Lupus and Stress: Triggers, Prevention, and Techniques

Many types of stress can trigger lupus flares in people living with lupus. Practicing stress management techniques may help you prevent future flares.

People with lupus — an autoimmune condition — are sensitive to both physical and emotional stress. High stress levels can cause symptoms to flare up. During symptom flares, inflammation can affect different parts of your body, including your joints and your organs.

Lupus flares often follow stressful life events, like a divorce or the death of a loved one. But they can also be triggered by ongoing stress at home or at work. Physical stress, like an injury or surgery, can also trigger a lupus flare.

If you live with lupus, there are several strategies you can try to help you manage stress. This may help reduce disease activity and prevent serious organ damage.

A lupus flare is a period of time when disease activity gets worse.

You may experience worsening symptoms, like joint pain or fatigue. But sometimes lupus flares go unnoticed, which is why it’s important for you to see your doctor regularly for blood tests.

Some people experience the same symptoms during every flare-up, but it’s important to be on the lookout for new symptoms. New symptoms can appear at any time and may be a sign that your condition is affecting a new part of your body.

Symptoms of a lupus flare may include:

• extreme fatigue
• body aches
• joint pain
• hair loss
• fever
• swelling
• rashes, including a butterfly rash on the face
• skin lesions
• shortness of breath
• dry eyes
• chest pain
• headaches
• confusion
• memory loss

Because your body is inflamed during flare-ups, flares increase your risk of organ damage. Preventing flares is one of the main goals of lupus treatment.

According to the Lupus Foundation of America, emotional stress can trigger lupus flares. It is one of many possible triggers, including infections, ultraviolet light, and exhaustion.

Types of stress

Stress can come from many areas of life. A job or relationship can bring emotional challenges or a serious life event can throw things into turmoil.

Stressors that can trigger lupus include:

• parenting
• caregiving
• debt or financial distress
• job stress
• exams or other school stress
• grief or loss
• divorce or breakup
• discrimination and harassment
• anxiety
• trauma

If you have lupus, managing long-term stress can be an important part of preventing flares.

How stress affects the body

Whether or not you have lupus, your body may experience symptoms when you are under stress. These may include:

• trouble sleeping
• a weakened immune system
• headaches
• high blood pressure
• raised heart rate
• stomachaches
• weight gain or obesity
• fertility issues
• changes in your menstrual cycle
• reduced sex drive

Physical stress, like an injury, creates an immune system response which can trigger a lupus flare.

If you become pregnant, for example, you may be at greater risk for a flare, especially in the first or second trimester. Giving birth also increases your risk of a flare.

Infection, injury, certain medications, and stopping lupus medications are other kinds of physical stress that may lead to a flare.

The exact cause of lupus is unknown. But some researchers believe that PTSD or trauma increases the risk of developing lupus.

A 2017 study followed more than 50,000 women over a period of 24 years. The goal was to measure any association between trauma exposure and lupus.

The study found that exposure to trauma, even if there were no symptoms of PTSD, was strongly associated with lupus. Those with many PTSD symptoms were also at greater risk for lupus.

You can take steps to manage stress while living with lupus.

Adopt a “plan ahead” approach

You may be able to reduce stress by taking time to plan your daily tasks or important events like doctor’s appointments. Write down questions for your doctor before you go.

Before a hectic day, plan how to get from place to place and when you’ll have time to eat and relax between errands.

Have a flexible exercise routine

Research supports a link between exercise and lower stress levels. A 2019 study found physical activity reduced stress in the hours immediately following the exercise.

Consider staying active but listening to your body, matching the intensity of the exercise with how you feel from day to day.

Put relaxation on the agenda

Taking time out can help to preserve and restore your energy reserves.

The Lupus Foundation of America recommends scheduling breaks, such as 20 minutes during the workday or one full day on the weekend. During this time, you can read, meditate, be creative, or do nothing at all.

Prioritize quality sleep

Sleep deficiency can make you feel frustrated and worried. Lack of sleep can also worsen the fatigue that comes with a lupus flare. Consider these steps to improve your sleep hygiene to get enough nightly rest.

Reach out for help

According to a 2017 review of research, 24% of people with lupus have depression and 37% have anxiety.

Talking with a healthcare professional about mental health is the first step on the road to mental wellness. Community connection through lupus support groups can also help with managing emotional stress.

Emotional or psychological stress, as well as physical stress, can trigger lupus flares. People living with lupus can use stress reduction strategies such as exercise and community involvement to manage stress and prevent flares.

How to Balance Lupus and Work

Written by Bobbi Dempsey

• Managing Your Workload With Lupus
• Keep Stress Under Control
• What Should You Tell Your Employer?
• When and How to Tell Your Employer
• Your Privacy Is Protected
• If Your Employer Doesn’t Follow the Rules
• More

Managing lupus while working full time (or even part time) can be tricky, especially when you can’t predict when you’ll have symptoms or how bad they’ll be. Changes to your work schedule and environment can help you stay productive. So can strategies to deal with your symptoms.

You may or may not decide to tell your boss and co-workers about your condition. But if you do, federal disability laws require your employer to give you reasonable accommodations to help you do your job.

Lupus symptoms like brain fog, fatigue, and pain can get in the way of your workload. To minimize them, first work with your doctor to come up with an effective treatment plan. There’s no cure for lupus, but the right treatment can reduce flare-ups, address symptoms, and prevent complications.

A healthy lifestyle also makes a difference in how you feel. This includes exercise, eating well, getting enough sleep, and staying out of the sun (to avoid the sun sensitivity that affects many people with this condition).

Beyond that, try these tricks to manage brain fog on the job:

• Minimize distractions and avoid multitasking. Concentrating on one thing at a time makes it easier to focus. You might pause emails when you’re working on a project. Or wear noise-canceling headphones at times when you don’t need to interact with customers or co-workers.
• Pace yourself. Allow extra time when you’re working on something that requires concentration. It helps to plan out multi-step projects in writing. Let your boss or co-workers know if you need help.
• Visual cues can help. If you often forget things, leave yourself visual reminders. For example, put your headset on your keyboard to remind yourself about a recording you need to transcribe.

Fatigue is one of the most common symptoms that affects people with lupus. To deal with fatigue on the job, you might:

• Prioritize. Plan your work schedule ahead of time, if you can. Highlight the most important tasks so you can focus on them first. If you tend to get tired at certain times of day, schedule high-priority tasks for times when you have the most energy.
• Don’t skimp on rest. A good night’s sleep helps you start the day with as much energy as possible. Schedule breaks throughout your day, if possible.
• Change your environment or hours. Ask your boss if you can telework on days you’re feeling especially fatigued. If you usually stand up to do your job, see if you can sit for at least part of the time. A flexible schedule might help if you have less energy at certain times of day.
• Enlist help. Think about tasks you can delegate so you can focus on critical tasks that require your attention. And don’t underestimate the value of a good support network at home. That gives you more time to relax so you go to work well-rested.

It’s hard to concentrate on work when you’re in pain. Talk to your doctor about pain management. And take sick days when you need them. Some other things to try include:

• Helpful equipment. A more comfortable chair can make a difference. If typing hurts your fingers, try voice-to-text technology. A mobility scooter might be an option if you do lots of walking on the job.
• Movement breaks. Even a little exercise can reduce pain. Build several movement breaks into your day. Don’t sit in one position for long stretches.
• Hot or cold therapy. Some people get pain relief from heating pads. Others find that an ice pack helps. Try keeping one of these on hand at your workplace.

Stress can trigger a flare or make your symptoms worse. To cut down on workplace stress, make self-care a priority. Breaks help with this. When you’re not on task, reserve time for stress-relieving activities such as yoga, meditation, exercise, a stroll outdoors, or whatever works best for you.

If you have a nerve-wracking work situation coming up, like making a presentation, planning it out ahead of time can make it feel less stressful.

You’re not legally required to tell your employer you have lupus. Your symptoms and the type of work you do may determine how much you decide to share. But telling your employer and co-workers about your condition means they can provide help when you need it.

Since lupus affects so many parts of the body, in so many different ways, everyone’s situation is different. Some people with systemic lupus can work for years with few issues. But others need some type of accommodation, such as flexible work hours or more frequent breaks.

The federal Americans with Disabilities Act (ADA) requires employers with 15 or more employees to make reasonable accommodations for an employee with a disability or chronic illness such as lupus. A reasonable accommodation is something your employer can provide without “undue hardship.” In other words, it’s not significantly expensive or difficult.

Examples of the type of accommodations that may help you manage lupus symptoms at work include:

• Providing work equipment designed to be more comfortable and less stressful on your body

• Allowing you to work in the shade or arranging your workstation to avoid direct sunlight
• Setting up a dehumidifier, since humidity can worsen lupus symptoms
• Establishing a quiet work zone that minimizes sensory overload

You may want to start with an informal conversation with your supervisor soon after your diagnosis. Even if your symptoms are mild at that point, it keeps your employer in the loop so they aren’t caught off guard if you need accommodations later on.

If you do ask for accommodations, you don’t have to put your requests in writing. You can make them during a conversation with your boss, if you prefer.

Your employer may document your request in writing. (If not, you might ask them to so you have an official record of your request.) They may also ask you to provide documentation showing that you need these accommodations because of your condition.

Your employer must keep your medical information confidential. If you decide to tell your co-workers that you have lupus or discuss your symptoms, that’s your choice. But your boss and others at the company can’t reveal anything about your situation without your permission.

If you think your employer isn’t providing accommodations required by the ADA or is otherwise violating your rights, you can get help.

The federal Equal Employment Opportunity Commission is in charge of enforcing ADA regulations. You can file a complaint with the EEOC explaining how you believe your rights were violated. They’ll investigate and, if they find your complaint is valid, decide what remedies you should get.

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Stress induces inflammation in the prefrontal cortex in lupus – PCR News

Prepared by

Alina Suleymanova

Japanese scientists have shown in a mouse model of lupus that stress caused by sleep deprivation leads to the activation of microglia and the synthesis of interleukins 12 and 23 in the prefrontal cortex (PFC). Similar phenomena – high levels of interleukins and PFC atrophy – have been found in people with lupus. Thus, interleukins can be considered as a potential target for the treatment of the disease.

Prepared by

Alina Suleymanova

Systemic lupus erythematosus (SLE) is a serious autoimmune disease characterized by multiple organ damage, including inflammation in the central nervous system (CNS). Neuropsychiatric SLE (NPSLE) is one of the most severe forms of the disease, characterized by a range of symptoms ranging from mood swings to psychosis and delirium. It is known that stress increases the risk of developing autoimmune diseases and is involved in their exacerbation. But its role in the pathogenesis of NPSLE is poorly understood.

To investigate this issue, researchers from the University of Hokkaido disturbed the sleep of mice of the MRL / lpr line, reproducing the symptoms of lupus. To provoke stress in the body of rodents, they were placed in cages with a spinning wheel for two weeks. These observations were compared with MRL/MpJ control mice, which were also bred to study autoimmune diseases but showed an increased ability to regenerate. The authors then subjected the animals to behavioral tests, as well as immunohistochemical analysis of brain tissue and RNA sequencing to assess the effect of stress.

The lack of sleep really caused stress in rodents: the level of the hormone corticosterone in their blood increased. However, the MRL/lpr experimental mice were less anxious in behavioral tests than the MRL/MpJ mice, as well as their sleepy counterparts. It turned out that the anxiolytic effect (stress reduction) was mediated by medial prefrontal cortex (mPFC) neurons, which were abnormally active in stressed MRL/lpr rodents.

According to transcriptome analysis of mPFC cells, stress affected the expression of 509genes associated with microglial activation in MRL/lpr mice. Thus, activity was increased in microglia activating genes h3-Eb1 , Nos2, Il12b and Fcgr4 , and decreased in inhibitory genes Arg1, Nr4a3 and Treml4 . In particular, gene Il12b
encodes a subunit of interleukins IL12 and IL23, which are involved in the development of inflammation. The content of these cytokines was high in the cerebrospinal fluid of mice. Blocking of the IL12 and IL23 signaling pathways, as well as inhibition of the tyrosine kinase 2 involved in them, suppressed the stress-induced anxiolytic effect and microglial activation in mPFC in MRL/lpr mice.

An important part of the work was the measurement of the level of interleukins in the cerebrospinal fluid, as well as imaging of the brain in people with NPSLE and without. Scientists have found significantly higher levels of IL12 and IL23 in the cerebrospinal fluid of patients with NPSLE. For mPFC was characterized by severe atrophy. The authors conclude that the results obtained in mouse models may be applicable to humans.

According to the researchers, interleukins IL12 and IL23 can be used as markers in the diagnosis of NPSLE, as well as a new target for the treatment of this disease.

Source:

Abe N. et al. Pathogenic neuropsychiatric effect of stress-induced microglial interleukin 12/23 axis in systemic lupus erythematosus// Annals of the Rheumatic Diseases, 2022, published online 11 July 2022. DOI:
10.1136/ard-2022-222566

Neurology Immune system

Systemic lupus erythematosus (SLE) – treatment, symptoms, causes, diagnosis not foreign agents (viruses and bacteria), but own tissues. This causes an inflammatory response that is manifested by swelling, pain, and tissue damage throughout the body. In severe SLE, the kidneys, heart, lungs, nervous system, and hematopoietic system can be damaged. And although some patients with systemic lupus erythematosus may have very mild symptoms, it must be understood that the disease is chronic (lifelong) and, over time, the symptoms can become very serious. But in most cases, it is possible to control the course of the disease and prevent complications and damage to organs and systems.

This became possible thanks to drug treatment, exercise therapy and control by the attending physician. In addition to systemic lupus erythematosus (the most common), there are other types of lupus: discoid lupus, drug lupus, neonatal lupus and subacute cutaneous lupus.

The prognosis for people with systemic lupus erythematosus has improved significantly since adequate treatment has been available. Currently, almost 70% of patients have a chance to live 20 years or more after the initial diagnosis of the disease. The course of the disease is individual and it is difficult to predict periods of exacerbations. SLE usually develops slowly and sometimes a person does not notice symptoms for a long time.

Periods of exacerbation are sometimes called outbreaks or relapses. The periods following exacerbations are called periods of remission. In some cases, there is a rapid development of SLE. Relapses and remissions sometimes occur spontaneously, suddenly. And therefore, it is not possible to predict relapse, severity, duration of exacerbation. In addition, with a relapse, new symptoms may appear.

Children can also get lupus, although as a rule the disease develops in adolescence or in an older group. SLE in childhood is more severe than in adults and damage to organs and systems (kidneys and heart) often occurs. – due to the difference in metabolic rate and the degree of completeness of tissue differentiation. Some patients are forced to lead a less active lifestyle than healthy people due to the presence of fatigue, joint pain. In addition, the ability for aerobic physical activity (walking or swimming) is reduced, which is necessary for better blood oxygen saturation. Some patients experience the following complications of SLE:

• Pregnancy problems
• Kidney problems
• Heart problems
• Respiratory problems
• Hematopoietic systems
• Nervous system
• Mental disorders.

Most people with systemic lupus erythematosus continue their normal daily physical activity. But it is not uncommon to have to adjust the level of physical activity due to fatigue, joint pain or other symptoms, up to the complete cessation of activity.

Most patients with SLE can be predicted to have a normal or near-normal life expectancy. This depends on the presence of damage to vital organs (such as the kidneys) and the degree of impairment of their function. SLE usually does not cause damage or deformity of the joints, as happens with rheumatoid arthritis or other autoimmune disease. The medications used to treat moderate and severe SLE have a lot of side effects, and it is often difficult to understand whether the symptoms are caused by the disease itself or by the side effects of the drugs with long-term use of these drugs. In the recent past, the pathogenesis of SLE was not understood and patients often died in at a younger age, especially when complications appeared in the internal organs. At the present time, when pathogenetic treatment has appeared, the prognostic life expectancy has increased significantly. About 90% of patients live 5 years or more after diagnosis and almost 70% live 20 years or more.

Causes

Systemic lupus erythematosus (SLE) is an autoimmune disease, that is, the immune system aggressively reacts to its own tissues, perceiving them as foreign. SLE is not an infectious disease and is not contagious. So far, it has not been possible to find out why the immune system affects its own tissues. The genetic determinism of the immune system failure is partly assumed. But most scientists agree on the influence of a combination of factors that provoke an autoimmune reaction.

Excessive exposure to ultraviolet radiation (usually sunlight) triggers a process or exacerbation.

It is believed that estrogens also affect the possibility of lupus. This is due to the fact that women are more sick with SLE. And although hormone levels are highest during pregnancy, a significant proportion of women become ill after the age of 45, when estrogen levels are at their lowest.

Smoking increases the risk of SLE and worsens the prognosis of existing disease.

Some medications are considered SLE triggers.

Some infections are considered triggers of SLE. In some patients with cytomegalovirus, hepatitis C, parvovirus, systemic lupus erythematosus developed after some time. In children, such an infection is considered the Epstein-Barr virus.

Intoxication with various chemicals (eg trichlorethylene).

Risk factors :

• female
• race (blacks are more susceptible)
• ages 15 to 45
• presence of relatives with SLE
• taking drugs that provoke the appearance of SLE.

Symptoms

If you have SLE, you may have symptoms such as fatigue, skin rashes, or joint pain. If the disease is severe, then there are problems with the kidneys, lungs, heart, blood or nervous system.

The severity of symptoms depends on the affected organ and the extent of its damage.

Fatigue: Fatigue is common in all patients with systemic lupus erythematosus. Even with moderate SLE, patients are significantly reduced in their ability to perform normal physical activities. Fatigue is a classic symptom of SLE, as are rashes on the face (in the form of a butterfly).

Joint and muscle pain: Most patients have periods of joint pain (arthritis). Approximately 70% of patients had joint and muscle pain as the first symptom of the disease. This can manifest itself as swelling, hyperemia of the joints and stiffness in the morning. As a rule, with SLE, arthritis occurs on both sides and mainly in small joints (hands, wrists, ankles), sometimes in the knees.

Skin manifestations: Most patients present with skin rashes. The nature of the lesions is often the key to diagnosing SLE. In addition to rashes on the face, on the cheeks and the bridge of the nose (in the form of a butterfly), there may be red spots in the neck, on the head on the lips, arms, chest. The rash tends to flake.

Sensitivity to light: Exposure to ultraviolet radiation from sun exposure or tanning bed worsens skin manifestations and may cause flushing of the face. Sensitivity to light is greater in patients with fair skin ..

Nervous system disorders: Some patients have nervous system disorders, usually with headaches. It is not entirely clear whether headaches are a direct symptom of SLE or are associated with chronic stress and fatigue. However, memory or concentration disorders are not characteristic of SLE.

Cardiac disorders: Patients with SLE may have inflammation of the heart sac (pericarditis), which can cause sharp pain in the left side of the chest, radiating to the neck, shoulder, arm.

Lung disorders: Patients with SLE may have inflammation of the lung sac around the lungs (pleurisy), which can cause coughing and chest pain when breathing.

Psychiatric disorders : Patients with SLE may have disorders such as anxiety and depression. These disorders may be caused by lupus, drugs used to treat it, or associated with the chronic stress that accompanies the disease.

Fever (febrile): In most patients, subfebrile condition is noted for a long time and this is often the first symptom of the disease.

Changes in body weight: Most patients with active disease lose weight.

Hair loss: In SLE, there may be significant hair loss as skin rashes develop on the scalp.

Swollen lymph nodes: It is not uncommon for facial rashes to develop swollen lymph nodes.

Raynaud’s syndrome: Raynaud’s syndrome sometimes occurs in patients with SLE. This syndrome occurs as a result of narrowing of the capillaries of the fingers and toes. This is manifested by blanching or blue fingers (this is due to circulatory disorders) and they are cold to the touch.

Swelling in the hands and feet: Due to possible kidney damage, patients may have edema in the hands and feet due to impaired excretion of fluid from the body by damaged kidneys.

Anemia: Anemia is a decrease in the hemoglobin content of red blood cells. In addition, in patients with SLE, there is an inhibition of the hematopoietic germ and a decrease in the number of red blood cells.

Diagnosis

Sometimes the diagnosis of systemic lupus erythematosus is difficult and can take from several weeks to a year. SLE manifests itself in different ways in people and sometimes it takes a certain time until the symptoms characteristic of this disease appear. To diagnose the disease, a doctor needs a medical history, a physical examination and the identification of certain criteria for this disease. Criteria are necessary for differential diagnosis with other diseases. If 4 out of 11 criteria are present, we can talk about the presence of SLE. These signs may appear simultaneously or one after the other over time.

Criteria for systemic lupus erythematosus:

• Butterfly rash on the cheeks
• Eruption on the face, arms, neck, lower back (disc-shaped)
• Skin rash that appears after exposure to sunlight or ultraviolet light (photosensitivity).
• The presence of painless sores in the mouth or nasal cavity.
• Swelling, pain, stiffness of two or more joints (arthritis).
• Inflammation of the mucous membranes surrounding the lungs (pleurisy) or the heart (pericarditis).
• Abnormal urinalysis in the form of an increase in protein, erythrocytes or kidney cells (casts) in the urine.
• Nervous system disorders such as seizures or psychosis, without apparent cause.
• Blood disorders such as a decrease in the number of red blood cells, platelets or white blood cells.
• Laboratory tests showing high autoimmune activity.
• Presence of antibodies to the nucleus of cells

If there are clinical signs of SLE and a positive test for antinuclear antibodies, further testing is usually not required. But in some cases, if necessary, an additional examination may be prescribed.:

• blood tests for the presence of other antibodies
• dna analysis
• thorough urinalysis
• blood test for thromboplastin.

Identification of possible organ damage:

Urinalysis for cell protein can help detect kidney damage.

Kidney biopsy. This analysis can help identify inflammation of the kidney tissue and select the appropriate treatment. But as a rule, this method is prescribed quite rarely for SLE.

CT (Computed Tomography) and MRI (Magnetic Resonance Imaging) are prescribed to visualize organs that are secondarily affected by SLE.

Treatment

The main task of treatment is to prevent exacerbations, during which there is an increase in symptoms such as fatigue, joint pain, skin rashes. For this, it is necessary to systematically visit a doctor, and not only when an exacerbation occurs. During a relapse, the task of treatment is to stop the symptoms as quickly as possible and minimize possible damage to internal organs.

Treatment for moderate lupus includes:

Avoid exposure to sunlight. If you have to stay in the sun, then you need to protect the exposed areas of the body with clothes, and lubricate the face with a special sunscreen.