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PubMed This is a summary of 23 peer-reviewed journal articles Updated
Rheumatology

What Causes a Lupus Flare-Up? Symptoms & Triggers

At a Glance

A lupus flare-up occurs when the immune system becomes overly active, causing symptoms like profound fatigue, joint pain, rashes, and fever to return or worsen. Common triggers include UV light exposure, stress, infections, and missing medication doses.

In this answer

3 sections

01

Recognizing the Symptoms of a Flare

02

What Triggers a Lupus Flare?

03

When to Call Your Doctor

A lupus flare-up is a period when systemic lupus erythematosus (SLE) becomes more active, causing symptoms to suddenly return or worsen after a period of stability [1]. During a flare, the immune system becomes overly active, leading to increased inflammation that can cause both new and returning symptoms throughout the body [2][3]. Flares can develop gradually or come on suddenly, and their duration varies greatly from person to person.

Recognizing the Symptoms of a Flare

Flares involve a combination of visible physical signs and internal symptoms [4][5]. Because the immune system can affect almost any part of the body, a flare often brings a mix of the following:

  • Crushing fatigue and cognitive issues: This is frequently one of the first warning signs. Unlike normal tiredness, lupus fatigue is profound and often does not improve with rest [4][5]. It is frequently accompanied by “lupus fog” — a sense of cognitive impairment, confusion, or difficulty concentrating [6].
  • Worsening joint pain and swelling: You may notice an increase in stiffness, swelling, or pain, particularly in your hands, wrists, or knees [4].
  • New or worsening rashes: Cutaneous (skin) symptoms are very common. This includes the classic butterfly rash across the cheeks and nose, or the appearance of other new skin lesions [7].
  • Fevers: An unexplained low-grade fever is a strong signal that your immune system is overactive [4].
  • Organ-specific symptoms: More severe flares can involve internal organs. For example, inflammation of the kidneys (lupus nephritis) might cause swelling in the legs, while inflammation around the lungs or heart can cause chest pain [8][9].

What Triggers a Lupus Flare?

While flares can sometimes happen unpredictably, they are frequently set off by specific, identifiable triggers. Recognizing and managing these triggers is a key part of keeping lupus under control:

  • Ultraviolet (UV) Light: Exposure to the sun and certain artificial lights (such as unshielded fluorescent or halogen bulbs) is a well-known environmental trigger [10][11]. UV light interacts with the skin to provoke an immune response, which can trigger not just skin rashes but also full-body systemic flares [10][12].
  • Emotional or Physical Stress: Major life events, chronic stress, anxiety, or physical trauma (like surgery or an injury) can significantly increase disease activity [13][14].
  • Infections: Viral or bacterial infections, such as COVID-19, Epstein-Barr virus, or even common colds, force the immune system to kick into high gear. In someone with lupus, this immune response can easily spill over into a flare [15][16][17].
  • Maintaining Your Medication Routine: Skipping doses or stopping your lupus medications (like antimalarials or immunosuppressants) is one of the most common and preventable causes of a flare [18][19]. Taking your medication exactly as prescribed maintains stable drug levels in your blood, which keeps the disease suppressed [20][21].

When to Call Your Doctor

It is vital to have a plan for when symptoms return, as untreated flares can lead to permanent tissue damage.

  • Do not guess the cause: Because symptoms like fever and severe fatigue overlap heavily with viral infections, you should not try to guess whether you are experiencing a flare or an infection. Contact your rheumatologist for guidance, as the treatments for each are very different [17][22].
  • Seek immediate or emergency care if you experience “red flag” symptoms such as severe chest pain when breathing, a sudden high fever, profound weakness, or significant shortness of breath. These can be signs of serious organ involvement that require urgent medical evaluation [8][9][23].

Common questions in this guide

What are the first signs of a lupus flare-up?
Crushing fatigue and a sense of cognitive impairment, often called 'lupus fog,' are frequently the first warning signs. You may also experience worsening joint pain, new skin rashes, or an unexplained low-grade fever.
What commonly triggers a lupus flare?
Common triggers include exposure to ultraviolet (UV) light, emotional or physical stress, and infections like the common cold or viruses. Skipping your prescribed lupus medications is also a major, preventable cause of flare-ups.
How do I know if I am having a lupus flare or an infection?
It is very difficult to tell the difference on your own because symptoms like fever and severe fatigue overlap significantly. You should contact your rheumatologist for guidance rather than guessing, as treatments for a flare and an infection are very different.
When should I go to the emergency room for a lupus flare?
Seek immediate emergency care if you experience severe chest pain when breathing, a sudden high fever, profound weakness, or significant shortness of breath. These red flag symptoms may indicate serious internal organ involvement.
Why does the sun cause my lupus to flare up?
Ultraviolet (UV) light from the sun and certain artificial lights interacts with your skin to provoke an overactive immune response. This can trigger not only new skin rashes but also full-body systemic symptoms.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.What specific signs should I look for that indicate I need to call you rather than wait for my next appointment?
  2. 2.How can we distinguish if my fever is being caused by an infection or a lupus flare?
  3. 3.Which over-the-counter medications are safe for me to take for joint pain or a mild fever during a flare?
  4. 4.What sun protection strategies do you recommend specifically for my skin type and medication regimen?
  5. 5.Can we create a specific 'Flare Action Plan' so I know exactly what to do when symptoms start?

Questions For You

Tap a prompt to share your answer — we'll use it plus this page's context to start a tailored conversation.

Related questions

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References

References (23)
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    Performance of a New Instrument for the Measurement of Systemic Lupus Erythematosus Disease Activity: The SLE-DAS.

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    Mitochondrial Dysfunction in Systemic Lupus Erythematosus: Insights and Therapeutic Potential.

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This page provides educational information on lupus flares and triggers. It does not replace professional medical advice. Always contact your rheumatologist if you experience new symptoms, as flares and infections require different treatments.

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