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Flare ups- Recognition, Triggers and Prevention

What is a lupus flare?

Lupus is an incurable immune system illness which can affect any part of the body, and subsequently produces many symptoms. The disease occurs in cycles of flare ups and remission. A flare up can result in symptoms becoming worse for a few weeks or longer, and when the symptoms settle down this is known as remission. The reason why symptoms flare up or settle down is not yet known.

Due to the range of symptoms the condition can vary dramatically from one person to the next, which makes it difficult to define a lupus flare. However, after much research, the medical community now has the following definition:

“A flare is a measurable increase in disease activity in one or more organ systems involving new or worse clinical signs and symptoms and/ or laboratory measurements. It must be considered clinically significant by the assessor and usually there would be at least consideration of a change or an increase in treatment.”

Lupus flares can also be classified as mild, moderate or severe:

Severity and how it affects the body

- Mild- Joint and skin problems, tiredness

- Moderate- Inflammation of other parts of the skin and body, including your lungs, heart and kidneys

- Severe- Inflammation causing severe damage to the heart, lungs, brain or kidneys can be life-threatening

How is a lupus flare recognised?

Most people with lupus will have symptoms of muscle and joint pain as well as fatigue on a regular basis. Therefore, it is important to recognise the warning signs of a pending lupus flare. These may include:

· Aching or increased swelling of the joints

· Weakness or pain in the muscles

· Unusually high or more frequent fevers

· An increased level of fatigue or extreme exhaustion

· Hair loss

· Headaches

· Dizziness or forgetfulness

· Abdominal discomfort or digestive problems

· The development of a rash

· Any new or unexplained symptoms

What can trigger a lupus flare?

It is not fully understood what causes lupus but we do know that it involves the immune system being overactive. The immune system is there to protect us from foreign invaders such as germs, bacteria and viruses, but in someone with lupus, the immune system gets confused and attacks not only the invader but also the body’s own tissues. Consequently, in a person with lupus, anything that stimulates activity in the immune system can trigger a flare. Potential flare triggers include:

· Infections. For example, a cold or the flu can activate the immune system and trigger a flare.

· Stress. Flares are common after an emotional or physical trauma (for example, surgery, accidents, emotional distress).

· Pregnancy. Flares are common during pregnancy as well as during the period directly after the birth of the baby.

· Sunlight. Especially for those with photosensitivity.

· Starting or stopping a new drug. Certain drugs and herbal supplements have been shown to trigger lupus flares.

How to prevent a lupus flare?

The key to preventing flares is to become well-educated about lupus itself, the more you understand, the better you will be able to manage your condition.

It is important to follow the treatment plan prescribed specifically for you which may include anti-inflammatory medicines, hydroxychloroquine (for fatigue, skin and joint problems) or steroid tablets, injections and creams for kidney inflammation and rashes. There are also other treatments to treat severe lupus that work on the immune system to reduce the number of antibodies in your blood.

Apart from medication and treatments, there are things that you can do to manage your symptoms and reduce the risk of flares. These include:

· Eat a healthy, balanced diet

· Try to stay active, even when you have a flare-up try walking or swimming

· Get lots of rest

· Try relaxation techniques to manage stress as this can make symptoms worse

· Use high-factor (50+) sunscreen

· Wear a wide-brimmed hat in the sun

· Do not sit in direct sunlight or spend a lot of time in rooms with fluorescent lights

· Tell your employer about your condition – you might be able to adjust your working pattern

· Ask for help from family, friends and health professionals

· Do not smoke, stopping smoking is the most important thing to do if you have lupus

Despite your best efforts, lupus flares may still occur. If you suspect you are having a flare please contact your doctor immediately.

This article is intended to inform and give insight but not treat, diagnose or replace the advice of a doctor. Always seek medical advice with any questions regarding a medical condition.

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