Lupus is a chronic autoimmune disease with often unpredictable periods of remission and flare-ups. Symptoms are different for everyone, and they can affect just about every part of the body. During a flare, these symptoms increase or intensify. New symptoms may appear, and your treatment plan may need reevaluation.

Many things can trigger a lupus flare-up. If you have lupus, learning what your triggers are is important. Some are avoidable; some are not. But knowing when a flare-up is coming can help you manage it better.

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1.

Stress

Stress has not only been shown to be associated with the onset of autoimmune diseases like lupus, but it is also related to flare-ups. One small study on people with lupus found that more than 60 percent reported stress as a trigger, but this seems to vary depending on race and ethnicity.

In the same study, 85 percent of white patients reported stress as a cause for flare-ups compared to only 50 percent of black participants and 45.5 percent of Asian participants.

woman sitting at computer rubbing her eyes Jirapong Manustrong / Getty Images

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2.

Trauma

Stress and trauma are different and the body responds to each differently but both can cause flare-ups of lupus and other autoimmune diseases. One study showed that any traumatic event, excluding illness, doubled the odds of a lupus flare-up.

woman sitting infront of her doctor explaining her trauma PeopleImages / Getty Images

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3.

Hormones

About 90 percent of people with lupus are women, and many of them experience flare-ups due to fluctuations in hormones. Hormonal changes throughout a woman's menstrual cycle, pregnancy, and menopause can all lead to flare-ups.

Between 45 and 70 percent of women have flare-ups during pregnancy. Menstruation can cause symptoms to worsen, and hormonal birth control and hormone replacement therapy are associated with increased risks of flare-ups. Conversely, during menopause, when hormones like estrogen decrease, most women experience fewer, less severe flare-ups.

Woman looking at her skin in the mirror Boyloso / Getty Images

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4.

Infections

Flare-ups can result from infections because, like lupus, an infection affects the immune system.

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People with lupus are at higher risk for infections, especially if they take medication like corticosteroids or immunosuppressants. Because many bacterial, viral, or fungal infections can have the same symptoms as flare-ups, like inflammation and fever, people with lupus should contact their doctors if they have a fever. Man scratches the flaky skin on his hands with eczema, psoriasis and other skin diseases such as fungus, plaque, rash and spots. Autoimmune genetic disease. Tanja Ivanova / Getty Images

5. Sunlight

Most people with lupus have some degree of light sensitivity. One study showed that many experience flare-ups after sun exposure, although they reported that the flare-ups were short-lived rather than lasting for weeks or months. It is unknown whether sunlight increased the symptoms of people with lupus in the study or if those with more active lupus are more sensitive to sunlight. woman touching her forehead from heat invizbk / Getty Images

6. Medications

Certain medications can cause lupus flare-ups. Two antibiotics, sulfamethoxazole and trimethoprim, known as "sulfa" antibiotics, are known to lower blood counts and increase sun sensitivity in people with lupus, which can lead to flare-ups. These medications are often used to treat urinary tract infections or given before surgery to prevent infection, but there are other effective antibiotics available. If you have lupus, be sure to talk about options with your doctor. woman looking at her phone and holding two pill bottles Milko / Getty Images

7. Overexertion

Overexertion occurs when people push themselves too hard mentally or physically. Everyone is at risk for overexertion, but people with lupus may already experience extreme, unpredictable, frequent fatigue not relieved by rest. Their threshold for overexertion is lower, and the subsequent exhaustion can lead to a flare-up. Tired truck driver having a headache after working extra hours andresr / Getty Images

8. Lack of Sleep

Sleep disturbances are common with lupus, and they have many effects that can lead to flare-ups. People with lupus commonly experience fatigue, so when they do not get enough sleep, it takes a significant toll on their bodies. Lack of sleep can lead to increased stress and a greater chance of physical and mental exhaustion, both of which can lead to flare-ups. Lack of sleep can also affect the immune system, making people with lupus even more likely to get an illness that can cause a flare-up of symptoms. Young Asian woman feeling sick and suffering from a headache, lying on bed and taking a rest at home AsiaVision / Getty Images

9. Poor Nutrition

A balanced diet can be effective at preventing and managing lupus flare-ups. Specifically, studies show that a diet rich in healthy fats, protein, fiber, and vitamins A, B6, C, D, and E and low in sodium can prevent lupus flare-ups. person waiting to eat junk food bymuratdeniz / Getty Images

10. Environmental Toxins

Many environmental toxins may cause lupus flare-ups, including things like heavy metals, pesticides, and air pollution. One of the most studied toxins is silica. Silica is used in glass production and can form fine dust in some situations that can easily be inhaled. People exposed to silica at work have between two and five times the risk of developing lupus, and continual exposure may lead to flare-ups. A woman, on a balcony, wears a face mask to protect herself against very dangerous level of air pollution. A thick yellow fog coming from the nearby forest fires covers Canberra city. Daniiielc / Getty Images

11. Smoking and Alcohol

It is common knowledge that smoking causes a wide range of damage to the body; perhaps unsurprisingly, it has also been linked to skin flare-ups in people with lupus. While alcohol in and of itself does not cause flare-ups, it can interact with multiple medications commonly prescribed for lupus, including over-the-counter and prescription pain medications, which can mean less control over symptoms. person holding a cigarette and with drinks on the table LAW Ho Ming/ Getty Images

12. Vaccinations

People with lupus generally do not receive vaccines. The concerns are that because people with lupus do not have strong immune systems, live vaccines can result in infection, and inactivated or live vaccines can cause an autoimmune response that will lead to flare-ups. The risk, then, is that unvaccinated people with lupus are at greater risk of catching serious illnesses. Research shows that inactivated vaccines seem to be safe, but people with lupus should talk to their doctors to determine what vaccines are appropriate. Close up of senior Asian woman getting Covid-19 vaccine in arm for Coronavirus immunization by a doctor at hospital. Elderly healthcare and illness prevention concept d3sign / Getty Images
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