When should you go to the ER for lupus?

Lupus is an autoimmune disease that can affect multiple organ systems in the body. It is characterized by periods of flares, where symptoms worsen, and remission, where symptoms improve. Lupus flares can sometimes be life-threatening and require emergency medical care. Knowing when to go to the emergency room is an important part of managing lupus.

Go to the ER if you have severe chest pain or trouble breathing

One of the most dangerous lupus flares involves inflammation of the sac surrounding the heart, called pericarditis. This can cause severe chest pain and difficulty breathing. Pericarditis can lead to a buildup of fluid in the pericardial sac, called pericardial effusion. A large effusion can put pressure on the heart and affect its ability to pump blood properly. This is a medical emergency requiring immediate ER care. Other lung-related issues can also warrant an ER visit, like pleurisy, pneumonia, and blood clots in the lungs.

Seek emergency care for symptoms of stroke

Some lupus patients are at increased risk for blood clots and stroke. Go to the ER right away if you experience any sudden neurological symptoms, like numbness on one side, vision changes, trouble speaking, or loss of balance. Rapid treatment is crucial to minimize brain damage and disability after a stroke.

Go to the ER for severe headache with fever and neck stiffness

Lupus can sometimes lead to inflammation of the membranes surrounding the brain. This is called acute aseptic meningitis. Symptoms include severe headache with fever, neck pain, and stiffness. Without prompt treatment, it can progress to brain inflammation or permanent neurological complications. Seek emergency care if you have these neurological red flags.

Seek immediate help for symptoms of lupus nephritis

Many lupus patients will develop kidney inflammation called lupus nephritis. This can initially cause fluid retention, frothy urine, and hypertension. However, it can quickly progress to kidney failure and require dialysis if untreated. Go to the ER if you notice decreasing urine output, swelling in the legs or eyes, or shortness of breath, which may indicate kidney problems.

Go to the ER for signs of internal bleeding

Lupus can disrupt the process of blood clotting and lead to excessive bleeding. Signs of internal bleeding include vomiting blood, bloody or black tarry stools, heavy vaginal bleeding, seizures, and fainting. Go to the emergency room right away if you experience any of these symptoms, as untreated internal bleeding can be fatal.

Seek emergency help for infections or fever over 100.4°F

Due to their weakened immune system, lupus patients are at high risk for infections. Many take immunosuppressant drugs that further inhibit their ability to fight infections. Even a minor infection can quickly spiral out of control. Seek emergency care if you have an unexplained fever over 100.4°F, shaking chills, worsening cough or sore throat, or new onset of confusion.

Go to the ER for signs of preeclampsia in pregnancy

Pregnant women with lupus are at increased risk for developing preeclampsia. Symptoms include sudden high blood pressure, headaches, changes in vision, and swelling in the face and hands. Preeclampsia can be dangerous for both the mother and unborn baby. Go to the ER immediately if you notice any suspicious symptoms during pregnancy.

Seek emergency care for severe abdominal pain

Some lupus patients develop inflammation of the pancreas, liver, or spleen. This can cause severe steady abdominal pain that worsens after eating. Lupus-related vasculitis can also lead to insufficient blood flow to the intestines and abdominal angina. Seek prompt ER care for unexplained severe belly pain to identify potentially serious problems.

Go to the ER if you have symptoms of a blood clot

Having lupus increases the risk of developing dangerous blood clots, called thromboses. These often occur in the legs as deep vein thrombosis but can travel to the lungs and cause a pulmonary embolism. Go to the ER immediately if you experience calf pain, leg swelling, shortness of breath, or chest pain, which may indicate a blood clot.

Seek emergency help for any sudden or unusually severe symptoms

In general, you should go to the emergency room any time you experience a sudden lupus flare with symptoms more serious than you typically experience. Even if you are unsure whether it is an emergency, it is better to seek medical care than wait and risk serious complications. Listen to your body and go to the ER if your symptoms seem ominous.

Have your lupus management plan and emergency contacts handy

When you go to the ER, bring a copy of your lupus management plan from your rheumatologist. Include your medical history, medication list, typical disease manifestations, and emergency contact information. This will help ER providers understand your complex medical history and deliver appropriate emergency care.

Notify your rheumatologist when you seek emergency care

Contact your rheumatologist’s office when you go to the ER, even if it’s in the middle of the night. Leave a message explaining your symptoms so they can follow up with you and coordinate care. Your rheum will have the most in-depth knowledge of your lupus case and can best advise ER doctors.

Do not ignore painful or unusual symptoms – seek help!

Some lupus patients downplay their symptoms and delay seeking emergency care. However, this puts you at risk for life-threatening complications. Do not try to “tough it out” – go to the ER if you experience any concerning or severe symptoms. It is always better to have a symptom checked than to assume it’s nothing to worry about.

Have someone drive you to the ER if possible

If you are experiencing severe symptoms, it is best not to drive yourself to the hospital. Have a trusted friend or family member drive you so you can get medical attention as soon as possible. Or, call 911 for an ambulance if your condition is too unstable to drive yourself.


Experiencing a lupus flare can be frightening, with many concerning symptoms that require emergency care. Know the warning signs that warrant an immediate ER trip – such as chest pain, trouble breathing, neurological issues, decreased urine output, abdominal pain, or severe infection. Do not delay seeking help, as prompt treatment can prevent serious complications from lupus flares. With proper emergency care and ongoing management from your rheumatology team, you can successfully control your lupus symptoms and stay healthy.

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