Flare Speed

I would like to know the science behind these things called flares. How does one go from feeling ok and after a 30 minute nap, wake up like they have been hit by a bus? What can possibly trigger such painful inflammation at such speed? The regular everyday pains always exist but those sudden bursts? I can see neurological issues doing this but does our kind of inflammation blast off with such fury? And my worst pain is usually while horizontal. While doing yard work I feel ok but and hour later while sitting still, BOOM! A wave of pain hits anywhere and everywhere and then calms down as random as it came on. I often wake up from a deep sleep nap and don’t know how I will get off the sofa, everything just aches like a bad flu. I feel very weird sometimes!

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Think of your immune system as being a toddler aged around two. They can go from smiling sweetly to screaming on the supermarket floor in a nanosecond, remember. And for little good reason too.

An immune system primed for PsA is simply no different.

The science behind it is that you’re immune system is wrongly primed to think you’re being attacked so charges off at very high speed to try and minimise that alledged attack but instead gets it totally wrong and stupidly attacks you instead.

This is all very simplified but it’s precisely what happens. I don’t get it so much with Cosentyx except for every 4th week, just before my next dose. For example my next dose is tonight. Walking the dog yesterday one foot and my back were decidely unhappy with what I was asking both to do. Which was simply walk the dog.

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Good illustration @Poo_therapy. Now if we had something that would just as quickly stop the tantrum that is legal! It’s so frustrating in how unpredictable it is. There is always the , “oh it looks like a bad week coming on” reality and then the added, “yikes! Why am I having trouble putting my arm through my sleeve when all I did was walk a bit further”? I suspect that my PsA would have me pretty much laid out if it weren’t for the Rinvoq. But the Rinvoq isn’t doing as much as I wanted it to. I’m back to wondering if I should try something else but scared that I might regret cuz it could be worse. I was better when in 25mg of oral MTX but didn’t like the side affects so have been weened to 10mg. I wonder if more MTX injectable would work better without the side effects?

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Mxt hated me all ways, but millions of people do extremely better by taking it by injection as to side effects at any rate. It’s surely worth a try? If it helps then increasing the dose back up doesn’t cause a problem does it?

Cosentyx certainly loves me but I still will need painkillers and anti-inflammatories too. I keep trying without but it just doesn’t produce the level of capacity I require to do the things I must do daily.

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Many patients tolerate MTX better when injected. You could explore folic acid → folinic acid as well.

Which anti-inflammatories work for you?

Yes, been on folic acid since I started mtx

Celebrex was fantastic for me until I was told no more NSAIDs.

I find over the counter ibuprofen peaks and troughs too much and actually seems to exacerbate exactly that high-speed, fly-by-night flare. The Celebrex was a 12 hour formulation, so I could easily make sure i took so that it covered my natural troughs - lowest between 1 and 4am, next worst between 2pm and 5 pm.

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I used to think that those high-speed flares were basically an overreaction of my pain system to a little extra inflammation (because the entire pain system is upregulated by inflammation).

But since I’ve started having these weird extra-intestinal manifestations of Crohn’s that are highly visible (like a rash on the face or swollen tongue), I have learnt that my body really can go from a slight grumble to near-hospital in three hours flat - so fast it almost looks like an allergic reaction.

This is not something we can often see with our joints, because many of us don’t swell as visibly on the outside. But I am starting to wonder if the same process can happen in our joints in severe cases - massive, fast, targeted inflammation. There is still a lot that the doctors don’t know and are researching.


Arcoxia not unlike celebrex either. I get it prescribed in the lowest dose possible so I can flex it up and down as appropriate. So that’s 30mg and the highest I take ever per day is 90mgs. A stomach protector like omeprazole etc is essential though.

As always all of these meds come with their own problems too. And there’s all sorts of stuff out there about what long term use of anti-inflammatories and/or stomach protectors do. But I take the view however - please let me have the best capacity I can have today so I can get on and do and achieve as frankly I’ve spent a helluva lot of days not being able to do anything much. And that helps nothing useful.

A painfree, capacitated me with a smile on my face consequently, always makes my world a happier place.

We also get refered pain. This is when nerves start firing pain signals and they go crazy firing off everywhere.

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“PsA” doesn’t even begin to describe this!

I am not sure what causes a flare. This is what I think happens to me, I push myself to do more and I am not too bad on the day. The following day or the day after which is often worse then I flare up and I suffer. It doesn’t seem to matter that I know that if I do more than I should, I just have to sometimes get things done or it is something or somewhere I want to go even though I know I will suffer the consequences a day or two later. Other times I don’t have a clue what brings on a flare. I do know that if rain is on its way and there is a low pressure I can get worse. Cellabrex and MTX helps. Do make sure you get meds that will protect your stomach. I didn’t know this and finished up with Colitis which causes belly cramps and numerous bowel movements and eventually bleeding. The hospital said I would be good in about a fortnight and it took me 6 months to get over the worst of the Colitis. I am left with occasional bouts of Colitis. but mostly under control by going on a low fibre diet until it settles.

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Goodness! That’s a long time with colitis. My father in law has colitis and he is always having trouble. I hope you have found some relief!