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.
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.
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.
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.
Infections
because, like lupus, an infection affects the immune system. 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.
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.
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.
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.
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.
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.
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.
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.
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.
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