Lupus flare symptoms: What are the early signs of a lupus flare?

Overview: What does lupus flare feel and look like?

Lupus is an autoimmune disorder in which the immune system attacks healthy tissues throughout the body. No one is certain about the causes of lupus, but it seems to be a combination of genetics, hormones, the immune system, and environmental triggers. The severity of lupus can differ from person to person. Some people may have only skin symptoms, while others may experience severe and even life-threatening problems throughout the body. Symptoms are always a sign of disease activity during a lupus flare. Because lupus can affect the entire body, there is a bewildering variety of flare symptoms. The most common symptoms are fatigue, fever, sickness, weight loss, skin rash, hair loss, joint pain, joint swelling, and muscle pain. Less common signs of a lupus flare include chest pain, cold hands, headache, and red eye, but any other problems can occur, and new symptoms frequently appear during a flare.

What are the early signs of a lupus flare?

Everyone with lupus will eventually recognize their unique early signs of lupus flare. The most common early signs of a lupus flare are:

• Feeling tired

• Fever

• Pain

• Skin rash, usually around the nose (“butterfly rash”) or disc-shaped

• Other symptoms like headache or gastrointestinal issues

Other lupus flare symptoms

Lupus can affect many parts of the body, so many different symptoms are possible. Symptoms can vary from person to person and from flare to flare. The most common symptoms are constitutional symptoms (90%), skin and mucus membrane symptoms (80%), muscle and joint symptoms (80% to 90%), and headaches (50%).

Constitutional symptoms of a lupus flare include:

• Fever

• Fatigue

• Feeling sick

• Loss of appetite

• Weight loss

• Swollen lymph nodes

Rash and skin lesions are a common symptom of a lupus flare and include:

• Butterfly-shaped rash around the nose

• Disc-shaped rash

• Bumpy rash

• Photosensitivity

• Mouth sores

• Nasal ulcers

• Skin sores

• Skin discoloration

• Cold hands and feet (Raynaud’s phenomenon)

• Hives

Joint and muscle problems associated with a lupus flare include:

• Joint pain (usually the hands, wrists, and knees)

• Joint swelling

• Joint stiffness (especially when walking)

• Muscle pain

Symptoms associated with blood problems due to a lupus flare include:

• Symptoms of anemia such as tiredness and weakness

• Susceptibility to infections

• Bleeding and bruising

When the nervous system is involved in a lupus flare, symptoms can include:

• Intractable headaches

• Seizures

• Vision changes

• Movement problems

• Changes in cognition

• Psychiatric disorders, including anxiety and depression

• Psychosis

• Numbness, tingling, or burning on the skin

• Symptoms of stroke

• Hiccups

When a lupus flare affects the lungs, the most common symptoms are:

• Chest pain that may worsen with coughing or sneezing and improve when taking small breaths

• Shortness of breath

• Fast breathing

• Dry cough

• Fever

If the heart is affected by a lupus flare, the most common symptoms are:

• Chest pain 

• Rapid heartbeat

• Heart palpitations or abnormal heart rhythms

• Fever

• Fatigue

• Trouble breathing

• Dry cough

Digestive system problems happen when a lupus flare affects tissues somewhere in the gastrointestinal tract. Symptoms may include:

• Heartburn

• Throwing up

• Trouble swallowing

• Chest pain

• Abdominal pain

• Diarrhea

• Abdominal swelling

• Weight loss

• Fever

If the liver is involved, symptoms might include:

• Enlarged liver

• Abdominal pain or discomfort

• Fatigue

• The appearance of small blood vessels on the skin

• Yellowing of the skin and eyes (jaundice)

If the eye is involved, symptoms can include:

• Red eye

• Dry eye

• Swelling

• Eye pain

• Vision changes

Nearly everyone with lupus will have their kidneys affected, and about 50% of patients will develop kidney disease. However, kidney problems due to lupus (lupus nephritis) are a chronic condition rather than a manifestation of a lupus flare. 

Lupus flare vs. Sjögren's syndrome symptoms 

Sjögren's syndrome is a rare autoimmune disease affecting about as many people as lupus. Both involve the immune system. Both can affect the skin, joints, blood vessels, lungs, heart, digestive system, and kidneys. So, they can share many of the same symptoms, including fever, fatigue, swollen lymph nodes, joint pain, cough, shortness of breath, chest pain, Raynaud’s, stomach pain, regurgitation, diarrhea, etc. However, unlike lupus, Sjögren's syndrome primarily affects glands that excrete water: the salivary glands and tear glands. The distinguishing symptoms are dry eye and dry mouth. These are always almost present in someone with Sjögren's but uncommon in people with lupus. 

Types of lupus flare: How can I tell which one I have? 

There are four types of lupus, but only two are permanent conditions: systemic lupus erythematosus (SLE) and cutaneous lupus erythematosus (CLE). The other two are temporary: being born with lupus or getting lupus as a side effect of a drug.

People with SLE can have flare-ups that involve organs throughout the body, including the skin, lungs, nervous system, blood, gastrointestinal tract, or heart. People with CLE have flare-ups that only affect the skin and membranes inside the mouth or nose.

A third type of lupus flare is a symptomless flare, sometimes called a silent or sneaky flare. Symptoms may be absent or very subtle. The disease is active, but this disease activity can only be identified with a blood test. Just because there are no symptoms doesn’t mean these flares are harmless.

When to see a doctor for lupus flare symptoms

When first experiencing a lupus flare, see a doctor. Diagnosis requires blood tests to identify markers of disease activity. People more experienced with flares should be seen by a doctor when experiencing symptoms so that treatment can shorten the flare. A specialist in autoimmune disorders will diagnose most people called a rheumatologist. Lupus patients might also see a skin disease specialist (dermatologist) or an immune system specialist (immunologist). Once a treatment plan has been created, flare-ups can sometimes be treated by a primary physician.

Get immediate medical treatment if experiencing symptoms such as difficulty breathing, chest pain, rapid swelling and pain in the calf, sudden weakness or numbness on one side of the body, difficulty talking, changes in consciousness, confusion, psychosis, seizures, or vision changes. These are signs of potentially severe complications of lupus.

Complications of lupus flare

Lupus flares can damage tissues in the body. Skin and joint tissue damage is bad enough, but serious complications can result from repeated damage to vital organs. Repeated untreated lupus flares can result in complications such as:

• Permanent skin damage

• Hair loss

• Fibromyalgia

• Miscarriage

• Pre-eclampsia and eclampsia

• Congenital heart block in a baby

• Neonatal lupus

• Anemia

• Infections

• Bleeding and bruising

• Blood clots that could lead to heart attack or stroke

• Kidney dysfunction

• Kidney failure

• Atherosclerosis and coronary artery disease

• Psychiatric disorders

• Depression

• Vision loss

• Neurological deficits

Unfortunately, treatment for lupus flares can also have both short-term and long-term complications, including:

• Infections

• Cancer

• Glaucoma

• Cataracts

• Fluid retention

• High blood pressure

• Personality changes

• Weight gain

• Vision loss

• Lung disease

How to treat lupus flare symptoms

While some lupus flares will resolve without treatment, healthcare professionals typically treat lupus flares to speed remission and prevent injury to the body’s tissues. Lupus flare symptoms are primarily treated with drugs that weaken the immune system:

Hydroxychloroquine

Hydroxychloroquine, an antimalarial drug, is often the first treatment for skin and other symptoms of lupus

Topical corticosteroids or immune suppressants

Topical steroid creams or tacrolimus cream is another common treatment for lupus rash and skin lesions

Corticosteroids or immune suppressants

For body-wide symptoms, oral or injected corticosteroids or immune suppressants are used

Biologics

For more severe symptoms, people may take antibody injections that reduce white blood cell activity

Nonsteroidal anti-inflammatory drugs

Over-the-counter NSAIDs can help relieve pain, fever, and joint swelling

Living with a lupus flare

Lupus flares come and go. They are often the result of environmental triggers, so a few rules can help reduce the incidence of lupus flares:

• Avoid anything you’ve experienced as a lupus flare trigger

• Protect your skin from ultraviolet light by avoiding midday sun, using high-SPF sunscreen, and wearing protective clothing

• Also, limit the time spent under fluorescent or halogen lights

• Quit smoking and avoid secondhand smoke

• Decrease stress

• Get plenty of sleep

• Maintain a healthy weight

• Exercise regularly

• Eat foods or supplements enriched with vitamin D

• Take your lupus medications as instructed 

What’s next? Additional resources for people with lupus flare symptoms

Test and diagnostics

• 2019 European League Against Rheumatism/American College of Rheumatology classification criteria for systemic lupus erythematosus, Arthritis & Rheumatology

• Systemic lupus erythematosus, StatPearls

• Systemic lupus erythematosus: primary care approach to diagnosis and management, American Family Physician

• When to call the doctor, Lupus Foundation of America

Treatments

• Diagnosing and treating lupus, Centers for Disease Control and Prevention (CDC)

• Lupus treatments and medications, SingleCare

• Systemic lupus erythematosus, StatPearls

• Systemic lupus erythematosus: diagnosis and clinical management, Journal of Autoimmunology

• Your lupus flare plan, Lupus Foundation of America

Scientific studies and clinical trials

• Current treatment of systemic lupus erythematosus: a clinician’s perspective, Rheumatology International

More information on related health conditions

• Autoimmune disease symptoms: what are the early signs of autoimmune disease, SingleCare