Predicting a Lupus Flare – Can it be Done?

Headed towards a lupus flare? New research into predictive biological markers may hold the answer.

Lupus symptoms can come and go depending on the activity of the disease. When symptoms are light, or not present, lupus is in quiescence (or “remission”); when enough symptoms are present, it is called a lupus flare.

There are many ways to measure lupus activity, but the two most commonly used in research are:

1. Safety of Estrogen in Lupus Erythematosus National Assessment-Systemic Lupus Erythematosus Disease Activity Index
   • Also known as: SELENA-SLEDAI
   • Increase of 3-11 points indicates a moderate lupus flare
   • Increases greater than 12 points indicates a severe lupus flare
2. British Isles Lupus Assessment Group disease activity index (BILAG)

These scales both attempt to define a lupus flare as a result of specific symptoms. Because it is difficult to predict a lupus flare, many research studies look at the medical history of participants along with a measure of disease activity to determine if a person is experiencing a flare.

Looking for tips & tricks for managing a flare? Check out insights from 3 top lupus bloggers!

Do certain symptoms seem to come on before you go into a full-on lupus flare? Share your experiences and learn from other Lupus Warriors. Click below!

Predicting a flare – sticking to the treatment plan

Your lupus treatment team has worked to put together a treatment plan that keeps lupus symptoms at bay. A major part of this is taking medications as prescribed.

Anti-malarial drugs, such as Plaquenil, are particularly important when it comes to managing lupus flares. Some days, it can seem like the side effects and complicated dosing instructions for medications are more trouble than they are worth. But, according the John’s Hopkins Lupus Center, anti-malarial medications “may help reduce flares by as much as 50%.”

In addition to sticking to your treatment plan, it is important to track your symptoms. A 2013 study conducted by Dr. Michelle A. Petri of Johns Hopkins found that kidney involvement (renal problems) was linked to a doubling of the 1-year risk of having a lupus flare.

There is also empirical evidence suggesting that the following strategies can help minimize flares:

• Avoiding ultraviolet (UV) light
• Managing stress and anxiety
• Eating a healthy diet
• Exercising
• Getting enough physical and emotional rest

Advanced predictors of a lupus flare

New research is exploring “biomarkers” as a potential indicator for lupus flares. A biomarker is something that can be measured or identified in a person (or other organism) that indicates the presence of a disease or infection.

Some examples of biomarkers that have been explored for a connection to lupus flares includes:

• Anti-double-stranded DNA antibodies (anti-dsDNA)
• Complement or complement split products (examples include: C3, C4, & CH50)
• Anti-C1q antibodies
• Anti-nuclear antibodies (examples include: Anti-Sm ab, ANA)
• Cytokines or chemokines (examples include: BAFF/BLyS, IL-2R)

A review published in October 2017 looked into 69 studies previously conducted on flare biomarkers. Despite many studies having positive results across a number of biomarkers, the researchers concluded that, “none of the newly studied biomarkers stood out,” and that “none of these biological markers is completely reliable in diagnosing exacerbations.”

The researchers acknowledge many of the challenges in comparing these studies, including the lack of data standardization. There was hope in the review that some of the antibodies researched could be useful following additional study.

Unfortunately, at this time, there is no gold standard for predicting or identifying a symptom flare. But, biologic research of this type is quite promising.