Lupus is an autoimmune disease where the body’s immune system attacks its own tissues and organs, including the joints, skin, kidneys, blood cells, brain, heart, and lungs. It is a chronic condition that causes inflammation throughout the body. Lupus can range from mild to life-threatening. While the exact causes of lupus are not fully understood, it is believed to be triggered by a combination of genetic, environmental, and hormonal factors. There is currently no cure for lupus, but the symptoms can be managed with medications and lifestyle changes. Some key facts about lupus:
- Around 1.5 million Americans have lupus, with 16,000 new cases diagnosed each year.
- Women are 9 times more likely to develop lupus than men.
- Lupus often first appears between the ages of 15-44.
- There are several types of lupus including systemic lupus erythematosus (SLE), cutaneous lupus, drug-induced lupus, and neonatal lupus.
- Common initial symptoms include fatigue, fever, joint pain, and a butterfly-shaped facial rash.
- Flare-ups of symptoms can range from mild to severe.
- While there is no cure, early diagnosis and proper treatment can help control symptoms.
So can lupus suddenly appear out of nowhere, or does it slowly develop over time? Let’s take a closer look at how lupus progresses and whether sudden onset is possible.
The progression of lupus
For most people diagnosed with lupus, the disease does not suddenly appear but rather develops slowly over months to years. Early symptoms are often vague and mild, so many people with lupus do not realize they have an underlying autoimmune disorder right away. Over time, the symptoms become more pronounced and severe as the immune system continues to mistakenly attack healthy tissue.
The progression of lupus typically goes through the following stages:
- Early, non-specific symptoms – These include fever, fatigue, joint pain or swelling, and muscle pain. At this point lupus may not be suspected or diagnosed because the symptoms mimic those of the flu, arthritis, or other common conditions.
- Mild lupus – As the immune system begins attacking tissue, symptoms increase but are still considered relatively mild. Rashes, low-grade fever, arthritis, and fatigue are common.
- Moderate lupus – More body systems are impacted as the disease progresses. Symptoms may now include chest pain, mouth or nose sores, sensitivity to sunlight, hair loss, anemia, kidney problems, and additional rashes and arthritis.
- Severe lupus – Widespread inflammation can now affect vital organs like the heart, lungs, kidneys, and brain. Symptoms exacerbate and require intensive treatment to prevent permanent damage.
For most lupus patients, it takes from 3-6 years after the initial symptoms before progressing to severe disease. However, some people do experience what seems like a sudden onset of lupus symptoms.
Is it possible to suddenly get lupus?
While not typical, there are some scenarios in which lupus can appear to come on suddenly:
- A major flare – Those already diagnosed with mild lupus may experience a major flare seemingly out of nowhere. This happens when something triggers the immune system to go into overdrive attacking tissues, causing symptoms to dramatically worsen.
- Misdiagnosed initial symptoms – Early lupus symptoms like fatigue, achiness, and fever can be overlooked or mistaken for another condition. Later, more severe symptoms finally lead to a lupus diagnosis even though the disease has been developing covertly for some time.
- Rapidly progressing lupus – Most people experience a gradual increase in symptoms over months and years. But for a small subset of patients, lupus rapidly worsens over just weeks to a few months. This form called acute lupus can be severe from the start.
- Drug-induced lupus – This type of lupus is caused by certain prescription medications. Symptoms of joint pain, fever, and rash can show up suddenly within weeks after starting the medication.
In these situations, lupus may seem to appear out of the blue. But in most cases, people have usually had early symptoms for a period of time before the lupus attacks became severe enough to lead to diagnosis.
Who is at risk for suddenly developing lupus symptoms?
Certain factors can increase a person’s risk of rapidly progressing lupus or suddenly developing more serious symptoms:
- Women – Due to hormones, women are generally more likely to have sudden exacerbations of lupus.
- Younger patients – Younger people often develop more acute symptoms than those who are middle-aged or older when diagnosed.
- Genetic predisposition – Having genes associated with acute lupus increases risk of sudden onset.
- Environmental triggers – Sunlight, stress, infections, and certain medications can abruptly worsen lupus.
- Organ involvement – Lupus affecting vital organs like the kidneys raises the risk of rapid worsening.
- Previous mild lupus – Those with pre-existing low levels of disease activity may suddenly experience a bad flare.
- Pregnancy – Hormonal changes of pregnancy can trigger a sudden lupus flare.
Being aware of these risk factors can help identify who is vulnerable to abruptly developing serious lupus symptoms so that treatment can be started early.
What causes a sudden lupus flare?
There are certain triggers known to cause a dormant case of lupus to suddenly flare into active disease. Common causes include:
- Sunlight – Exposure to UV light can cause a lupus flare, particularly in skin areas that are exposed to the sun. Sunscreen helps prevent flares.
- Infections – Viral or bacterial illnesses like the flu, pneumonia, or UTIs can be lupus triggers as the body reacts to the infection.
- Stress – Increased stress levels raise certain hormones that can exacerbate lupus inflammation and symptoms.
- Pregnancy – Hormonal changes and immune system alterations during pregnancy put some women at risk of lupus flares.
- Medications – Certain prescription drugs like antibiotics, diuretics, and NSAIDs have been associated with sudden lupus flares.
- Hormones – Estrogen surges related to menstrual cycles, birth control pills, or estrogen therapy may worsen lupus.
- Blood pressure drugs – Hydralazine and similar blood pressure medications can induce drug-induced lupus.
Being aware of these common flare triggers helps those with lupus take steps to prevent sudden symptom worsening. See a doctor promptly at the first sign of a flare to get needed treatment adjustments.
What are the symptoms of a sudden lupus flare?
During a flare, existing lupus symptoms become more intense and new symptoms may appear suddenly. Signs to watch for include:
- Fatigue and weakness
- Fever and chills
- Joint swelling, pain, and stiffness
- Muscle pain or tenderness
- Red rashes on the face, neck, or chest
- Mouth or nose sores
- Chest pain when taking a deep breath
- Severe headache
- Confusion or memory loss
- Blood in the urine
- Nausea, vomiting, or abdominal pain
- Shortness of breath
Flare symptoms vary from person to person. Sudden onset of any combination of these complaints warrants urgent medical evaluation to modify treatment and prevent serious organ damage. Do not delay in contacting the doctor if a flare seems to be happening.
Diagnosing a lupus flare
To confirm that a sudden worsening of symptoms is due to a lupus flare, the doctor will perform:
- Medical history and physical exam
- Blood tests checking white blood cell count, kidney function, protein levels, and autoantibodies
- Urine test for protein, blood, or casts signaling kidney involvement
- Imaging tests like X-rays, CT scans, echocardiograms, MRIs
- Skin or kidney biopsy if organs appear impacted
Comparing current blood work and imaging to past stable test results clearly points to whether there is new organ inflammation indicating a flare. The doctor also ensures no other infection, illness, or complication is causing the worsening symptoms.
How are sudden lupus flares treated?
Treatment focuses on calming inflammation and managing the current symptoms. Options may include:
- Increasing oral corticosteroid dose for a few weeks to reduce swelling and pain
- Prescribing immune-suppressing drugs to prevent the immune system from attacking tissues
- Adding antimalarial drugs like Plaquenil that have anti-inflammatory effects
- Injecting steroids directly into severely inflamed joints
- Hospitalization for adminsitering IV steroids may be needed in severe flares
- Prescribing pain medications, blood pressure drugs, or diuretics to control specific symptoms
- Plasmapheresis to filter out antibodies may help in kidney or CNS involvement
The goals are to treat any organ inflammation before permanent damage can occur and bring the overall lupus disease activity back down to a stable level. Closely following the treatment plan helps prevent recurrent flares.
How can sudden lupus flares be prevented?
There are steps those diagnosed with lupus can take to lower the chances of a sudden flare:
- Avoid direct sunlight and wear protective clothing and sunscreen outside.
- Reduce stress through techniques like yoga, meditation, therapy, or support groups.
- Get regular moderate exercise to improve strength and health.
- Eat a balanced diet emphasizing fruits, vegetables, and anti-inflammatory foods.
- Get enough rest and sleep by maintaining good sleep habits.
- Take medications exactly as prescribed and keep up with medical appointments.
- Learn your lupus flare triggers and try to avoid them when possible.
- Stop smoking cigarettes and limit alcohol which can exacerbate lupus.
Being vigilant to notice early signs of a flare gives the best chance to receive prompt treatment. Contact your doctor with any concerning symptoms or worsening of your condition. With proper management, those with lupus can often prevent flares from occurring.
What is the outlook for a person with sudden onset lupus?
The long-term outlook for someone diagnosed with lupus after a sudden flare or rapid progression depends on several factors:
- Severity of initial flare symptoms and organ involvement
- How consistently they follow the recommended treatment plan
- Presence of major organ damage prior to diagnosis
- Ability to avoid possible flare triggers going forward
- Response to corticosteroids and other medications used to control inflammation
- Development of other related autoimmune disorders like rheumatoid arthritis
With aggressive treatment of the initial flare, medication compliance, and lifestyle changes to keep lupus in remission, many patients go on to live a normal lifespan with well-controlled symptoms. However, in some cases, permanently impaired kidney function or other organ damage resulting from a severe untreated flare may worsen long-term outlook.
That’s why early diagnosis, optimal treatment during flares, follow up care, and daily preventive measures are key to the most positive prognosis after sudden lupus onset. Working closely with a rheumatologist and primary care doctor improves outcomes.
Conclusion
Although lupus most often develops slowly over months to years, some people do experience what seems like a sudden onset or worsening of symptoms. Major disease flares, previously misdiagnosed initial symptoms, rapidly progressing lupus, reaction to medications, and certain risk factors can all make lupus appear to arise abruptly. Triggers like sunlight, infections, hormones, and stress are known to spark flares. Symptoms may intensify rapidly and need urgent treatment to halt tissue damage. While preventing all flares is impossible, many can be avoided with vigilance, preventive steps, medication compliance, and prompt doctor follow up at the first sign of worsening disease activity. With comprehensive treatment guided by a medical team, the prognosis for those with sudden lupus onset can still be very positive in many cases. Staying aware of the potential for unexpected flares and being prepared to respond appropriately is key for anyone living with lupus.
