published by nonprofit Johns Hopkins Press
posted in Flares In Lupus on August 20, 2024 by
Updated September 29, 2026
Did you know that even mild to moderate lupus flares carry a twofold higher risk of ongoing permanent organ damage? Our goal in treating systemic lupus erythematosus (SLE) is remission on medications, getting off steroids, and preventing all flares. Learn how to prevent flares. Be proactive in your healthcare.
In this article, I describe what lupus flares are. I also explain how to prevent them, and what to do when they occur.
Make sure to download, print, and fill out “My Flare Plan.” Get your doctor’s help with filling out some of it.
NOTE: Johns Hopkins University Press, publisher of The Lupus Encyclopedia, is a nonprofit publisher. If you purchase JHUP books, like The Lupus Encyclopedia, you support projects like Project MUSE.
In brief terms, a lupus flare is one of these:
The first type is something that gets worse. Someone has mild, continuous, painless ulcers on the roof of the mouth. Those sores then become more numerous and painful. That is a lupus flare.
The second type is lupus that had settled and then returns. Someone feels fine one day. The next day they develop a fever, fatigue, and joint pains.
The third type is a new problem. The person with painless mouth sores then spills a lot of protein in their urine. They have never had this before. Their doctor diagnoses lupus nephritis.
See your rheumatologist for any new or unusual flare. My patients know to contact my medical assistant, or to send a portal message. They get in to see me or one of my associates quickly, usually within 24 hours. We ask about mouth sores, pleuritic chest pain, sun exposure, rash, and joint pain.
On examination, we look for active lupus. That includes painless mouth-roof ulcers, hair loss, active cutaneous lupus, and inflammatory arthritis. We use an ultrasound machine in our exam rooms to look for joint inflammation. We treat this as part of the physical exam.
Your description of how you feel matters. Lab tests also help us diagnose a flare and judge how severe it is. Go back to the patient with mouth sores. Check their lupus labs, including urine and blood work. Make sure nothing more serious is happening in the kidneys, liver, or blood counts.
Some labs show whether the lupus immune system is more active. These tests help when a non-lupus problem is possible. That problem needs different treatment than a flare. Take someone with SLE and lung inflammation plus scarring (interstitial lung disease, ILD). They then develop a fever, cough, and shortness of breath. An infection such as pneumonia needs an antibiotic. Doctors treat an ILD flare with immunosuppressants. Those drugs can make pneumonia worse.
These tests can show increased lupus immune activity. Non-lupus problems are less likely to cause them:
We check a CBC, liver enzymes, kidney function, and urine protein in every patient. Other tests look for problems that may affect that person. An ultrasound exam of the joints can find inflammatory arthritis in someone with joint pain. A cardiac MRI can look for heart muscle inflammation (lupus myocarditis). An ECG and echocardiogram can look for pericarditis.
Prepare for flares, and know what to do when one starts. A flare can permanently damage the organs it hits. An arthritis flare can damage joints. Any flare can inflame and damage blood vessels. That raises the risk of heart attacks and strokes.
Download and print “Your Flare Plan.” I developed it for the Lupus Foundation of America at www.lupus.org/FlarePlan.
Fill out as much as you can. Then bring it to your rheumatology visit. Ask for help with the questions, including what you can do at home during flares.
If you get painful mouth sores, keep prescription-strength dental steroid paste on hand. Your doctor may also give you a short steroid course, such as a methylprednisolone Dose Pak, to keep ready.
A steroid shot in the buttock may work better. The FLOAT study (Flares in Lupus: Outcome Assessment Trial) supports this. Johns Hopkins Lupus Center in Baltimore, Maryland, ran that trial. The shot can work faster, and it may be safer. Ask if this option suits you, and how to arrange it quickly. My patients know they can call my medical assistant and come in right away for this cortisone injection. The FLOAT study used a cortisone called triamcinolone. In our office, we use 40 mg DepoMedrol plus 4 mg dexamethasone. Triamcinolone can cause fat atrophy and a dimple at the injection site.
See your doctor for moderate to severe flares. Learn which flares need that visit.
Find the causes (triggers) of your flares. Following my “Lupus Secrets” is one of the best ways to avoid them. Possible triggers include:
Some triggers, like stress, are hard to prevent. Work pressure is one example. Chapter 38 of “The Lupus Encyclopedia” lists practical ways to reduce the harm stress can do. You can still teach your mind and body to handle stress better. Practice mindfulness every day, exercise regularly, and get enough sleep.
Menstrual cycles, infections, pollution, and weather changes can influence lupus flares. You have less control over these. Still, stay current on vaccines (chapter 22). Keep a HEPA filter at home, and stay inside on poor air quality days.
Kaleidoscope Fighting Lupus explains more in this video: What Happens to Your Body During a Lupus Flare?
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Read more in The Lupus Encyclopedia, edition 2
Look up your symptoms, conditions, and medications in the Index of The Lupus Encyclopedia
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If you have lupus, what has your experience been? What do you recommend for other patients?
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Thanks for the helpful information, Dr. T! I just wanted to share that I have been diagnosed 33 years ago when I was 15. I identified my flare triggers and stayed away from them as much as I can. So far I am doing well without organ involvements. I did have proteinuria at the beginning of my diagnosis but it is well controlled. Wish everyone here well!
Janie: Whenever I hear this, I always wonder if my patient could have thrush (candidiasis) as the cause due to decreased saliva formation. Our patients often do not get the white patches of thrush, but instead get sore tongue and mouth with some increased redness (erythematous atrophic candidiasis). I usually give a trial of cevimeline (to increased saliva flow) and clotrimazole troches (anti-fungal). Just a thought. Feel free to show this to your docs and ask what they think. Medication induced mucositis (like from methotrexate) is another common cause.
I love this article. I wonder if all Rheumatologist are aware of the tests for flares that you listed. I wish more doctors were as thorough as you.
The first commentor mentioned that their proteinuria was well controlled…how? I’m very curious as to how we can get that lupus symptoms under control
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