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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. - PowerPoint PPT Presentation
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HOW TO MANAGE A FLARE
Psoriatic Arthritis
What is psoriatic arthritis?
Psoriatic Arthritis
Arthritis is inflammation of jointsPsoriasis 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 psoriasisSkin 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
Asymetrical Oligoarticular “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 psoriasisInflammation 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 jointsAffected joints become painful and swollenTendons and ligaments may be inflammed
What is a flare?
A flare may be short or may last a few weeksFlares can occur following an infection,
surgery or often for no apparent reason at allThey 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 stiffnessHelp things to settle down and reduce the
length of the flareHelp 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 properlyJoints should not be totally immobilisedSplints 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 neededDuring a flare they can be taken regularlyAnti-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 jointsMaintain joint movementMaintain weight – reducing pressure on jointsImprove fitness and reduce risk of
cardiovascular diseaseEase 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 oftenCan cause flare when stoppedIf 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
The End
Any Questions?