Lupus is an autoimmune disease that can cause a wide variety of symptoms. One common symptom that lupus patients report is feeling shaky or having tremors. In this article, we’ll explore the connection between lupus and feeling shaky, look at the potential causes, and discuss treatment options.
What is lupus?
Lupus is an autoimmune disease where the immune system attacks healthy tissue instead of infections and foreign invaders. This leads to inflammation throughout the body and can affect many different organs and systems including the skin, joints, kidneys, blood cells, brain, heart, and lungs.
Some of the most common symptoms of lupus include:
- Fatigue
- Joint pain or swelling
- Skin rashes
- Fever
- Chest pain
- Hair loss
- Sensitivity to sunlight
- Dry eyes
- Headaches
- Memory issues
However, since lupus can impact any part of the body, the range of potential symptoms is very broad.
Can lupus cause shaking or tremors?
Yes, feeling shaky or having tremors can be a symptom of lupus. Researchers estimate that 10-20% of people with lupus experience tremors or shaking.
The tremors may occur occasionally or be an ongoing issue. They can range from mild to severe. In some cases, the shaking is barely noticeable, just a fine tremor in the hands. In other instances, it can be pronounced and affect the arms, legs, neck, head, and torso.
What causes the tremors?
There are a few possible causes for lupus-related tremors:
- Central nervous system issues – Since lupus can cause inflammation in the brain and spinal cord, it can lead to problems with controlling and coordinating muscle movements. This inflammation can directly cause tremors and shaking.
- Medication side effects – Some of the medications used to treat lupus symptoms like pain, inflammation, and immune system overactivity can cause tremors as a side effect. Examples include corticosteroids like prednisone, anticonvulsants, and some antidepressants.
- Associated conditions – People with lupus are at increased risk for neurological disorders like multiple sclerosis. The damage caused by these associated conditions can also cause tremors.
- Infections – Lupus can make people more prone to infections, and some infections like meningitis can cause tremors.
- Stress and anxiety – Many lupus patients experience higher levels of stress due to coping with a chronic disease. Stress and anxiety can also worsen tremors.
Are the tremors constant or intermittent?
The shaking and tremors caused by lupus can be:
- Intermittent – Coming and going. The tremors may only happen occasionally or during lupus flares.
- Persistent – Ongoing, present most of the time.
- Intention tremors – Shaking that gets worse when trying to perform precise movements like writing, tying shoes, or drinking from a glass.
- Resting tremors – Shaking that persists even when the muscles are relaxed and at rest.
The characteristics of the tremors will depend on the underlying cause. For example, medication side effects are more likely to cause resting tremors. Central nervous system problems can cause intention tremors.
Are the tremors mild or severe?
The lupus-related tremors can range from barely noticeable to severe:
- Mild – A slight shaking of the hands or difficulty holding things steadily. May come and go.
- Moderate – More pronounced shaking that makes daily tasks like writing or lifting a cup more difficult. Can spread to arms, legs, head, and torso.
- Severe – Full body shaking and loss of motor control. This level of tremor can make walking, eating, and self-care nearly impossible without assistance.
In rare, severe cases, lupus can even cause seizures due to inflammation and damage to the central nervous system.
Who is at risk for lupus tremors?
Some lupus patients are at higher risk of experiencing tremors or uncontrolled shaking. Risk factors include:
- Having lupus that affects the central nervous system or brain
- More severe lupus overall
- Longer disease duration
- Older age at disease onset
- Taking medications like corticosteroids and anticonvulsants
- Presence of antibodies associated with neurological lupus like anti-P, anti-NR2, and anti-Sm
- History of stroke
- Deficiency in vitamin D or vitamin B12
As many as 60% of people with central nervous system lupus experience tremors. But even those whose lupus mostly affects other parts of the body can still develop tremors in some cases.
When do the tremors happen?
Lupus-related tremors can come and go. Many people notice them more strongly at certain times such as:
- During lupus flares when disease activity increases
- Times of high stress or anxiety
- When taking certain medications
- When ill or fighting an infection
- During or after strenuous activity
- In the morning after waking up
- After long periods of sitting or being inactive
Paying attention to when the tremors happen most can help identify triggers.
How are lupus-related tremors diagnosed?
To diagnose lupus tremors, doctors will typically:
- Ask about your medical history and lupus symptoms
- Conduct a physical exam looking for neurological abnormalities
- Have you describe the tremors in detail including when they happen and what parts of the body are affected
- Review your medications to check for drugs that could cause tremors
- Order blood tests to look for anti-brain and anti-neuron antibodies
- Use imaging tests like MRI or CT scans to look for central nervous system inflammation or damage
- Check vitamin D, vitamin B12, and thyroid hormone levels since deficiencies can cause tremors
- Potentially order an electromyography (EMG) to measure nerve and muscle function
Based on the exam and test results, your doctor can determine if the tremors are likely caused by lupus-related central nervous system dysfunction, an associated condition like multiple sclerosis, medication side effects, or another cause.
What treatments help with lupus tremors?
Treatments for lupus tremors aim to:
- Reduce inflammation in the central nervous system
- Prevent damage to nerve cells
- Manage specific neurological disorders associated with lupus
- Address nutritional deficiencies
- Change problematic medications when possible
- Improve symptoms like shaking, loss of coordination, and muscle weakness
Some potential treatment options include:
- Corticosteroids – Prescription steroids help suppress the overactive immune system and reduce inflammation causing the tremors.
- Immunosuppressants – Drugs like azathioprine, methotrexate, cyclosporine, and mycophenolate mofetil calm the immune system. They may allow steroids to be reduced.
- Intravenous immunoglobulin (IVIG) – IVIG also dampens the immune system and may help neurological symptoms.
- Rituximab – This targeted B cell therapy improves neurological symptoms for some lupus patients.
- Plasmapheresis – This blood filtering technique removes antibodies attacking the nervous system.
- Anticonvulsants – Some seizure drugs like lamotrigine help control tremors.
- Beta blockers – Propranolol blocks adrenaline’s effects and can reduce shaking.
- Clonazepam – This benzodiazepine helps reduce tremors and muscle spasms.
- Vitamin B12 – Supplements may help if a deficiency is contributing to tremors.
- Vitamin D – Low vitamin D is linked to neurological issues, so supplements may help.
- Occupational therapy – OT helps you adapt daily tasks like eating, dressing, and writing to work around tremors.
The specific treatment will depend on the likely cause and severity of the tremors. Mild tremors may just need periodic observation. More severe tremors require medication and possibly hospital treatment to prevent permanent damage.
Tips for living with lupus tremors
Having shakes or tremors from lupus can make daily life more challenging. Some tips that may help include:
- Avoid caffeine, energy drinks, and other stimulants that can worsen tremors
- Exercise regularly but avoid overexertion
- Use stress management and relaxation techniques
- Get enough rest and sleep
- Ask for help with tasks when needed
- Use weighted utensils to make eating easier
- Use slip-on shoes and clothes without buttons or laces
- Take breaks between writing or typing tasks
- Avoid carrying hot liquids or breakable items when shaking is worse
Occupational therapists can provide more personalized tips and tools to make daily activities easier and safer.
The takeaway on lupus tremors
Feeling shaky or having tremors is a relatively common symptom in people with lupus. It’s often caused by inflammation in the central nervous system or side effects of medications used to treat lupus. Tremors can range from mild to severe.
There are treatments available to help reduce lupus disease activity causing the tremors and to improve the shaking symptoms. While tremors can be challenging to live with, certain lifestyle changes and assistance devices can also help you manage daily tasks more easily.
By understanding the causes of lupus tremors and working closely with your medical providers, it is often possible to find an effective treatment approach and adapt to live well with the shaking and instability.
