Axial Spondyloarthritis Flares: Causes, Signs, and Management - Verywell Health

Axial spondyloarthritis (axSpA) is a disease of ups and downs. Some days, your back and joint symptoms are well-managed and you can go about your day with little or no discomfort. On other days, the swelling and pain are magnified, and you struggle to do simple tasks.

A flare, or a flare-up, is when symptoms of axSpA increase, causing pain and discomfort, and might affect your ability to get around. Most researchers describe a flare-up as when your axSpA symptoms increase over a short period. The main symptoms of an axSpA flare-up include pain, fatigue, immobility, and emotional symptoms.  

An axSpA flare can cause different symptoms as no two people experience the same symptoms. Triggers, which are factors that make your axSpA flare up, may not cause the same response in someone else.

There has been plenty of research on flare symptoms on triggers. Triggers of axSpA flares include stress, overdoing activities, missing a medication dose, weather changes, or an injury or illness. 

This article will cover the types of flares seen in axial spondyloarthritis, symptoms, triggers, and more. 

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Types of Flares

Researchers have identified two main flare-up types in axial spondylitis: localized and generalized.

Localized flares will affect only one area of the body—for example, a flare in one part of the low back. In addition to low-back pain, you might experience back stiffness, fatigue, and emotional symptoms. The research on localized flares has found that people who report localized flares perceive those as increases in disease activity rather than a "true flare."

A generalized flare is much worse than a localized one. It can affect several joints and cause flu-like symptoms, fatigue, sleep and mood troubles, muscle pain, and spasms. The research on generalized flares has found that persons who experience them describe them as whole-body flares that might be "crippling, acute, and devastating."

Axial Spondyloarthritis Flare Symptoms

"Axial spondyloarthritis" is an umbrella term for different types of inflammatory arthritis affecting the spine and the sacroiliac (SI) joints linking the lower spine to the pelvis. It affects around 1.4% of the American population.

The two subtypes of axSpA are non-radiographic axial spondyloarthritis (nr-axSpA) and ankylosing spondylitis (AS). These conditions occur because the immune system malfunctions and attacks healthy tissues, mainly the vertebrae (the small interlocking bones of the spine), but any joint can be affected.

Nr-axSpA is characterized by active inflammation of the spine and SI joints but no radiographic (seen on X-ray) evidence of joint and bone damage. It is sometimes a precursor to AS.

AS, on the other hand, causes inflammation severe enough to damage the spine and SI joints. AS joint changes can be seen on radiographic imaging. 

Both types of axSpA can flare up. Common symptoms of an axSpA flare are:

• Back stiffness and pain: AS flare-ups often cause increased back pain and stiffness. These symptoms can make lying down, sitting up, walking, or sleeping difficult.
• Fatigue: Fatigue is often one of the earliest flare symptoms occurring before back pain and joint pain set in. Researchers believe that fatigue in axSpA is due to systemic (whole-body) inflammation, which leaves you drained and feeling low on energy. Fatigue is also linked to other flare symptoms—pain, depressed mood, and sleep troubles. 
• Joint pain: During an axSpA flare, you might also experience pain, stiffness, swelling, and tenderness in other joints, including the knees, ankles, hips, neck, and rib cage.
• Enthesitis: An axSpA flare might also cause inflammation in the areas where tendons and ligaments meet bones (the entheses).
• Depression: An ax-SpA flare can lead to a depressed mood due to the mental and physical stress that pain and stiffness put on a person. Research shows people with axSpA have a higher risk for anxiety and depression.
  

What Causes Flares?

Flare-ups in axSpA cannot always be prevented. For many people with the condition, specific triggers cause their disease to flare up. Knowing your triggers might help you to prevent flares. 

Examples of triggers that might cause your axSpA to flare up are:

• An injury or illness
• Weather changes 
• Missing medication doses 
• Emotional stress 
• Overdoing physical activity 
• Excess fatigue or getting less sleep
• Eating foods considered to be pro-inflammatory 
  

How to Manage Flares

The duration and severity of your axSpA flare-ups will differ from someone else's. For most people, a flare can last from a few days to a couple of weeks. One 2021 study published in Rheumatology Advances in Practice found that axSpA flares lasted an average of four days, occurring every 35 days.

Most flares can be managed at home regardless of the length and frequency of the flare. 

Treatment Options and Coping Techniques

Some symptoms of a flare, including pain and swelling, can be managed with over-the-counter (OTC) nonsteroidal anti-inflammatory drugs (NSAIDs) like Advil (ibuprofen) or Aleve (naproxen sodium). If you experience severe pain and swelling, your healthcare provider may prescribe a stronger NSAID pain reliever.

If your healthcare provider thinks you might benefit from a corticosteroid, they can prescribe an oral drug or have you go into their office for an injection. A corticosteroid might help reduce inflammation quicker and reduce the length and severity of your flare.

If you take a conventional disease-modifying antirheumatic drug (DMARD) or a biologic drug, your healthcare provider can increase the dosage. They might make this change because they feel the medication is not working as well as it used to.

Additional ways to cope with an axSpA flare include:

• Getting plenty of rest and sleep
• Gentle exercises and stretching 
• Hot and cold therapies
• Taking a warm bath or shower 
• Getting a massage
• Relaxation breathing or other stress management techniques 
  

Flare Prevention Tips

It might be possible to prevent flares or reduce the number you experience through healthy habits and managing triggers.

Healthy lifestyle habits, including regular exercise and an anti-inflammatory diet (which emphasizes fruits, vegetables, lean protein, nuts, seeds, and healthy fats), might help you prevent flares and reduce joint pain and stiffness.

Managing triggers through stress management, pacing yourself, and dressing for the weather might also help reduce the chance of a flare.

Additional triggers of axial spondylitis flare-ups are smoking and secondhand smoke. Smoking is also a risk factor for severe axSpA. People with axSpA who smoke are at an increased risk for spine damage, and because axSpA can also affect your heart, smoking further increases your risk for heart disease and stroke. 

If you find it challenging to quit smoking, reach out to a healthcare provider. They can give you information and resources to help you quit the habit.

A helpful way to prevent flares is to follow your treatment plan. If you find your medications are not managing symptoms well or if you are experiencing new or worsening symptoms, let your healthcare provider know. They can review your treatment plan and make changes to manage axSpA better. 

When to Seek Care for a Flare-Up

If you are going through an axSpA flare-up that doesn't improve after a few days, reach out to your primary care provider or rheumatologist. They can prescribe medication to help you get the flare under control. 

Your healthcare provider might also want to monitor you to see how you feel after you start treatment. They can order blood work to check your inflammation levels to help them decide if changing medicines or medication doses are necessary. 

Summary 

Flare-ups are common in axial spondyloarthritis. What causes a flare isn't always known, but some flares might be linked to triggers like stress, weather, and diet. It might be possible to prevent a flare by managing triggers and taking medications as prescribed. 

An axSpA flare can cause low-back pain and stiffness, fatigue, and emotional symptoms like anxiety and depression. It can last from a few days to a few weeks. 

Most flares can be treated at home with NSAIDs, rest, hot and cold therapy, and other home remedies. If a flare lasts more than a couple of days or seems severe or hard to handle, you should reach out to your healthcare provider. They can prescribe medicine to treat the flare and assess whether you are on the best treatment course.

A Word From Verywell 

Axial spondyloarthritis is a lifelong condition that will get worse with time. Because of its chronic nature and the symptoms it causes, it is not usual to struggle with your emotional health. If you find it challenging to cope with axSpA, talk with your healthcare provider or seek help from a mental health professional.

You might also consider joining a support group to give yourself some control over your health. A support group also offers opportunities to talk to others who have axSpA and are working hard to manage their conditions.  

Frequently Asked Questions

• The most common symptoms of an axial spondyloarthritis flare are pain and stiffness, extreme fatigue, and changes to mood or mental health. It is also possible to experience flu-like symptoms (i.e., fever or sweating) and other symptoms like muscle pain and spasms. 
  

• The research shows that the average length of a flare is between four and five days. You should reach your healthcare provider if you experience a severe flare that lasts more than a few days. 
  

• Remission in axial spondylitis refers to a period of few or no disease symptoms. A key goal in treating axSpA is always remission or low disease activity. Talk to your healthcare provider to see what you can do to best treat axSpA and potentially put it in remission.