Lupus is an autoimmune disease that causes inflammation throughout the body. For those living with lupus, symptoms tend to fluctuate over time, with periods of flares and remission. Many lupus patients report that their symptoms worsen during the winter months. But why does this happen? Does lupus truly get worse in the winter?
Quick Answers
– Many lupus patients do experience worse symptoms during the winter months, including increased fatigue, joint pain, rashes, and Raynaud’s phenomenon.
– Cold temperatures, less sun exposure, drier air, and changes in immune function during the winter may contribute to lupus flares.
– Steps like dressing warmly, using humidifiers, getting sufficient rest, following a healthy diet, and working with your doctor can help reduce lupus flares during the winter.
Why Lupus Symptoms May Worsen in the Winter
There are several theories as to why those with lupus often experience a worsening of symptoms during the winter months:
Cold Temperatures
Cold temperatures cause blood vessels to constrict in an effort to preserve body heat. This constriction of blood vessels can reduce blood flow to the joints, skin, and other tissues affected by lupus.[1] Reduced blood flow may then lead to increased inflammation, pain, and tissue damage in people with lupus.
Many lupus patients are especially sensitive to the cold due to Raynaud’s phenomenon, which causes fingers and toes to become numb, change color, and feel cold in response to low temperatures. Exposure to winter temperatures can trigger Raynaud’s attacks.[2]
Less Sun Exposure
Lack of sun exposure during winter can also worsen lupus symptoms. Ultraviolet rays from the sun cause the skin to produce vitamin D. Vitamin D deficiency is common in lupus patients and has been linked to increased lupus activity.[3]
Getting less sun exposure during winter can reduce vitamin D levels in the body. This drop in vitamin D may exacerbate lupus symptoms like fatigue, joint pain, and skin rashes.
Dry Air
Heated indoor air during winter is very dry. This dry air can irritate the skin, eyes, mouth and lungs in individuals with lupus.[4] Dry eyes and mouth may cause discomfort. Dry skin can worsen rashes and itching. Dry airway passages can exacerbate breathing issues.
Changes in Immune Function
Some research indicates that immune system function may fluctuate by season, due to factors like melatonin levels, temperature changes, and viral exposures.[5]
For those with autoimmune diseases like lupus, dips in immune function during the winter may reduce the body’s ability to regulate inflammation and prevent flares. More research is needed in this area, however.
Lupus Symptoms Most Affected by Winter
The lupus symptoms most commonly exacerbated during the winter months include:
Fatigue
Extreme fatigue and exhaustion are hallmark symptoms of lupus. Many patients report increased episodes of “lupus fog” and debilitating fatigue during the winter.[6]
Contributing factors may include weaker sunlight, disrupted sleep cycles due to shorter days, effects of cold weather on the body, and increases in depression.
Joint Pain
Pain, stiffness, and swelling in joints affected by lupus arthritis tend to worsen during winter. This is likely due to direct effects of cold temperatures on inflamed joints and reductions in blood flow.[7]
Those with Raynaud’s phenomenon may also experience painful chilblain lesions on the fingers and toes when exposed to winter cold.
Skin Rashes
Skin rashes caused by lupus, like the butterfly rash on the face and malar rash on the arms, often flare up during winter months. This may be related to drier winter air, reduced sun exposure, and other factors.[8]
Raynaud’s Phenomenon
Raynaud’s phenomenon involves severe coldness and impaired circulation to the extremities in response to cold temperatures and stress. Exposure to cold winter weather is a common cause of Raynaud’s attacks.[9]
These painful attacks cause fingers and toes to turn white, blue, and numb. Attacks are more frequent during winter months.
Hair Loss
Some lupus patients experience increased hair loss during winter months, potentially related to effects of cold on circulation as well as drier and damaged hair.[10]
Stress around the holidays may also contribute to temporary increases in telogen effluvium (shedding of hair).
Steps to Manage Worsening Lupus Symptoms in Winter
While lupus symptoms may be exacerbated during the winter, there are many things patients can do to prevent flares and stay healthier:
Dress Warmly
Bundling up in layers, insulating jackets, warm boots, gloves, scarves and hats will help protect skin and joints from direct effects of the cold. Fleece-lined clothing can help hold in body heat.[11]
For those with Raynaud’s, mittens are warmer than gloves. Wool socks will help keep feet warm and dry.
Use Humidifiers
Running indoor humidifiers can add moisture back into dry winter air to help soothe irritated airways and skin.[12] Portable humidifiers can help humidify just the room a person is in.
Try Infrared Heating
Infrared radiant heaters warm up people and objects, rather than warming the air. This avoids drying out the air further. Portable infrared heating pads can also help direct soothing heat to affected joints.[13]
Get Regular Moderate Exercise
Low-impact exercise like walking, swimming or cycling helps circulate blood flow and keeps joints and muscles limber.[14] Seeking a warm indoor pool is ideal for exercising in the winter without exacerbating Raynaud’s or other lupus symptoms.
Don’t Skimp on Sleep
Fatigue and sleep disturbances are common with lupus. Make sure to get adequate, high-quality sleep to help the body cope with and recover from flares.[15] Maintaining good “sleep hygiene” by limiting electronics at night, sticking to a schedule, and creating a restful sleep environment can help boost sleep quantity and quality.
Follow an Anti-Inflammatory Diet
Filling up on anti-inflammatory foods like fatty fish, olive oil, leafy greens, berries, citrus fruits and spices like turmeric may help control immune function and prevent flares.[16] Avoiding processed foods, excess sugar, alcohol and caffeine can also help reduce inflammation.
Take Vitamin D3 Supplements
Taking Vitamin D3 supplements during the winter months can help make up for reduced sun exposure. Check with a doctor to determine the optimal dosing based on individual needs and D levels.[17] Vitamin D helps modulate immune function and reduce inflammation.
Consider Phototherapy Lamps
Using home phototherapy light boxes that mimic sunlight may help boost vitamin D levels and warmth.[18] Light therapy is an emerging area of research for lupus treatment. Check with a rheumatologist before trying.
Seek Emotional Support
Coping with worsening symptoms, winter isolation, and lupus flares can take an emotional toll. Connecting with therapists, support groups, family and friends can help manage the stress and depression of coping with lupus in winter.[19]
Communicate with Your Doctors
Notify rheumatologists and other care providers about any worsening of symptoms in winter. They may adjust medications, order labs to check on disease activity, or suggest other interventions to help prevent complications of flares.[20] Being proactive will help keep symptoms in check.
The Bottom Line
Many patients with lupus do experience a worsening of symptoms like fatigue, joint pain, rashes and Raynaud’s phenomenon during the winter months. This appears to be related to direct effects of cold temperatures on the body, drier indoor air, reduced sun exposure and subsequent vitamin D decreases, and fluctuations in immune function.
While lupus may flare up more during winter, proactive steps like dressing warmly, properly humidifying indoor air, maintaining a healthy lifestyle, working with your care team and seeking support can go a long way in keeping symptoms in check. Staying vigilant about managing lupus effectively even during the winter months can help patients feel better and stay more active when they need it most.
References
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