By: Ashley Holden

Lupus & You is a free educational series where people with lupus and their family and friends can learn more about the latest in lupus research and managing the disease.

Here’s a summary of the most commonly asked questions from our Lupus & You: Environmental Triggers and Flares Event. Speakers Karen H. Costenbader, MD, MPH and Diane Kamen, MD, MSCR explored how environmental exposures can play a role in lupus flares, shared the latest findings and provided tips for lifestyle changes and modifications to reduce disease activity.

If you missed the event, you can watch the video here: 

What is an environmental trigger?

While a person’s genes may increase the chance that they will develop lupus, it takes some kind of environmental trigger to set off the illness or to bring on a flare. The following are common environmental triggers:

• Ultraviolet rays from the sun or from fluorescent light bulbs
• Sulfa drugs, which make a person more sensitive to the sun, such as: Bactrim® and Septra® (trimethoprim-sulfamethoxazole); sulfisoxazole (Gantrisin®); tolbutamide (Orinase®); sulfasalazine (Azulfidine®); diuretics
• Sun-sensitizing tetracycline drugs such as minocycline (Minocin®)
• Penicillin or other antibiotic drugs such as: amoxicillin (Amoxil®); ampicillin (Ampicillin Sodium ADD-Vantage®); cloxacillin (Cloxapen®)
• An infection, a cold or a viral illness
• An injury, particularly traumatic injury
• Emotional stress, such as a divorce, illness, death in the family, or other life complications
• Anything that causes stress to the body, such as surgery, physical harm, pregnancy, or giving birth
• Exhaustion

It’s important to remember that lupus doesn’t have one clear origin. Researchers believe it comes from a complex equation of factors; most believe it’s a combination of genes, hormones and environment.
A lupus "flare" or "flare up" is when your lupus symptoms worsen and you feel ill as a result. Here’s a flare plan template that is designed for you to fill in with help from the doctor who is managing your lupus care and treatment. You can use the completed plan as a guide when you have a lupus flare. 

How can I plan for a flare? 

A lupus "flare" or "flare up" is when your lupus symptoms worsen and you feel ill as a result. Here’s a flare plan template that is designed for you to fill in with help from the doctor who is managing your lupus care and treatment. You can use the completed plan as a guide when you have a lupus flare. 

How can I limit my silica exposure?

The environmental exposure that has one of the best-studied connections with lupus is silica. Silica is a mineral that people can be exposed to in mining and glass production. Silica is all around us, and we likely have more exposure to silica than we think.

The problem seems to lie in the fine dust from rock or sand, or in products such as pottery, ceramics,quartz surfacing materials, or tile dust. Inhalation of silica is thought to have the most impact (in comparison to ingestion or on the skin). The lungs have an integral function with the immune system. For those that are genetically predisposed to lupus, inhalation can heighten your risks.

It’s important to focus on the environmental triggers that we can control, such as a healthy diet, staying physically active and getting adequate sleep. Try to avoid dusty trades/hobbies such as pottery, jewelry making, sand blasting, and any other hobbies that increase your exposure to the dust from rocks or sand. 

Does secondhand smoke have a similar effect as smoking? 

It’s clear that smoking complicates and accelerates the ill effects of lupus. It can also lower the effectiveness of medications used to treat lupus. In terms of secondhand smoke, researchers have examined data in the Nurses Health Study. Unfortunately, when looking at the data, most women who were exposed to smoking as a child also smoked.

We do know that there is no safe level of exposure to secondhand smoke and that those who are exposed to secondhand smoke, even for a short time, can suffer harmful effects. The good news is that the risks of exposure go down over time once you are no longer smoking or exposed to secondhand smoke. 

Are certain foods triggers?

You may see claims that certain foods like garlic can cause inflammation or that nightshade vegetables (potatoes, eggplant and peppers) and animal protein can make lupus worse, but there is no scientific evidence to support this.

Unless particular foods seem to trigger a lupus flare for you, there is no reason to avoid them. Foods that seem to trigger a flare vary greatly from person to person.  A food that causes problems for one person may have no effect on you. If you have lupus and notice an increase in your lupus symptoms after consuming certain foods, you should discuss it with your doctor.

In general, a low fat, low sugar, low junk food diet is best for you and will keep your heart, kidneys, liver, and other organs healthier. Avoid sugar-sweetened and artificially-sweetened sodas and concentrated sweets as much as possible.

For more information on this topic, listen to this episode of our podcast, The Expert Series, that addresses diet and lupus. 

What are epigenetics? Is it possible to turn off the lupus part of the gene once it's been activated through lifestyle?

Epigenetics refers to an area of scientific research that studies how environmental influences can affect the expression of genes. It's important to remember that while we inherit certain genes, we are also shaped by many environmental factors.

It is likely that doing things that are good for us (healthy lifestyle choices) and limiting harmful exposures could change the way the genes are expressed and limit inflammation. We can't currently switch genes on and off willingly, but our lifestyle choices may have some influence over them. There have been some animal studies looking at diet influencing epigenetics and lupus related gene expression. It’s an interesting topic but more studies are needed.

Is there a link between birth control and lupus?

Hormonal methods, like birth control pills, are very effective at preventing pregnancy. There are 2 main types of hormones used in birth control:

Progestin only: This type is typically safe for people with lupus 
Estrogen and progestin: People with lupus who have antibodies that predispose to clotting (anti-phospholipid antibodies) and people who have very active lupus are at higher risk of complications from estrogen-containing birth control.

Research studies suggest that birth control pills containing lower doses of estrogen may not cause lupus or make lupus worse in someone who has already been diagnosed. If you have well-controlled lupus, birth control pills with lower amounts of estrogen are generally safe without increasing the risk for lupus flares. Your rheumatologist and a special doctor called a gynecologist can help you find a method that’s safe and effective for you.

Does Medical Marijuana (cannabis) affect lupus flares?

Medical marijuana is not approved by the U.S. Food and Drug Administration (FDA) to treat lupus or any other condition. There’s a great deal that we don’t know about whether medical marijuana can help people with lupus. Research is just starting to study how it might help manage or treat lupus.

If you have lupus and are thinking about trying any alternative treatments or products – including medical marijuana – you should talk with your doctor first. Some of these products might not be safe, may interact with medications or could make symptoms worse. However, there are a growing number of studies that show that smoking marijuana is probably related to risk of lung disease and lung cancer just like smoking cigarettes are.

Are there any research studies or clinical trials for men that have lupus?

Participation in research studies is very important. Research study participants can play a more active role in their own health care, gain access to new research treatments before they are widely available and help others by contributing to medical research.

Lupus research studies need participation from people with different backgrounds,  including men! All clinical trials have guidelines about who can participate, and most trials and studies would be open to men.

Using inclusion/exclusion criteria is an important principle of research studies that helps to produce reliable results. The factors that allow someone to participate in a clinical trial are called "inclusion criteria" and those that prevent someone from participating are called "exclusion criteria". These criteria are based on such factors as age, gender, the type and stage of a disease, previous treatment history, and other medical conditions.

Help us diversify lupus research studies by enrolling in our patient registry, RAY: Research Accelerated by You. 

Can you provide more information about diet/nutrition, brain fog and fatigue? 

This is a great question! We encourage you to watch recordings from our past Lupus & You events. We’ve had highly-knowledgeable experts cover these topics in depth.  

You can also visit the National Resource Center for Lupus, for information on these topics.
 

The Lupus Foundation of America and our health education specialists have answered some of your most common questions. The provided answers are for educational and information purposes only. Consult with your doctor/health care team for medical advice.