u/Patient_Promise_5693

TL;DR what is the difference between daily pain and a flare?

Ok, maybe not entirely like I’m five. I’m familiar with autoimmune diseases - this is not the only one in my household. I understand psoriasis and the inflammation causing the arthritis. This question comes about because I think I had my first known flare and figuring that out has me somewhat confused.

TL;DR what is the difference between daily pain and a flare? Or is there a difference? Should I pretty much blame all my pain from here on out (outside an obvious injury or an event that would cause pain)on PsA? I see posts all the time of people saying their pain is persistent and daily. So I really don’t understand the difference or what role medication hopefully plays? I get you can have breakthrough flares, but do meds hopefully control both? Is all pain a flare? Does consistent pain indicate joint damage? If you have joint damage is there anything that can be done? What do you do to manage a flare?

Flare info: I had several Charley horses one night and my knees were so stiff and painful - way more than one would expect. I have had knee pain from tight muscles in the past (way before PsA symptoms) and my muscles were tight and uncomfortable so I chalked it up to that, albeit a seemingly crazy outcome from Charley horses. I could barely walk. It got a little better daily, but was persistent. This diagnosis is new to me and has been pretty narrowly defined. So even though it definitely should have occurred to me, it just didn’t.

Background info: I got diagnosed in April accidentally. My derm diagnosed me when I asked about what I was pretty sure was psoriasis on my elbows. She asked me about PsA symptoms and determined I did in fact have PsA. My feet and hands hurt in the morning and my feet hurt when I sit a while. Honestly, I thought this was a general stiff getting old thing. I started otezla at the end of May so not long enough for it to fully be working, however I am having less foot and hand pain. The improvement is sporadic but it is both in the amount of pain and also I’m starting to have *some*, not many but some, pain free mornings.

First off, I don’t sleep well. I know that is a factor and I actually have an initial consultation with a sleep specialist in a few days. Regardless of how well I sleep, or how long I am in bed it is so hard for me to wake up. This is true in the physical aspect of waking up to an alarm, the act of getting out of bed, and the process of how long it takes me to get my brain online. It can take me two or more hours before I feel like an actual human. I read an article recently about how not only do people with adhd have delayed circadian rhythm, we also have delayed cortisol release in the morning. I knew the first part, but the second part was new information, but makes sooooo much sense.

What do you do to get moving?! I feel like I waste so much time every day feeling groggy and generally not like myself.

Any and ask help is appreciated, but I think I’m really hoping someone has a good idea for the mental waking up part.

Things that are maybe relevant: I’m a stay at home mom (my therapist and I are currently discussing that I probably need less freedom/more structure), I’m a night owl and have problems falling asleep and staying asleep, but more importantly problems with quality of sleep. I try to take my adderall with an earlier alarm (probably 69-75% success), I probably have too much caffeine, I think I’m entering perimenopause, but this is not a new problem for me.