Systemic lupus erythematosus (SLE) is a chronic autoimmune condition where the immune system mistakenly attacks healthy tissues and organs (including joints, skin, kidneys, and brain). This process creates inflammation and widespread damage. A lupus “flare” is a period of increased disease activity, defined as a measurable worsening of symptoms or new clinical signs that prompt a change in treatment. Flares can range from mild, such as a localized rash, to severe, involving major organs.
Recognizing a Lupus Flare
Recognizing a lupus flare requires identifying a significant change from the body’s baseline state, as symptoms are varied and often mimic other conditions. One of the earliest indicators is severe fatigue that differs from the general tiredness associated with SLE. This fatigue is not relieved by rest and signals a systemic increase in disease activity.
Skin manifestations frequently mark the onset of a flare, most notably the malar or “butterfly” rash across the cheeks and the bridge of the nose. Other skin lesions or rashes may also appear or worsen, especially in sun-exposed areas. Additionally, many individuals experience a persistent, low-grade fever not attributable to an infection.
Musculoskeletal symptoms are common, involving increased joint pain, stiffness, and swelling, often in the fingers, hands, wrists, and knees. A flare can also involve specific organs, presenting as pleuritis or pericarditis, which cause sharp chest pain, or new mouth sores. Kidney involvement (lupus nephritis) might lack obvious initial symptoms, but is indicated by general swelling in the legs or blood and protein detected in a routine urinalysis. Early recognition is crucial because organ-specific flares, such as those affecting the kidneys or central nervous system, can cause irreversible damage.
Common Triggers of Flare Activity
Lupus flares are often precipitated by internal or external factors that stress the body and stimulate the immune system. A widely recognized environmental trigger is exposure to ultraviolet (UV) light, whether from the sun or indoor sources. UV exposure can directly cause skin lesions and activate the systemic disease process.
Physical stressors, such as infections, are significant flare catalysts because they force the immune system into overdrive. Minor illnesses like the common cold or severe events like surgery or major injury can activate the inflammatory cascade. Emotional and psychological stress is also a potent trigger, as stress hormones can alter immune responses and increase inflammation.
Changes in medication management represent another common trigger for disease worsening. Suddenly stopping prescribed medications, such as antimalarials, or not adhering to the maintenance schedule can quickly lead to a loss of disease control. Certain other medications, including specific antibiotics or hormonal therapies, can also interact with the immune system and inadvertently trigger increased disease activity.
Immediate Steps for Flare Management
When a flare is suspected, the immediate step is to contact the rheumatologist or healthcare team. Prompt communication allows for assessment to confirm the flare and rule out other possibilities, such as infection. It is helpful to document new or worsening symptoms, noting their severity, onset time, and any recent triggers.
The medical team typically uses a combination of physical examination, clinical assessment, and laboratory tests to measure increased disease activity. Blood tests may check for changes in complement levels or anti-dsDNA autoantibodies, which can rise during a flare, and a urinalysis screens for kidney involvement. Based on the severity and organ involvement, the medical professional will then prescribe acute treatment.
Common acute treatments include a short-term increase in the dose of corticosteroids, such as prednisone, to rapidly suppress inflammation. For milder flares, nonsteroidal anti-inflammatory drugs (NSAIDs) may be used to manage pain, swelling, and fever. In cases of severe organ-threatening flares, high-dose intravenous corticosteroids or stronger immunosuppressants may be necessary.
Strategies for Reducing Future Flares
Maintenance therapy and lifestyle modification are the most effective strategies for reducing the frequency and severity of future flares. Strict adherence to the prescribed medication regimen, especially antimalarials like hydroxychloroquine, is foundational for decreasing flare risk. Never adjust or discontinue medications without consulting a physician, even during periods of remission.
Consistent sun protection must be practiced. This includes applying broad-spectrum sunscreen (SPF 30 or higher) daily, wearing protective clothing, and avoiding peak sun hours (typically 10 a.m. to 4 p.m.). Managing emotional and physical stress is equally important and can be achieved through techniques like meditation, gentle exercise, or prioritizing adequate rest.
Routine monitoring through regular doctor visits and lab work is essential. These appointments allow the healthcare team to detect subclinical disease activity, such as changes in blood markers or early signs of kidney issues, before symptoms escalate. A proactive approach to health, including sufficient sleep and a healthy diet, supports the body’s resilience against inflammation.