Active psoriatic arthritis: recognising and managing a flare

Psoriatic arthritis can present with tender, swollen or stiff joints, stiffness after rest, a whole swollen finger or toe, heel or sole pain where tendons attach, and back stiffness. Skin plaques or nail pitting may change at a different time from joint symptoms, so clear skin does not by itself show that joint inflammation is controlled. Fatigue and reduced function can also signal that the disease is affecting daily life.

Contact your rheumatology team when swelling, stiffness or pain is new, persistent or disrupting sleep and normal tasks. Record which joints or tendon areas are affected, when stiffness is worst, and any skin, nail or eye changes. Keep prescribed disease-modifying treatment unchanged unless the prescriber advises otherwise. During a flare, balance short rest periods with gentle movement; a physiotherapist can adapt exercise without repeatedly loading an inflamed joint or tendon attachment.

A red, painful eye with light sensitivity or blurred vision needs urgent eye assessment because psoriatic arthritis can occur with eye inflammation. Seek same-day medical advice for a single joint that becomes suddenly very hot, markedly swollen and extremely painful, particularly with fever or illness, because infection must be excluded. Get urgent help for chest pain, severe breathlessness, weakness on one side or a serious medication reaction.

Ask whether your current symptoms reflect active inflammation, mechanical strain or both, and which examination, blood test or imaging finding will guide the decision. Discuss whether treatment needs adjustment, which pain relief is compatible with your medicines, and how to modify work or exercise. Mention infections and new medicines before taking an immune-modifying dose.