25/10/2025
Navigating the Storm 🌀
Ankylosing Spondylitis & Flares.
AS flares are a challenging but common part of living with the ankylosing spondylitis.
Here is a comprehensive guide to understanding, managing and differentiating flares from overall disease progression.
1. How Do We Know It Is a Flare???
• A flare is a noticeable temporary increase in disease activity, you know it’s a flare when 👇
Flare can intensified Pain: Your usual baseline pain significantly worsens often becoming more sharp,burning or debilitating.
Increased Stiffness: Your morning stiffness is more pronounced and lasts much longer than normal ( hours instead of minutes).
Profound Fatigue: You experience an overwhelming exhaustion that is not relieved by rest (often described as flu-like fatigue).
New/Worsening Joint Pain: Pain or swelling occurs in peripheral joints (like knees, ankles or shoulders) that are not typically affected or is worse than usual in previously affected joints.
Systemic Symptoms: Symptoms like low-grade fever, night sweats or signs of associated conditions (like a red, painful eye from Uveitis) appear.
BASDAI Score: If you track your disease activity using a tool like the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) a flare is indicated by a noticeable spike in your score ( a 50%-250% increase in major flares).
2. How Long Can a Flare Last???
The duration of an ankylosing spondylitis flare varies significantly from person to person and from one episode to the next.
Minor/Localized Flares may last from a few days up to one week.
Major/Generalized Flares can persist for an average of two to four weeks and in some cases for months if no treatment adjustment is made.
3. How Do We Know the Flare is Gone???
A flare is considered resolved when return to Baseline your symptoms pain,stiffness and fatigue return to your manageable chronic baseline level.
Improved function your ability to move, exercise and perform daily activities returns to the level you experience when your disease is controlled.
Normalized BASDAI your disease activity score drops back to its typical number indicating lower overall inflammation.
4. Which Medicine Can We Temporarily Use in Flares???
Do not change your medication without consulting your rheumatologist.Your doctor can provide a specific "rescue" plan. Temporary medications often include 👇
• NSAIDs, These are the most common first-line treatment. If you already take them, your doctor may recommend a temporary increase in dose to control inflammation and pain.
• Corticosteroid injections a steroid shot may be injected directly into a severely inflamed joint (like a knee, shoulder or heel) to quickly reduce localized pain and swelling.
• Oral Corticosteroids a short low-dose course (like Prednisone) may be prescribed to quickly suppress a severe generalized flare. This is not for long-term use due to side effects.
• Simple Analgesics Over the counter pain relievers like Acetaminophen (Paracetamol) can be used for general pain relief, often in combination with anti-inflammatories, if cleared by your doctor.
5. Flare vs Disease Progression
Is My Current Medicine Still Working???
This is the most critical factor to determine whether its flare or disease progression, please read very carefully to judge "Its a "Flare" vs "Disease progression"
If the Increase is a "FLARE"
•Sudden, identifiable start, often traceable to a trigger (stress, overexertion).
•Responds to rescue meds, The symptoms are successfully knocked down by a temporary increase in NSAIDs or a steroid dose.
•Baseline is still good, Once the flare subsides your activity level and pain go back to a tolerable well-controlled state.
If the Increase is "DISEASE PROGRESSION"
•Gradual persistent worsening symptoms slowly get worse over months with little return to the previous good baseline.
•Poor response to rescue meds,The flare treatment does little to curb the severity of the symptoms.
•New higher baseline, Your best day is now worse than your worst day used to be. Imaging may show new structural damage (fusion/syndesmophytes).
If you are experiencing frequent flares that are lasting longer or flares that no longer respond to your rescue plan, it strongly suggests that your current maintenance medication may be losing effectiveness and needs to be adjusted or changed by your rheumatologist.
6. How Frequent Are Flares in Ankylosing Spondylitis???
Flares are very common in ankylosing spondylitis though the severity varies some studies suggest that up to 70% of people with AS feel they have a flare in any given week, most of these are minor/localized.
Major generalized flares are also frequent, but in those people who are experiencing higher level of disease activity even in "flare-free" periods.
The frequency is highly individual and often a measure of how well the maintenance therapy is working. Frequent flares once a month often signal a need for a treatment review.
7. Shoulders Blade Pain and Swelling???
Yes, pain and swelling in the shoulder blades and surrounding areas are common manifestations of Ankylosing spondylitis..
• Peripheral Arthritis: AS can cause inflammation in joints outside the spine. The shoulders are the most commonly affected peripheral joint with about 30% of AS patients experiencing shoulder involvement.
• Enthesitis: AS causes inflammation where tendons and ligaments attach to bone (entheses). The areas around the shoulder blade including the ribs and sternum are common sites for enthesitis leading to pain, tenderness and stiffness.
• Frozen Shoulder: People with AS have an increased risk of developing adhesive capsulitis (frozen shoulder) due to chronic inflammation which causes severe stiffness and reduced range of motion.
Living with Ankylosing Spondylitis is like navigating a stormy sea, but with the right knowledge and support you can find calm waters and chart a course for a better life...
