase in swollen joints, psoriasis plaques or fatigue. They found psychological aspects of their disease — such as social withdrawal, emotional distress, frustration and depression — equally debilitating. Their flare triggers were similar to those for psoriasis and included stress, strenuous physical activity, a change in medication and the weather. 

Gout 

Uncontrolled uric acid levels trigger crystals to form in and around the joints, causing inflammation and pain in people with gout. Medications can control uric acid levels and over time reduce or eliminate gout flares

When you first start taking urate-lowering medications — such as allopurinol— you may have a flare because of the sudden changes in uric acid levels in your blood. A common sign that long-term gout therapies are actually working is an initial worsening of disease. That’s why colchicine and other anti-inflammatory medications are used to manage flares when initiating uric acid-lowering therapy. 


Develop Flare Awareness And Protocol

Regardless of how a flare is defined or triggered in RA, OA, gout or PsA, experts agree that being aware of how your body feels and identifying triggers is the best method for limiting the damage.  It does help for patients to track their flares, such as in a diary or journal. Not all flares require medical attention, but recurrent mild flares may indicate a suboptimal control of the disease.In our field of specialty, mechanical trauma is a frequent causative or contributing agent. The change in seasonal footwear, activity increase, specialized sport footwear, changes in environment ( cottage or vacation), or simple direct trauma. Once identified, avoiding the causative trigger is the best policy even if significant change is required.  If you don’t already have an agreed flare protocol with your doctor, call them on first signs of a flare so you can adjust your treatment and minimize the permanent destructive changes. 


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