Quick answers
Lupus flare ups can be caused by many factors, including:
- Stress
- Hormone changes
- Medication changes
- Sunlight exposure
- Infections
- Fatigue
What is lupus?
Lupus is an autoimmune disease where the immune system attacks healthy cells and tissues, causing widespread inflammation and damage. There are several types of lupus:
- Systemic lupus erythematosus (SLE) – Most common type, can affect any part of the body
- Cutaneous lupus – Affects the skin
- Drug-induced lupus – Caused by certain medications
- Neonatal lupus – Affects newborns
In lupus, the immune system loses its ability to tell the difference between foreign substances (like viruses and bacteria) and healthy cells. It makes autoantibodies that attack the body’s own tissues and organs.
This causes widespread inflammation and damage that can affect the joints, skin, kidneys, heart, lungs, blood vessels, and brain. Symptoms come and go in cycles of flares and remission.
What triggers a lupus flare?
There are many potential triggers that can cause a lupus flare. The most common include:
Stress
Physical and emotional stress is one of the most frequent causes of lupus flares. Stress causes the release of hormones like cortisol that can aggravate inflammation and stimulate the immune system. Things that can trigger lupus flares include:
- Injury or surgery
- Severe illness
- Emotional stress and anxiety
- Heavy physical exertion
- Poor sleep
Finding healthy ways to manage stress through relaxation techniques, counseling, exercise, or other means can help prevent flares.
Hormone changes
Hormonal changes related to menstruation, pregnancy, and menopause can trigger lupus flares in some women. This may be due to effects on the immune system. Strategies include:
- Birth control pills to regulate hormones
- Estrogen therapy during menopause
- Close monitoring of symptoms during pregnancy
Medication changes
Changes in medications used to treat lupus and other conditions can unintentionally lead to flares. For example:
- Stopping corticosteroids like prednisone too quickly
- Interactions between lupus drugs and other medications
- Reducing the dose of immunosuppressant drugs
Work closely with your doctor and pharmacist to monitor for issues when making medication changes.
Sunlight exposure
Sunlight contains ultraviolet rays that can stimulate the immune system and trigger lupus flares, particularly of the skin. To prevent flares:
- Wear sunscreen and protective clothing
- Avoid peak sun exposure hours
- Use medication that blocks UV light effects
Infections
Infections are a common cause of lupus flares because they stimulate the immune system. Potential triggers include:
- Urinary tract infections
- Respiratory infections like bronchitis
- Gastroenteritis
- Sinus infections
- Skin infections
Preventing and treating infections quickly can help minimize flares. Get frequent urinalysis to check for UTI’s, practice good hygiene, and see a doctor for antibiotics if needed.
Fatigue and overexertion
Extreme fatigue is a main lupus symptom. Pushing yourself too hard mentally and physically when fatigued can overwhelm the body and trigger an autoimmune reaction. To prevent flares:
- Respect fatigue signals from your body
- Practice good sleep habits
- Pace activities appropriately
- Make time for rest and relaxation
Less common lupus flare triggers
While less common, other factors that may contribute to lupus flares include:
Food sensitivity
Some people may experience lupus flares after eating certain foods. These food sensitivities seem to be individual. Food dye, MSG, and high sodium foods may be problematic for some people with lupus. An elimination diet can help identify triggers.
Smoking
Smoking can increase inflammation, constrict blood vessels, and may stimulate the immune system. Quitting smoking is recommended to help prevent lupus flares.
Medications
Certain prescription and over-the-counter medications have been linked to drug-induced lupus or flares in some people. These include hydralazine for blood pressure, procainamide for arrhythmia, minocycline acne medication, and TNF inhibitors used for rheumatoid arthritis.
Vitamin D deficiency
Low vitamin D levels are common in lupus, and this vitamin helps regulate the immune system. Correcting a deficiency may help minimize flares in some people.
Signs of an oncoming lupus flare
Recognizing early signs of a flare up can give you a chance to take action and try to minimize symptoms. Watch for:
- Fatigue
- Joint pain or swelling
- Muscle aches
- Low grade fever
- Skin rashes
- Headaches
- Difficulty concentrating
Keep in mind flares can range from mild to severe. Tracking your symptoms and potential trigger exposures in a journal can help you identify patterns.
Preventing lupus flares
While lupus flares can’t always be prevented, the following self-care strategies can reduce your risk:
- Get regular exercise appropriate for your fitness level
- Eat a healthy, balanced diet
- Reduce stress through yoga, meditation, counseling, or other methods
- Get sufficient sleep and rest
- Avoid excessive sun exposure – use sunscreen and protective clothing
- Take medications as prescribed and discuss any desired changes with your doctor
- Avoid smoking and excessive alcohol consumption
- Consider supplements like vitamin D
- Stay current on vaccines, especially annual flu shot
- Attend regular doctor visits to monitor disease activity
Being diligent about self-care helps prevent lupus flares. But even with the best efforts, flares can still occur. Working closely with your healthcare team is key to successfully managing this disease.
Treating a lupus flare
Treatment during a flare aims to reduce inflammation and calm the overactive immune system. Options may include:
- Corticosteroids – Potent anti-inflammatories like prednisone used for short periods
- NSAIDs – Non-steroidal anti-inflammatory drugs like ibuprofen to relieve pain and swelling
- Immunosuppressants – May be added to reduce immune system activity long-term
- Antimalarials – Hydroxychloroquine helps minimize flare ups
- Biologics – Newer injections target overactive immune cells
- Rest and relief – Getting extra rest and avoiding stressors aids healing
Strong communication with your healthcare providers is important when adjusting treatment plans. Never abruptly stop prescribed medications, as this can worsen flares.
When to seek emergency help for a lupus flare
Severe lupus flares require emergency medical care. Go to the ER immediately or call 911 if you have:
- Difficulty breathing
- Chest pain that spreads to jaw, neck, or down the arm
- Sudden severe headache or confusion
- Seizures
- Heavy bleeding or bruising
- Sudden loss of vision
- Severe swelling in legs or feet
- Racing heart rate or passing out
- Unrelenting fever over 102°F (39°C)
These symptoms can indicate a medical emergency like a heart attack, kidney inflammation, stroke, or other organ damage from a severe lupus flare.
Coping with the challenges of lupus flares
Flares can take an emotional toll as well as a physical one. Give yourself credit for the strength it takes to cope with this disease. It’s normal to feel frustrated, sad, or limited during flares. Useful coping strategies include:
- Sharing feelings with a therapist, support group, or trusted loved ones
- Trying meditation, deep breathing, or prayer
- Practicing positive self-talk and mantras like “This will pass”
- Engaging in hobbies you can do from home like reading, puzzles, or crafts
- Listening to uplifting music or watch funny shows
- Making accommodations at work if needed
- Setting small, manageable goals each day
It’s important not to isolate yourself when you feel unwell. Stay connected with your support network. With effective coping methods, flares do not have to rule your life.
The takeaway
Lupus is a disease of flares and remissions – and flares can occur even with careful self-management. Triggers are not always avoidable. The keys are paying close attention for early signs of flares, taking action to manage symptoms, and working closely with your healthcare providers to adjust treatment as needed. Patience, communication, and support from loved ones also helps in weathering lupus flares.
