Pain that flares up at any time in your chest, joints and muscles. Rash over cheeks. Feeling tired most of the time and loss of appetite. This is what lupus patients can experience during a flare-up.

You might be curious to find out what lupus disease is, and how to recognise this condition. Let’s go through some definitions first.

Lupus is an autoimmune disease that can cause inflammation on any several parts of your body. An autoimmune disease happens when your immune system has problemsis altered and that that causes it to attack the body’s healthy cells. Inflammation of the affected organ could result in pain, swelling or a variety of other symptoms.

Symptoms of lupus include:

• Hair loss,
• Rash over sun-exposed areas such as cheeks and nose,
• Sores in the mouth,
• High blood pressure with leg swelling,
• Decreased kidney function,
• Chest pain and trouble breathing,
• Bruise easily,
• Joint pain and stiffness or have
• Inadequate red blood cells 

Living with lupus is challenging because of the pain and fatigue during flare-ups, but many people with lupus still lead fulfilling lives. Treating lupus involves taking medication to make flare-ups more manageable, lifestyle changes and a strong social support network.

The 4 common types of lupus are: 

1. Systemic lupus erythematosus (SLE), which can cause inflammation in several organs at the same time
2. Cutaneous lupus erythematosus (including discoid lupus) that causes scaly rashes.
3. Drug-induced lupus erythematosus (caused by drugs).
4. Neonatal lupus: lupus in babies born to mothers with SLE

Lupus flare-ups can happen at any time. You might be going about your day like what you do normally and yet develop lupus symptoms like chest and joint pain.

But how does a person get lupus? As mentioned earlier, it could be due to a combination of factors such as genetic makeup, hormonal regulation and environmental exposures.

Avoiding some of these common environmental triggers could help to manage some of the symptoms of lupus.

1) Minimise UV light exposure

Many people with lupus are photosensitive (sensitive to light) to UV light from natural and artificial sources, like the sun or UV light lamps.

UV light exposure can trigger lupus symptoms like a butterfly rash or malar rash, stiffness (hard to move limbs) and joint pain.

The most common way you’ll get exposed to UV light is through direct sunlight. Here’s how you can reduce your exposure:

●        Avoid direct Sunlight

Try to avoid direct exposure to the sun when the sun is at its brightest, between 11 am to 3 pm. That’s also when the UV rays are the strongest.

Even staying for a short while under direct UV light can trigger lupus symptoms in some patients. Therefore, it is advisable to avoid direct exposure to the sun during the brightest time of the day.

Whether you’re just crossing the road or going out to buy lunch or doing exercise, protect your sun exposed skin with sunscreen, cover up with clothing, carry an umbrella or wear wide-brimming hats or hats with neck protection.

●        Wear sun-protective clothing

If you need to go outside for a longer time (like for exercise), wear long-sleeved shirts, long pants, a wide-brim cap or hat and sunglasses outside.

Also, apply broad spectrum sunscreen (at least SPF50) on your exposed skin (usually it’s the face, neck, and back of your hands and arms) and carry an umbrella. Reapply sunscreen every 2 hours when outdoors and every 4 to 6 hours when indoors.

Some kinds of clothing have sun-protective features that provide extra protection from UV light. These are usually sports clothing for exercise or outdoor activity.

How do you choose sun-protective clothing? Here are some tips:

1. Tight-weave clothing like denim (jeans) and cotton shirts provide greater sun protection. Tight-weave clothing tends to be more stiff and rigid.
   
   
2. Wear broad-brimmed hats with an all-around brim of at least 7 to 10 cm or a hat with neck flap.
   
   
3. Use sun-protective gloves (like sports gloves for cycling) to protect small patches of exposed skin.
   
   
4. You can buy clothes and hats made of UV-protective clothing from most sports shops. Look for the UPF (ultraviolet protection factor) label. The higher the number, the better the UV protection.
   
   
5. Choose sunglasses with 100% UVA/UVB blocking to protect your eyelids.
   
   
6. Choose the right size when buying stretchy sports clothing like yoga pants. If you choose clothes that are too small, you might need to stretch them more when wearing them. But did you know that stretching fabrics actually lowers their UPF ability?
   
   
7. Sunscreen alone may not protect your skin from very strong sunlight. Carry an anti-UV umbrella with a UPF range of at least 30.

●     Observe indoor UV protection

Protecting yourself with UV protection like clothes, umbrellas and sunblock is one thing, but how do you protect your indoor living space from UV light?

Consider installing blinds, sunshades and tinted window film in your car and house. You can apply UV-protective tinted window film to make your windows darker - it prevents UV light from getting in while still letting you see clearly through the glass.

2) Quit smoking

Smoking does a lot of damage to your body and is generally bad for the health of people with lupus:

●  Smoking can increase risk of certain respiratory infections and people with lupus are more susceptible to infections in general.

●   People with lupus are at risk of heart disease and stroke, and smoking can exacerbate the risk of heart disease and stroke as well.

●   People with lupus can develop kidney disease. Smoking contributes to high blood pressure which worsens kidney disease.

Quit smoking (if you don’t smoke, don’t start). Here are some things you can do to help yourself quit:

●    Chew on candy or mints when you get the craving to smoke.

●    Throw away cigarettes, ashtrays and anything that reminds you of smoking (you can even ask a family member to hide or throw them away for you).

●    Set a goal for when you’re going to quit, like a date or month.

●    Find out what your smoking triggers are, so you can avoid them.

●    Distract yourself with a healthier habit instead of smoking - it can be anything, from picking up a new hobby to exercising. (10)

Quitting smoking is hard, and sometimes you may need a medical professional to help you. You can see a doctor for nicotine replacement therapy, counselling, or other alternatives - just book an appointment with a counsellor at SGH’s Smoking Cessation Clinic.

3) Observe hygiene and cleanliness

●        Wash your hands

Practising good personal hygiene can avoid many infections.

So, keep yourself healthy and avoid infections by wash your hands after using the toilet and before eating. 

●        Keep your house clean

A dirty living environment can expose you to more bacteria and viruses, so clean your house regularly.

Replace any cleaning tools that are old and soiled, like kitchen sponges, rags and mops. They can breed bacteria if used for too long.

●        Go for vaccinations

Vaccinations help prevent infections. You can ask your polyclinic or family GP for vaccinations against influenza, pneumococcus and shingles to prevent infections and serious diseases.

If you have not had previous hepatitis B vaccination, this should be considered as well.

●        Treat injuries quickly

A cut or scrape may not be painful, but any open wound is a chance for bacteria to get in and potentially infect you.

Clean wounds with a saline solution (you can get these from a pharmacy) and cover with dressing (plaster). Don’t use homemade salt solution or iodine. 

If your injury is serious (e.g. prolonged bleeding) or covers a large part of your skin, it is advisable to visit a general practitioner to examine the wound.

●        Limit exposure to toxic chemicals

Toxic chemicals and substances include mercury, pesticides (weed killer) or silica dust. Silica dust may be one of the risk factors for triggering lupus.

What is silica dust? It’s a fine particle that can be carried in the air. Silica dust exposure can come from glass production, pottery, ceramics, tile dust, rocks and sand. 

For those of you who work in offices, F&B and retail, you usually won’t be exposed to silica dust daily.

But if you work in industrial manufacturing (factories or studios where there’s a lot of sand blasting or glass production), take these precautions to prevent excessive silica dust exposure:

●    Your employer should provide you with respirators (breathing equipment to filter out harmful particles) and protective attire. Always wear these while you are working, for your safety.

●     Don’t eat, drink or rest in dusty areas.

●     Shower, change and wash your clothes right after getting home, as you might bring silica dust into your house.

●     Wash your hands and face before eating at your workplace.

4) Exercise regularly

Lupus causes joint and muscle pain, so exercise regularly to keep your joints, bones and muscles in good condition. 

●        Light or low impact exercises

Light and low impact exercises like walking, cycling, swimming, certain types of yoga and tai chi can strengthen muscle and bones without aggravating joint pain.

Aim for at least 150 minutes of aerobic activity in a week.

●        Don’t exercise under direct sunlight

Don’t exercise under direct sunlight. Go to indoor gyms, indoor swimming pools, or covered sports courts where you are not directly exposed to UV rays.

You can exercise outside early in the morning or evening when the sunlight isn’t so strong.

●        High-impact exercise

If you have not exercised for some time, starting off with high impact exercises such as basketball and soccer can put stress on your joints. This can result in joint pain and inflammation. It is better to speak to your doctor to find out the intensity of exercise suitable for you.

5) Get sufficient and good sleep

●        Get enough sleep

A study suggested that chronic low sleep duration (≤5 hours a night) was associated with higher SLE risk. Get enough rest and sleep at least 7-8 hours at night.

●      Managing stress in people with lupus

     Stress can make lupus symptoms feel worse. Taking steps to manage stress may help to reduce the severity of some symptoms such as joint pain and fatigue.

If you are struggling with poor mental health, or if it’s affecting your daily activities, join a support group or seek professional help. Speaking to others who face similar problems can help you find ways to manage stress better.

●        Create a bedtime routine

You might find it hard to sleep when you’re stressed or busy with work and other commitments. It could be because you haven’t let your body wind down and prepare for sleep yet. Try setting up a bedtime routine that can help you sleep faster and better.

For some people, reading a book, having a warm bath, and dimming the lights half an hour before bedtime helps them fall asleep faster.

●        Plan in advance

Having anxiety over missed deadlines or a long to-do list? Plan your day to avoid stressing out. You can set early reminders for tasks and errands on your phone.

6) See a healthcare provider early

●        Talk to your healthcare provider

What are some early warning signs? Talk to your doctor if you experience: 

●        Persistent joint pain or joint swelling or joint stiffness

●        A butterfly shaped rash on your face

●        Hair loss

●        Sores in the mouth

●        Swelling in the feet or around the face

●        Unexplained and persistent fevers

●        Chest pain when breathing deeply

●        Extreme fatigue

Your healthcare provider may recognise these symptoms and suggest appropriate blood and urine tests to check carefully. As lupus shares a lot of symptoms with other diseases, it is important to talk to your healthcare provider to find out whether you have lupus or different health problem.

You could visit your nearby polyclinic doctor first, and if required, a referral to a rheumatologist may be arranged later on.

7) Adopt a healthy, balanced diet

What foods make lupus worse?
There is no specific type of food that causes lupus. But some foods have compounds (chemicals) that can make your immune system more active and increase inflammation.

Avoid:

●        Alfalfa sprouts

●        Alcohol

●        Excessive salt

●        Food containing saturated and trans fats

Eat a variety of healthy foods:

●     Try to make half your plate fruits and vegetables at each meal.

●     Choose whole grains like whole wheat bread or pasta, brown rice – fill quarter plate with whole grains.

●     Fill quarter plate with healthy protein such as lean meat, poultry, fish with omega-3 fatty acids (such as salmon, sardines and mackeral) and eggs.

●     Choose healthy fats such as olive oil, avocados and nuts.

Let’s look at some frequently asked questions about causes of lupus. causes and whether it’s contagious.

●  Is lupus caused by lifestyle? 

Medical experts aren’t sure what causessay that lupuslifestyle behaviours do not singly and directly cause lupus since it’s an autoimmune disorder.

Remember what we mentioned earlier? Autoimmune disorders happen when there’s alteration with your immune system. There is no one single cause that can directly cause the alteration of the immune system but could be a result of several contributing reasons over time. Reasons can include genetic makeup, hormonal regulation and environmental exposures.

Environmental factors like silica dust and UV light exposure and infections are common triggers for lupus.

This doesn’t necessarily mean that silica dust and UV light are the only cause of lupus. It means that there is a trend of patients developing lupus after being exposed to these environmental factors.

●  Is lupus fatal?

Lupus cannot be completely cured till date. However, most people with lupus live fulfillingl lives like those without the condition.

Lupus can range from mild to life-threatening. In veryt’s rare cases,  for lupus canto cause death. When it does happen, it’s usually because lupus affected vital body parts like the heart, lungs and kidney failures or serious infections.

For example, lupus increases the risk of cardiovascular disease or “heart disease”, which can cause death among people with lupus. 

The leading causes of death in lupus patients areis heart disease, kidney failure and serious infection.

●   Is lupus contagious? 

No. Lupus cannot be spread from person to person. A person cannot catch the condition from another patient or “spread” the condition to another person.

Lupus develops due to a series of factors such as genetic makeup, hormonal regulation and environmental exposures.

Having lupus can make activities in daily challenging. Joint stiffness, pain, fatigue can make simple tasks hard to complete.

Having time for yourself to focus on your body is important. Take time to do activities that you enjoy.

Having the support of family members and making adjustments together helps to take away the stress of coping with the condition. Good communication among family members is important.

Managing work and school when a person has lupus can become demanding. Find the support that you need with a trusted colleague or mentor from school.

Support groups can help people with lupus to engage with other people affected by lupus and learn tips for coping. Remember: Lupus does not define you.