Triggers and Flares

What are the triggers?

Lupus can be triggered at puberty; during menopause; after childbirth; after viral infection; after sunlight exposure; as a result of trauma; after a prolonged course of medication; after a period of extreme emotional stress. There may be many other triggers too. It should be noted that many patients have a reduction of symptoms post menopause.

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What drugs can induce Lupus?

Drug-induced lupus (DILE) normally requires months to years of frequent exposure to a drug before symptoms appear. After discontinuing the drug, the symptoms usually fade after six months. The ANA may remain positive for years. There is definite proof (according to the LFA) that some medications are associated with drug-induced lupus. There are many more medications that are suspected of causing Drug-Induced Lupus or worsening systemic lupus.

Drugs known to be associated with SLE

Drugs that might be associated with SLE

This list from the "Bulletin on the Rheumatic Diseases", produced by the Arthritis Foundation in 1991.

Also, there is increasing evidence that Minocycline, (the teenage acne drug), can cause lupus-like symptoms in some people though it is successfully used to treat lupus in others. It is most often recommended for RA treatment only.

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What can I do to protect myself from flares?

Sometimes nothing. Some find dietary supplements keep them on an even keel. Others find that supplements can trigger flares. Some find that other forms of holistic healing can reduce their stress and thereby reduce their flares. Some general rules of thumb:

  1. Avoid sun exposure as much as possible: When you do go out, wear a wide-brimmed hat, sunblock (not sunscreen) and light-weight, color-blocking clothing even if you have no known photosensitivity. Often photosensitivity can cause fatigue and joint pain but no rash and the patient doesn't realize the connection. Often, the effects of such exposure are not seen for several hours or even a couple of days leaving the patient to think the exposure was not at fault. Also, photosensitivity can develop suddenly in a lupus patient where they had no significant sensitivity before. This means avoiding other sources of UV light too, such as unprotected fluorescent lighting and halogen bulbs. Tanning beds are mostly UVA. Newer data indicates that photosensitive patients are actually more sensitive to UVA though UVB is thought to be the more damaging radiation in healthy persons. At the very least, use these UV sources with extreme caution if you feel you must use them at all.

    The sun emits ultraviolet radiation in three bands known as A, B, and C. Only the first two, ultraviolet A (UVA) and ultraviolet B (UVB), are directly harmful to lupus sufferers and are probably harmful to most of us. When these bands of [UV] light hit the skin of the lupus patients, they damage [DNA of the underlying cells]. In some mouse lupus models, radiation to the top (epidermal) layer of the skin has resulted in the generation of [altered] DNA, which researchers have found can lead to the formation of anti-DNA and result in tissue damage. Also, [UV] light can induce the production of other antibodies - anti-Ro (SSA), anti-La (SSB), and anti-RNP - in a skin cell known as a keratinocyte. Most patients who test positive for the anti-Ro (SSA) antibody are very sun-sensitive. (based on: Dr. Daniel Wallace, The Lupus Book

    Autoantibodies and other immune components increased due to UV exposure can travel throughout the body and cause everything from mild symptoms such as fatigue and headache to life-threatening kidney dysfunction. In general, it seems unwise to tempt the disease on this issue and there are other good reasons not to get too much UV exposure. For the most part, the sunlight requirement for converting Vitamin D into a form the body can use is met by normal exposure (going shopping, posting a letter, etc.)
  2. Avoid allergens: Certain foods, medications, airborne contaminants such as pollen and dust, and insect allergies can trigger flares.
  3. Drink plenty of fluids and eat a sensible diet (as with all things): There are cases where too much fluid can present a risk - be aware of this if you have known kidney problems, and check with your doctor for how much fluid you should be consuming.
  4. Get plenty of rest whenever possible: The lupus fatigue - that "mind-numbing, feet-stuck-to-the-earth, swimming-in-treacle, body-being-weighed-down-by-3G's" feeling that almost all of us experience at some time or another - should not be ignored unless absolutely necessary. If your body screams "REST" then listen to it - it's telling you it needs to heal.
  5. Stay on your medications as prescribed by your doctor and discuss all medication changes or additions (such as herbal supplements, vitamins, fish oil, etc.) with your doctor before enacting those changes. This includes changes or additions in traditional medicines. Some medications, traditional or alternative, though readily available over-the-counter, can interfere with the effects of prescribed drugs. Some foods are also known to do this (e.g., grapefruit juice.) In short - discuss all medications with your doctor and discuss possible interactions with your pharmacist.

    DO NOT ATTEMPT TO STOP STEROID TREATMENT ON YOUR OWN WITHOUT YOUR DOCTOR'S KNOWLEDGE, CONSENT AND SUPERVISION. TO DO OTHERWISE CAN BE VERY DANGEROUS, EVEN DEADLY.

  6. In general avoid supplements that are made with alfalfa sprouts as a base. In small doses, such as on the occasional sandwich, sprouts are generally harmless. In the concentrated form found in many supplements they can increase inflammation in some patients. [See The Lupus Book Second Ed. pg. 179] Alfalfa sprouts are a legume and all legumes contain the same chemical (L-canavanine) that causes this inflammation but alfalfa contains this chemical in a higher concentration. Normal ingestion of legumes should not be of concern to most patients.
  7. Excessive amounts of Solanins appear to be problematic for some patients. This is the Nightshade family and includes tomatoes, peppers, tobacco, tomatillos, potatoes and many other plants.
  8. The Capsaicin in peppers is also thought to cause problems in lupus patients, despite the fact that capsaicin is used topically to treat muscle pain in healthy people. The mechanism by which this occurs is beyond the scope of this FAQ. In general, the hotter the pepper, the higher the capsaicin concentration.
  9. Noni Juice is a popular "cure all" being marketed aggressively in some areas. While there is little clinical evidence supporting or disproving the usefulness of this product, there is a general warning that should be heeded. Noni Juice is high in potassium and this can be problematic for individuals with kidney or heart disease. The LFA recommends not using this supplement if you have a condition that could be aggravated by large doses of potassium.
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Are there any medicines or drugs I should avoid?

Yes! Having said that, your body may react differently than someone else's to an any given substance. However, a few drugs are universally recognized as detrimental. These include Septrin and sulphonamides. These are often prescribed for urinary tract infections and are more commonly known as "Sulfa" drugs. Most lupus sufferers respond negatively to these drugs.

NOTE: Because a drug contains sulfur does not make it a "sulfa" drug. Always pay attention to any medication's effect on you as medications can quickly become allergens in autoimmune patients.

Drugs that claim to stimulate or modulate the immune system can be harmful. In general, Lupus treatment focuses on reducing the activity of the immune system. Most alternative drugs that claim to modulate the immune system are not understood well enough to know if they will be harmful or helpful. Again, always discuss your medications with your doctor. It is wise to add or subtract only one medication at a time (traditional OR alternative.) This will allow you to more accurately gauge the drugs efficacy or lack thereof.

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I've been told I must never become pregnant

The first important thing to know is that pregnancy is not a huge risk for every woman with lupus. Bear in mind that some older doctors may still give inaccurate advice. In the not too distant past women with lupus were routinely told their lives were at risk from pregnancy. This is no longer considered accurate advice.

Normally it's wise to avoid becoming pregnant during a flare up. If you have APS, then successful pregnancy is quite possible but you will need careful medical support and additional medication. For more on APS, go to Anti-Phospholipid (Hughes') Syndrome

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