Causes of a Lupus Flare: Symptoms, Triggers, and Treatments

Lupus is a life-long autoimmune condition. Symptoms from autoimmune conditions can come and go. Some days feel good, and some days feel not so good. Flares are what we call the “not so good” times — that is, the times when symptoms temporarily worsen. Learning about what can trigger flares and how to prevent them is one way you can take control of your lupus.

In this article, we explain the signs and symptoms of lupus flares, and offer tips on how to treat and prevent them.

What are the signs and symptoms of a lupus flare?

Though some days living with lupus may feel worse than others, not all of these days are flares. In 2010, the Lupus Foundation of America published an official definition for a lupus flare. Lupus experts from all over the world created this definition. A lupus flare is a temporary period of time when your particular lupus symptoms feel worse in a way your provider can measure (by examining you or with a lab test). It often requires a change in treatment. 

Lupus flares are different for each person, since everyone has their own version of lupus. When your lupus flares, the symptoms of your lupus will be worse than normal. Sometimes, new symptoms can also occur.  

For example, let’s say you get rashes and joint pain when your lupus is not well controlled. During a lupus flare, you could expect to have rashes, joint pain, and possibly a new symptom, too. 

Some common symptoms of lupus flares include:

• Painful and swollen joints

• Rashes

• Sores in the mouth or nose

• Fatigue

• Fevers (not caused by infection)

• Abnormal blood or urine test results

How quickly can lupus flare up?

It depends. Some flare-ups can occur suddenly, over the course of just 1 or 2 days. Some flares take a longer time to build up — over weeks to months.

What can trigger a lupus flare?

Many different things can trigger a lupus flare. Some triggers are within your control, but some aren’t. The good news is that the most common cause of a lupus flare — missing doses of your medication — is within your control. It’s crucial to take your lupus medications as directed. 

If you’re having trouble getting or taking your medications for any reason, talk to your healthcare provider or pharmacist. They can often help find a way to get you the medication you need. They can also help find an alternative if you’re having difficulty with side effects. If it’s hard for you to remember to take your medications, you could try using an app for medication reminders, setting an alarm on your phone, or placing the pill bottle by your toothbrush.

Other common causes of lupus flares include:

• Stress

• Not enough sleep

• Infection

• Pregnancy

• Major surgery (like gallbladder removal or hip replacement surgery)

• Traumatic injury (like a car accident)

• Certain medications: For example, sulfa antibiotics like Bactrim might cause lupus flares in some people (but not all). Talk with your healthcare provider to make sure any new medication is safe for you to take before starting it.

• Ultraviolet (UV) rays from the sun and certain kinds of indoor lights 

• Smoking

Can foods trigger a lupus flare?

Some foods — like alfalfa sprouts and garlic — may trigger lupus flares. That’s because they increase immune system activity, and the immune system is already too active in lupus. The studies to support this aren’t very strong, but many lupus experts agree that it’s reasonable to consider avoiding these if possible. Accidentally eating one of these foods is OK and will not result in immediate harm. The same is true for Echinacea, a dietary supplement some people take while sick to get better faster. Try to avoid this.

Treating a lupus flare

Lupus flares can make it hard to work, take care of your family, and do the things you enjoy. If you feel like you’re having a lupus flare, discuss your symptoms with your doctor. You might need to go in for an appointment or get blood and urine tests.  

Your provider might need to adjust your medication(s) if your symptoms are very severe or certain new symptoms are present. You might only need a new medication for a short amount of time. But you may need to take other medications for longer. There is no one-size-fits-all approach. You and your provider will work together to find the treatment that works for you.

You can take action to treat your lupus flare, too. The following can help you feel better sooner:

• Rest and sleep. This might mean taking some time off of work or asking for help around the house. You know yourself best. Take it easy.

• Focus on your mental health and stress levels. There are stress management resources out there to help. 

• Lean on your support system. Friends, family, or local lupus support groups can help you get through a flare.

• Take medications as directed. Missed doses of medications are a common cause of lupus flares, so be sure to stay organized.

Tips for preventing a lupus flare

Lupus flares are no fun — there’s no doubt about it. But there’s a lot you can do to decrease your risk of having a flare in the future.

First, try to avoid direct sunlight if you can. And use sun protection. Wear sunscreen with a minimum rating of SPF 50 that has both UVA and UVB protection (read the label on the bottle).  When outside, wear hats, long sleeves, and long pants. Remember that some UV rays can pass through windows in your car or home, so sun protection is important inside, too.

Other ways to help prevent lupus flares include the following:

• Getting enough sleep

• Maintaining a healthy diet and exercise habits

• Prioritizing mental wellness

• Stopping smoking

• Taking your medications as directed 

What medications can help prevent lupus flares?

Hydroxychloroquine is the best medication to help prevent lupus flares. It’s sort of like a bulletproof vest: It can’t protect 100% of your body, but it sure decreases the chances of dying from a gunshot wound. Many studies have shown that hydroxychloroquine decreases your risk of lupus flare. It also protects you from many other complications of lupus.

If you can’t take hydroxychloroquine due to side effects or allergy, chloroquine or quinacrine might be options. 

Is there a lupus diet I should follow?

Despite what you may have read online, there’s no specific lupus diet. But eating a balanced diet will help your body stay as healthy as possible — decreasing the chances of a lupus flare. A healthy diet will also decrease your risk of other health problems (like heart disease) that are more common in people with lupus.

Why trust our experts?

Written by:

Samantha C. Shapiro, MD

Samantha Shapiro, MD, is a board-certified rheumatologist and internist with expertise in autoimmune and inflammatory conditions. She founded the division of rheumatology at Dell Medical School at The University of Texas at Austin.

Edited by:

Mandy Armitage, MD

Mandy Armitage, MD, has combined clinical medicine with her passion for education and content development for many years. She served as medical director for the health technology companies HealthLoop (now Get Well) and Doximity.

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