Living with Psoriatic Arthritis (PsA)

What triggers a flare up?

@Amos I have a tough time with appropriate self-care, too. And what’s worse is that when you’re all inflamed and suffering you’re not in you right mind so you’re even less able to advocate for yourself than you might otherwise.

Sleep is a huge issue for me. I hate going to bed (fear of missing out?) and when I get to bed I often have trouble calming my brain. I’m a big fan of meditation and mindfulness and I’ve recently supplemented those two Ms with another M: melatonin. It’s been a really big boost to getting me in the right frame for sleep.

I feel your ego struggle, I do. Admitting you need a bit more sleep might seem like giving in to your illness, but truly it’s just one more weapon in your arsenal to fight off the inflammation.

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To be honest you’ll probably be able to offer help and support to others for a lot longer if you look after yourself now.

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So know that one. When PsA hit me, I spent the first year like that, basically having a temper tantrum. At least you’re taking the meds, I wasn’t then. The good guys on here helped me over that one.

Glad you’re finding out the benefit of ‘napping’ and ‘stopping’ when necessary.

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Great to hear about the nap… I know it seems a small start, but the thing with these self-care things is that if you persist they can snowball to make a surprisingly large difference- not always to how much you can get done, but certainly to your quality of life, which of course for most of us makes a huge difference to the quality of life of our loved ones, as we become less and less grumpy-pants :rofl:

Oh, and it’s still seriously common for me to have an afternoon nap on top of my 10 hours night sleep!

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I also agree about Einstien’s theory and I do the same “ease into a task.” I used to say what the hell and just jump in. Now I gentle take on the task and stop when I need to. Of course that doesn’t stop my stubbornness or unwillingness to give in! That’s for another post.

I don’t seem to be any smarter regarding “what triggers flares”. Been on MTX since March 2019 at 25 mg/wk. Sulfasalazine added 7 weeks ago. Two weeks a ago I thought everything was getting better and the BANG! I’m on my 3rd day of absolutely ridiculous foot pain…both feet feel like they have been pummelled on the bottom and arches with a bat. Its now so bad my shins ache, my right quad is yelling and left hamstring (new) feels like its been on a major workout. When horizontal, I just writhe around trying to get away from it all…switching which foot massages the other (sort of rubbing anyway). New and more intense back pain kind of in the hip/sacroiliac area. I developed a mouth sore that was pretty painful when eating. After 7 days of no Celebrex, the sore is gone but everything else just ramped right up. I have serious doubts that the DMARDs are doing much but maybe I would be worse without them. So, I’m in an unpredictable stage of things acting up. I have a 3 month appointment with my rheumatologist on Monday Jan 6/20. I’m almost at the point of fulfilling her obligation of having to be on Dmard’s of two types for one year before our health care will consider Biologics. Also got hit with a psoriasis flare…minor and managed with Protopic. I really thought I was past this degree of pain! Here’s hoping in the New Year, all the best to you!


Wow Amos it certainly sounds like neither and both DMARDs are doing enough for you. Stay like this till Monday so your rheumy can see it too as sometimes that’s the only way when appplying funding protocols for treatment to get things moved on. As you know I don’t get flares as such - just a deepening realisation that the med(s) has/have stopped working for me. Very similar to what you’ve just described above.

Best of luck on Monday and let us know how you get on.

That’s similar to what happens to me when I take statins. Do you take a statin for high cholesterol?

No, my cholesterol and BP is well within normal range. These episodes come in waves until a “crash” and then back off. I can’t think of any diet changes that trigger them or a predictable pattern. Maybe when the pain is intense there is an endorphins release that settles things. I really don’t know.

My pain and inflammation greatly reduced by taking magnesium powder in water also and eliminating carbohidrates and grains and sugar in general

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What triggers a flare? Hmmm? Tuesday at 2:37…

I’m not sure I know what a flare is? I’m not sure I could feel much worse. I guess that is not quite true, sometimes I really hurt like hell.

Otezzla, Enbrel, Cosentyx, now Humira every week. I am starting to wonder if I will ever see a remission, whatever that is.

I am traveling this week for work and called the wife and told her I felt like my traveling days were numbered. Driving is just getting too hard to do for more than an hour.

This month it has been in my feet and shoulders bad. I read on here where people talk about some relief, maybe for years, from one biologic or the other. I’m not sure what is left for me to try.

Sounds like you need to investigate the JAK inhibitors possibly? Just a suggestion.

I had to fly to Dublin this week for a funeral from the UK. I stayed over night too. Obviously it was unplanned and funerals in Ireland happen very fast. It’s left me tired, achy and my feet and hands swelled up. My hips and back ache again too. And that’s when I consider Cosentyx is working for me as it is working when I don’t have to jump on planes and indeed drive to airports and then drive hire cars on the other side.

When my life is more measured and things go to plan I’m virtually pain free. I feel I will be again when I’ve rested up again sufficiently - just quietly working from home and pacing myself again, planning physical activities in a measured way.

It doesn’t appear you can do that with your job from what you’ve said previously.

Hopefully what I’ve said helps.

Two things almost always guaranteed to put me into a flare are more than the usual amount of stress and getting overheated.

The overheated part is definitely stupidity. I know better but I stay out just a bit too long in 90* temps and 153% humidity and I’m down.

The stress part is the job (I’m a criminal defense attorney who writes appeals for a living). In Kentucky, trials are recorded. We don’t have those handy-dandy transcriptionists like on Law and Order. I’m my own transcriptionist. This past summer, I got a 202-hour trial (yep, the entire pre-trial, trial and sentencing were the equivalent of 5 40-hour weeks).

I got it (and all the crap I put off in order to get rid of the beast in the 61 days the Kentucky Supreme Court gave us to write it) done and immediately fall apart and into a flare. Part of it was stupidity–I volunteered for the damn thing with another attorney. Part of it was the stress of the deadline, the sheer amount of information and a difficult client.

One would think that at my “advanced age,” I would not be stupid. One would be wrong to think that. I’m my own worst enemy.

Lack of sleep doesn’t put me into a flare but holy crap, do I feel awful the next day (or two). Lack of sleep last night means lousy day and increased pain today. I think that’s mostly advancing age along with a tad of auto-immune nonsense.

Thanks, I appreciate your sharing. I hope things improve!

Hi Amos,
I’m confused about flares, too. I’ve had a recent really bad flare in my feet—the worst they’ve ever felt. Today, they were quite a bit improved. Here in MN it’s cold and then colder. We went to Duluth 2 weeks ago (Duluth is coldest) to walk through an amazing light show. That seems to have been the trigger. My back went into a flare too. We dressed appropriately because we knew it’d be crazy cold, but we still nearly froze to death. On top of the light show I just HAD to stand out on the icy pier with a couple grandkids (at 8:00 pm) to welcome a 1,000 ft. ship into the harbor! Sometimes I forget I’m not 10 years old anymore :face_with_hand_over_mouth: until the fun is over and the pain gets ugly.

Being North of you in Manitoba, I understand the beauty of the snow. This foot pain sure is strange…sometimes heat feels good and another time I’m standing barefoot on the packed snow finding relief that way. I also have 4 children and a recent 11th grandchild! Much joy!

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Well, you’re only 1 grandchild behind me! And, I agree about the hot and cold. I use both on my feet (neck and back, too) and they both work. I think the cold wind off Lake Superior was the killer! It’ll be a long time before I go up there in the winter again (the Bentleyville Light Show is worth it if you’re a healthy person, though).

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For me a huge trigger is stress! I don’t know if this was mentioned earlier, did not read all the posts.
A little background, I live in a community, they pay for my medical, I would get a $5,000 infusion of Remicade, then they would call me in and “Gaslight” me, (a lot of narcissists) Tell me I am a screw up, etc etc. I told the person in charge of medical, that it countered the effects of the expensive biologic, and if they wanted to chew me out, to wait until the end of the medication cycle, that way I get my money’s worth… The message got through and they backed off.
Physical stress would also act as a trigger, doing to much, but mental is by far the worse. Eating the wrong foods may also cause flares, like going to Cheesecake factory and eating half a double chocolate cheesecake with whipping cream(yum!), in fact any desert will trigger it, but that at least would taste the best…


HaHa! You can take away my sleep and trash my mobility, but don’t mess around with my chocolate! Yes, I too am starting to correlate stress (mental and physical) with flares. We need something that works fast like an epi-pen…at the first sign of a flare, “BOOM” hit with the “enthi-pen”! Rats! Some pharmaceutical company just stole my idea…