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Reviewed by: HU Medical Review Board | Last reviewed: September 2022

Like any form of arthritis, axial spondyloarthritis (axSpA) comes with good days and bad days. Periods when symptoms increase are called flares. Like many features of axSpA, flares are unpredictable and vary widely from person to person. Knowing what flares are, how to recognize them, and how they are diagnosed and treated can help you deal with them.1-3

What causes axial spondyloarthritis flares?

Unfortunately, doctors are not sure why flares happen. There is an increase in inflammation with flares, but it is not always clear why. Sometimes a flare occurs because a person overdid it with activity. Other times flares can be caused by stress at home or at work. Doctors are still learning whether flares result from axSpA progression or from predictable triggers.3,4

Signs a flare could be coming

People are different, and so are their flares. But there are some common signs and symptoms that people with axSpA experience during a flare.3,4

Discomfort and stiffness are common in axSpA. Increased pain and stiffness are the most common signs of an axSpA flare. Like the disease, the location of the pain varies greatly from person to person. Most commonly, increased pain is felt in the lower back and sacroiliac (SI) joints, where your pelvis meets your spine. Other areas may include:1-4

  • Neck
  • Shoulders
  • Hips
  • Feet

Other symptoms of a flare might include:3,4

  • Fatigue
  • Emotional symptoms
  • Loss of appetite
  • Uveitis, a condition that causes pain, redness, and sensitivity to light in one or both eyes

How long does a flare last?

A flare may gradually increase in intensity, or it may suddenly hit you hard. Flares can cause different levels of pain. Sometimes the pain is mild and goes away after a short time. Other times, the pain may be severe and constant. Flares can last days or even weeks.3,4

How are flares diagnosed?

The best way for your doctor to diagnose a flare is by talking to you about your symptoms. If you have worsening symptoms or discomfort, your doctor will likely call it a flare.3,4

Other tests also may help your doctor diagnose a flare, including:3

  • Magnetic resonance imaging (MRI)
  • Blood tests that look for signs of inflammation in the blood
  • Symptom scales, like the Ankylosing Spondylitis Disease Activity Score (ASDAS)

You may be in a flare and still not have MRI changes or abnormal inflammation in your blood. This does not mean you are not having an axSpA flare. Many people with axSpA never have changes on an MRI scan or in their blood that match the level of pain or discomfort they experience.1,2

How are they treated?

You may need to experiment a bit to find the treatment that works best for you during a flare. Options include:4

  • Medicines
  • Gentle exercise
  • Hot or cold packs on inflamed joints
  • Relaxation methods
  • Meditation
  • Sleep

Flares are an unfortunate part of living with axSpA, but they don’t have to control your life. With the right information and tools, you can learn how to best manage flares so that you can continue living as normally as possible. Talk to your doctor to find what works best for you.

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