Managing and Preventing Lupus Flares

Lupus is a chronic autoimmune disease that can affect any tissue or organ. In lupus, the body’s immune system that would typically fight illness or infection mistakenly attacks healthy parts of the body like the skin, joints, heart, brain, lungs, and kidneys. These attacks cause inflammation, leading to a variety of symptoms and sometimes permanent damage.

While lupus affects everyone differently, most people with lupus experience periods of remission, when their symptoms lessen or disappear, and periods of flares, when new or worsening symptoms appear.

Although there is no way to prevent the development of lupus, there are ways to manage flares and lower their frequency.

Symptoms of a Lupus Flare

Lupus affects everyone differently, but most people experiencing a flare feel like they’re becoming sick again. Initial symptoms that disappeared during remission may return, and new symptoms can also appear. Symptoms of a lupus flare range from mild to severe.

Mild Flare Symptoms

During a mild flare of lupus, symptoms may be vague and harder to notice right away. Mild flare symptoms include:

• Fever
• Pain in joints
• Skin rashes
• Sores in the mouth
• Fatigue
• Change in weight

Moderate Flare Symptoms

A moderate flare of lupus can have a bigger effect on quality of life. You may experience some or all the mild flare symptoms along with other symptoms. Symptoms of a moderate flare can include:

• Abdominal pain
• Diarrhea
• Nausea or vomiting
• Shortness of breath or difficulty exercising due to inflammation of the lining of lungs (pleurisy)
• Pain in the chest due to inflammation of the heart muscle (myocarditis)
• Increased heart rate due to hemolytic anemia
• Numbness, burning pain, pins-and-needles sensation from neuropathy
• Inflammation of the kidneys (nephritis)

Severe Flare Symptoms

During a severe flare of lupus, major organs are often affected. This causes serious conditions to appear that have their own symptoms.

Severe flares can lead to the following conditions and symptoms:

• End-stage renal disease: When your kidneys stop functioning, you have high blood pressure, restless leg syndrome, erectile dysfunction, and stoppage of menstruation.
• Inflamed aorta: When the aorta, the main artery that moves blood from your heart to the rest of the body, gets inflamed, you can experience headaches, loss of or double vision, stroke or heart attack.
• Blood clots: When blood clots in an abnormal way or place, you can have a stroke or a worsening of kidney disease.
• Cardiac tamponade: When the sac that surrounds your heart fills with fluid, you can experience chest pain, shortness of breath, dizziness, fainting.

My biggest sign of an oncoming flare is increased fatigue. This isn't simply, oh I'm more tired. It's life altering. My flares typically last from a week to a month, depending on severity and if my healthcare provider prescribes me medications.

CORY MARTIN, AUTHOR AND HEALTH WRITER WHO'S BEEN LIVING WITH LUPUS FOR MORE THAN FIVE YEARS

Identifying What Triggers a Flare

Flares are hard to predict. However, the longer you live with lupus, the more likely you are to recognize the things that tend to trigger a worsening of symptoms. To help identify what triggers a flare for you, try keeping a diary of symptoms with a list of things that occurred around the time of the flare.

Common triggers for a lupus flare include:

• Being in sunlight: Ultraviolet (UV) exposure from the sun can trigger a lupus flare. Being outside when the sun is the strongest—typically between 10 a.m. and 3 p.m.—can put you at higher risk of a flare. 
• Having stress: Emotional and physical stress can cause flares. Being stressed at work, going through a divorce, and experiencing a death in the family are examples of emotional stress. Physical stresses such as surgery, pregnancy, and childbirth can also trigger a flare.
• Overdoing it: Overworking yourself and not getting enough rest have been shown to trigger lupus flares.
• Stopping your treatment: People who take Plaquenil (hydroxychloroquine) for lupus management and stop taking it are at higher risk of entering a flare.

Managing and Treating Flares

When a lupus flare occurs, there are ways to manage and treat them. There are steps you can take to help yourself return to a state of remission, relieve symptoms, and prevent further damage to tissues and organs.

Taking Medications

While mild flares may not require medication, moderate to severe flares often do. If you experience frequent flares, your healthcare provider may consider other lupus medications that could be better at preventing flares. 

Medications to manage and prevent lupus flares include:

• Medrol (methylprednisolone): For moderate to severe flares, the most common medication are corticosteroids, prednisone or methylprednisolone are commonly used to relieve inflammation. Medrol is typically given in specific dosing schedules known as pulse therapy where tapered doses of the drug are prescribed for a short period of time to rapidly return the body to a state of remission.
• Antimalarials: Plaquenil is the standard of care for lupus. If you have not begun treatment with this medication and you’re in a flare, your healthcare provider may prescribe it for you to reduce frequency of flares and long-term organ damage.
• Immunosuppresants: In lupus, the immune system is overactive and doesn’t function properly. Immunosuppresants such as methotrexate, sold under brand names like Trexall and Rheumatrex, work by suppressing the immune system.
• Biologics: For people who haven’t responded to antimalarials and immunosuppresants, biologics such as Benlysta (belimumab) can be used to lower overall disease activity.

Lifestyle Habits

When you’re in the middle of a flare, it can feel overwhelming. But there are things you can do to improve symptoms and give yourself a sense of control. These include:

• Eat nutritious foods: While there is no specific diet for lupus, eating plenty of fruits, vegetables, and whole grains along with healthful sources of protein can help provide the nutrition your body needs to recover faster.
• Rest: Give yourself permission to rest. Put off chores that need to be done. Take a day off work. Say, "no," to plans that are too exhausting. Lying in bed is not lazy when you’re in a flare; it’s a way of helping you feel better sooner.
• Avoid the sun: It is well known that UV exposure can trigger flares and worsen existing symptoms. Wear sunscreen daily. Try to avoid being outdoors when the sun is at its strongest. If you must be outdoors, wear UV protective clothing and hats and find shady areas.

Complementary Methods

Complementary methods can help you manage a flare in conjunction with the treatment plan given by your healthcare provider. Some possible complementary methods include:

• Supplements: Research has shown that certain vitamins and supplements have promise in improving lupus symptoms. These include Vitamin D, Omega 3 fatty acids/fish oil, N-acetyl cysteine (NAC), turmeric, and DHEA. However, supplements are not monitored or require FDA approval, and should be discussed with a physician before use.
• Meditation: Meditating can bring a sense of calm, helping you deal with the stress of a flare. It has also been shown to reduce the intensity of pain from lupus.
• Therapy: Depression, anxiety, and reduced quality of life are common with lupus. Cognitive behavioral therapy can help with the management of the disease and provide a different outlook to living with chronic illness.
• Acupuncture: There is evidence that acupuncture can help relieve muscle, joint, and bone pain. The practice has also been shown to alleviate nausea and vomiting in people who are being treated with chemotherapy medications for lupus.

Giving myself permission to slow down helps me manage a flare. This was hard during the early years after diagnosis, but I had to come to the realization that if I didn’t slow down I would be in a flare much longer.

CORY MARTIN, AUTHOR AND HEALTH WRITER WHO'S BEEN LIVING WITH LUPUS FOR MORE THAN FIVE YEARS

When to Seek Further Medical Care

It may be possible to manage mild flares on your own. However, if symptoms persist or worsen or you experience new symptoms, it’s important to talk to your healthcare provider.

The goal of lupus treatment is to prevent further damage and reduce the amount of flares. A healthcare provider can help determine if new, persistent, or worsening symptoms are causing damage to your organs and develop a treatment plan to help bring your lupus back under control.

Seeking Emergency Care

With regular care, most people will not need emergency services for lupus. However, lupus can affect the heart, lungs, and blood. So if you experience any symptoms of a heart attack, stroke, or life-threatening symptoms such as difficulty breathing, seek emergency care immediately.

Symptoms of a heart attack include:

• Shortness of breath
• Chest and upper body pain
• Sweatiness
• Nausea

Symptoms of a stroke include:

• Sudden numbness or weakness in face arm or leg
• Difficulty speaking
• Sudden severe headache
• Sudden dizziness
• Loss of balance or coordination
• Difficulty seeing in one or both eyes

Preventing Flare-ups

While flares are unpredictable and sometimes have no known trigger, there are steps you can take to lower the frequency of experiencing flares:

• Adhere to your treatment plan: The best flare prevention is beginning and maintaining a treatment plan that a healthcare provider has outlined for you.
• Eat nutritious foods: Avoid or limit processed foods, sodium, sugar, and saturated fat.
• Exercise regularly: Find ways to move every day that work for you and your symptoms.
• Get enough sleep: Practice good sleep hygiene, which includes limiting screen time before going to bed and creating a comfortable sleeping environment.
• Avoid sickness: Having lupus makes you more susceptible to infection and illness, which can trigger flares. Avoid others who are sick and wash your hands often.
• Stop smoking: Smoking is a known trigger of lupus and flares.

A Quick Review  

Lupus is a chronic autoimmune disease that can affect your organs and tissue. Most people with lupus experience periods of remission and periods where new symptoms develop or existing symptoms worsen. These periods of disease activity are known as flares. Flares can range from mild to severe.  

Common triggers for flares include stress, sun exposure, and failure to adhere to a treatment plan. Treatment for flares includes medications such as corticosteroids to quickly reduce inflammation, antimalarials, biologics, and immunosuppressants. Some people also find that vitamins, supplements, acupuncture, and meditation complement their treatment plan and help them recover from a flare faster.

While most people do not need emergency services for a flare, it’s important to be on the lookout for any life-threatening symptoms such as those associated with heart attack or stroke.