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Symptoms of spondylitis (also called spondyloarthritis) can increase during periods of high disease activity — periods called flare-ups or flares. Flare-ups are unfortunately part of living with inflammatory arthritis. Even when spondylitis is properly managed, symptoms will vary from time to time as inflammation fluctuates.
Spondylitis flare symptoms are unpredictable, including in how severe they’ll be and how long they will last. Flare-ups can come and go, lasting days, weeks, or even longer.
Thankfully, there are some flare-up management techniques. Working with your rheumatologist, it is often possible to curb the frequency and severity of your flares.
The particular symptoms you experience during a flare-up can vary depending on the type of spondylitis you have. Someone living with enteropathic arthritis, for instance, might have more digestive symptoms during a flare, while someone with psoriatic arthritis might notice more skin issues.
Other common spondylitis symptoms that increase during flares include:
No matter what type of spondylitis you have, you will notice an increase in the severity of your symptoms during a flare-up. As one MySpondylitisTeam member wrote, “I have difficulty breathing and pain in my ribs, hands, wrists, elbows, ankles, shoulder blades — and, of course, the pelvis, where it always hurts!” Another member described experiencing increased jaw pain and a lack of coordination: “Does anyone’s spondylitis affect their jaw and balance? I feel like this is how I experience a flare.”
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Regular daily activities can become more challenging during a flare. One MySpondylitisTeam member wrote, “Bad flare day. Can’t sit, can’t stand.”
All flares tend to be painful and may take a toll on mental and emotional health. One study found that 75 percent of people living with ankylosing spondylitis — a type of spondylitis — reported heightened emotions, including depression and anger, while in a flare-up. “I am at the beginning of a flare,” one MySpondylitisTeam member wrote. “It affects my mental health. I am so fatigued that I can’t stay awake.”
Treating flare symptoms as soon as they appear is key. Managing symptoms can help you get through a flare-up and prevent some of the long-term damage associated with the disease.
Most MySpondylitisTeam members agreed that it is a process of trial and error to find what combination of therapies works best. For one member, it was “lots of stretching, heating pads, and baths.”
The first time you experience a flare, it is important to speak to your rheumatologist. You can work together to find the best treatment to manage your flares. If reliable techniques stop being effective, further medical advice from your rheumatologist is recommended.
Many factors called triggers can influence spondylitis disease activity and cause flares. Triggers can include:
One member discovered the hard way that a certain nightshade vegetable was a trigger. “I’m in a flare,” they wrote. “I just learned that eggplant is a no-no for me. Ugh!”
Some MySpondylitisTeam members find that weather can trigger a flare — especially abrupt changes in temperature. As one member described, “Weather changes make my symptoms worse.” However, some members praise the warm weather for its healing effects: “I feel like when I am on the beach, my pain isn't as intense,” said one member.
With all of these possible triggers, it is important to track which ones affect your spondylitis flares. Knowing what causes or worsens your symptoms may help you manage them during a flare — or even prevent flares from occurring.
Medications can help reduce disease activity or even promote medicated remission, allowing a person to become symptom-free. Spondyloarthritis flare-ups are inevitable, but taking your medication as prescribed is key to managing your symptoms.
Some of the most effective medications for treating spondylitis are biologic drugs. Biologics can tame the immune system and block inflammation at the source. Biologics alone won’t always be enough to manage severe spondylitis symptoms.
Biologics are not for everyone, and some people can manage spondylitis without this treatment. In these cases, their condition is often treated with nonsteroidal anti-inflammatory drugs (NSAIDs). Some NSAIDs, like Advil (ibuprofen), can be found over the counter (OTC). During a flare, your doctor might increase your regular NSAID dose or add a prescribed or OTC pain medication to your regimen to help relieve pain.
Note that some types of spondylitis are linked to gastrointestinal issues, such as irritable bowel syndrome and inflammatory bowel disease. In these cases, NSAIDs might not be a good choice. One MySpondylitisTeam member explained, “I'm not allowed to have NSAIDs because of a history of ulcers and gastrointestinal hemorrhage.” Other prescribed and OTC pain medications can be effective treatments with fewer gastrointestinal side effects.
Oral steroids and corticosteroid injections can provide great relief for spondylitis pain. Oral steroids often work quickly and efficiently to minimize breakthrough pain during a flare.
Corticosteroid injections take longer to help with pain, but the relief they provide can last for months. One MySpondylitisTeam member rejoiced, “I have injections in my L4-L5 and L5-S1 to stop my sciatica. The corticosteroid injection works so well.”
A transcutaneous electrical nerve stimulation (TENS) unit can help treat chronic pain. This type of therapy uses low-voltage electrical current to provide pain relief. A TENS device can be prescribed by a physical therapist in a rheumatology clinic and may be a safe and easy way to lessen flare pain. A TENS machine is small and portable, so you can use one to treat your pain nearly anywhere.
Some members find TENS units useful, while others do not find as much relief from the device. As one member wrote, “I found it pleasant, but had no real pain relief at all.”
For one member, the effects of a TENS unit wore off, but “physical therapy with a trained therapist and gentle stretching helped.” A flare-up may not be the best time to try a new exercise, but adjusting your regular exercise or physical therapy might help. Even some gentle exercises in bed may help reduce flare symptoms.
It is important to find the right balance between rest and movement during a flare. Keeping a good posture during rest is critical to reaping the benefits. Likewise, it is important to move carefully and not surpass a comfortable range of motion. If you’ve been prescribed technical supports, like canes or splints, be sure to use them as directed during a flare.
There is no one-size-fits-all solution for a spondylitis-friendly diet. Certain foods can trigger flares in some people but not others, so it is important to make personalized dietary changes as needed.
The Mediterranean diet is considered a helpful anti-inflammatory diet for people living with inflammatory arthritis. A diet high in probiotics is also recommended by health professionals for those with gastrointestinal issues. As one member explained, “I have ankylosing spondylitis and Crohn’s disease. A clean Mediterranean diet and probiotics saved me.”
Read more about the anti-inflammatory diet for spondylitis.
Other members swear that avoiding sugars helps them avoid flares: “I used to get really painful headaches, but I’ve cut out sugar now.” A low FODMAP diet is also popular among people living with spondylitis who are prone to gastrointestinal flares. (“FODMAP” stands for “fermentable oligosaccharides, disaccharides, monosaccharides, and polyols.”)
Hot and cold therapies can help relieve sore areas during a flare-up. A hot towel, shower, or pack can relieve tightness, pain, and stiffness in a joint. A cold pack or even frozen peas can be placed on a hot, swollen joint that is already inflamed for some short-term relief.
One member discovered the relief was worth the initial discomfort: “I bit the bullet and put an ice pack (frozen peas) on the spine. Within 10 minutes, the horrifying pain eased significantly.”
Stress can play a role in increasing the symptoms of a spondylitis flare-up. This relationship seems to go both ways: Stress can trigger a spondylitis flare, while flare-ups may lead to stress. One MySpondylitisTeam member reported, “Stress will always make my pain level go through the roof.”
Whether or not stress is involved in your symptoms, a flare-up is a good time to practice some stress-management techniques. Mindful wellness practices, such as meditation and breathing exercises, can help relax the body and mind. One member shared, “Meditation helps me a lot in dealing with spondylitis.”
Other members share that pleasant distractions help the most during a spondylitis flare. Spending time with a loved one was one member’s example: “I’m in a flare-up, but my day is tolerable because my grandbaby is with me.”
Living with spondylitis and its flares is challenging. Luckily, you’re not in it alone. MySpondylitisTeam is a social network support group with more than 69,000 members who share tips and tricks to help each other live better with spondyloarthritis.
Are any of these methods useful to you during a flare-up? Do you have techniques you would like to share? Let us know by commenting below or by posting on MySpondylitisTeam.
Ariel D. Teitel, M.D., M.B.A. is the clinical associate professor of medicine at the NYU Langone Medical Center in New York. Review provided by VeriMed Healthcare Network. Learn more about him here.
