Flares

What are flares?

The majority of people with AS tend to experience periods of worsened symptoms which can be described as a flare-up of disease. 

What are the symptoms?

Investigations have shown that the main symptoms of flare are pain, immobility, fatigue and emotional symptoms, such as depression, withdrawal and anger. 

Are there different sorts of flare?

There are thought to be two types of flare, localised flare which affect one area and generalised flares that tend to be more severe, affecting the whole body and include all of the symptoms of a localised flare, as well as a flu-like illness with hot and burning joints, muscle spasm and increased sensitivity.   

Do all people with AS get flares?

Like most aspects of AS, flares can vary greatly from person to person.  A study has shown that most AS patients experience flares at one time or another (96%) with a large percentage reporting symptoms between flares (83%) and less reporting no symptoms between flares (20-30%).  Therefore, it is possible to experience symptoms or be symptom free between flares, but the majority report continuous disease activity between flares.  In addition, some people, although a small minority, do not report flares at all. 

How often can I expect a flare?

People with AS often get between one and five localised flares a year. Generalised flares have been shown to be less common than localised flares, with some people never experiencing generalised flares. 

What causes flares?

Most people with AS have reported that stress and “over-doing it” can cause a flare, cold and damp weather conditions and also that no trigger (i.e. flares occur at random) have also been commonly reported.  Other triggers that were provided less frequently include remaining in the same position for a period of time (e.g. driving long distances), colds and flu, feeling run-down, food poisoning and allergies (such as food intolerances or allergies).

How long do flares last?

Studies have revealed that flares can last anything from days to weeks. 

Is there anything I can do manage flares?

Painkillers, analgesic injections from your doctor and relaxation are all thought to be useful in helping to control flares.  Members of a new group of drugs known as the biologics (anti-TNF) have had promising results for controlling AS and managing flares.  However, it was revealed that when the treatment is stopped the symptoms return and a flare will return on average, 18 weeks later.

Do flares have any long term effects?

In a study of 214 people, the majority (75% of groups interviewed) believed there was no long-term effect of flare on AS and that they would return back to how they felt before its onset.  However, some people reported that they may feel weak or fragile for the first few days after a flare.  To a lesser degree (25% of groups) it was thought that a bad flare could lead to loss of function (e.g. reduced mobility and increased stiffness).

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References:

Gadsby K & Deighton C.  Characteristic and treatment responses of patients satisfying the BSR guidelines for anti-TNF in ankylosing spondylitis. J Rheumatol 2007; 46(3):439-441. 

Stone et al. Assessment of the impact of flares in ankylosing spondylitis disease activity using the flare illustration. J Rheumatol 2008; 47(8):1213-8. 

Brophy S & Calin A.  Definition of disease flare in ankylosing spondylitis:  the patients’ perspective. J Rheumatol 2002; 29(5):954-8 

Zochling J & Braun J.  Remission in ankylosing spondylitis. Clin Exp Rheumatol 2006; 24(43)S83-S.