What Is a Lupus Flare?

Medically Reviewed by Sabrina Felson, MD on March 09, 2024
Written by Valerie Finholm
5 min read

Many people who have lupus have a mild case of the disease. But there are times when symptoms -- pain and inflammation -- get worse. That’s called a flare or flare-up. When flares happen, you may even get symptoms you haven’t had before.

Your immune system is designed to protect your body by making proteins called antibodies to attack viruses and other germs that can make you sick. When you have an autoimmune disease like lupus, your immune system mistakenly attacks healthy tissue. That causes inflammation. It can affect and damage almost any part of your body, including:

Lupus is not the same for everyone. Flares can come and go and can affect different parts of the body at different times. The symptoms depend on what part of the body is affected. Some common symptoms of a flare include:

  • A butterfly-shaped rash on the cheeks and nose
  • Rashes on other parts of the body
  • Pain or swelling in joints
  • Fever, often low-grade
  • Chest pain when taking a deep breath
  • Extreme fatigue
  • Sores or ulcers in the mouth or nose
  • Sun and light sensitivity
  • Headaches
  • Hair loss
  • Fingers or toes lose color and become numb when a person is cold or stressed
  • Anemia
  • Being confused or having trouble thinking

During a flare, your fatigue can become overwhelming, worse than the baseline tiredness almost all people with lupus get. By comparison, people who don’t have lupus can rest and sleep and feel better. That’s not the case for people with lupus, especially during a flare. One doctor says it’s like “nothing you can do seems to make the fatigue any better.” Fatigue can get worse if you do simple tasks, like bathing, cooking, or light housework. Depending on your fatigue level, it can even prevent you from doing those things.

Even though flares are defined as when your symptoms get worse, some flares can happen without symptoms. That’s why it’s important to see a doctor trained in treating lupus so they can keep an eye on your health.

Emotional or physical stress can set off lupus in the first place, or it can bring on a flare in people already diagnosed. These stresses are called triggers. Common triggers include:

  • Life complications, like a death in the family, a divorce, or other stressors
  • Pain from surgery, injury, pregnancy, and childbirth
  • Exhaustion
  • Infections
  • Colds or other viral illnesses
  • Getting too much sun

To help you identify your triggers, it’s important to keep track of them. You can do that in a diary to share with your health care team, so they get a good picture of how you’ve been doing between appointments. You can even use an app. You’ll want to note any changes in your health -- good or bad -- and any questions you want to ask your doctor. If possible, make your notes on the day of your symptoms, instead of relying on your memory from a day or two (or more) before. This can help you and your doctor see patterns and start to predict when a flare might happen.

Once you start to educate yourself about lupus and learn to identify triggers, you can work closely with your care team on a plan for managing flares.

Stick to your treatment plan. Once your health care team comes up with the right medications and lifestyle changes for you, do your best to stay on track. Make sure you go to your doctor appointments. Take your medicine as your doctors advise you to, and let them know if you seem to be having side effects. Keep track of your medicine dosages and when you take your meds. Write it down if you need to.

Avoid triggers when you can. After you start seeing patterns in what is triggering your flares, you can make changes to try to prevent them.

Make healthy choices. Eat nutritious foods. Exercise when you feel like it. Make sure your doctor signs off on your activity and how hard you push yourself. Do your best to get enough sleep and rest. Practice good hygiene so you won’t pick up any viruses or other infections.

Keep your stress levels in check. Stress is a major trigger, but there are ways to keep your stress down:

  • Know what your stress feels like. Does it make you feel worried? Does it affect how well you focus? Does it make you angry or frustrated?
  • The healthy choices we just mentioned above can help relieve your stress.
  • Relax. Whether it’s a soothing bath, a few minutes of meditation, or just taking a break from your routine, you should unplug, even for a little while.
  • Plan ahead. If you know a busy day is coming, get ready for it the night before. If you're nervous about seeing your doctor, write down what you want to say. If you have a lot of things to do, jot down a list.
  • Find a lupus support group. The Lupus Foundation of America is a good resource.

The foundation also has launched an online self-management program to support people who have lupus. SELF -- Strategies to Embrace Living with Lupus Fearlessly -- can help manage your symptoms, stress, medications, and organize how you work with your health care team.

Most people who have lupus have a primary care doctor who coordinates with specialists for their specific issues. This might include a dermatologist, cardiologist, or rheumatologist for symptoms related to your skin, heart, or joints.

Always report new symptoms to your doctor right away so your treatment plan can be changed if needed. The symptom might be caused by a flare, side effects from medication, or a new complication. Make sure you see your doctor right away if you:

  • Have a fever or if your temperature is much higher than it normally is
  • Have a seizure
  • Get chest pain or shortness of breath
  • Get confused
  • Have serious belly pain
  • Get several symptoms at once, like a bad headache with a stiff neck and a fever

Also, if a new medicine you’re taking doesn’t seem to be helping with your symptoms or is making them worse, let your doctor know.