How Lupus Affects the Aging Process

Lupus (systemic lupus erythematosus or SLE) can influence your normal aging process, and your normal aging process likewise can have an effect on your lupus symptoms and your quality of life. What should you know?

You probably know that lupus is a lifelong illness, and you know how you feel today. But how will the disease treat you as you grow older? Let's take a look not only at some of the problems you may face as you get older with lupus, but at some of the positive aspects of aging with the disease. Aging with lupus is not all negative.

Symptom Severity May Worsen With Age

Many people are relieved to hear that lupus-related symptoms may improve with age, but we've learned that the severity of the symptoms may increase. Part of the reason behind this is that as you get older you not only have to cope with your symptoms but must also cope with the sum of your disease activity in the past and the damage it has caused.

Chronic pain can be a challenging condition not only because of the pain itself, but also because of an increased risk of side effects related to pain treatments. Nonsteroidal anti-inflammatory (NSAID) medications such as Advil (ibuprofen) may cause kidney dysfunction or gastrointestinal bleeding, and Tylenol (acetaminophen), when it helps, may not be the best choice if you have abnormal liver function. The kind of pain that may have been controllable with a single pain-related treatment when you were younger may now require multiple treatments.

Fatigue can also be progressive—and sedentary behavior related to the accumulation of lupus damage aggravates fatigue that is already present.

Lupus-Related Damage Over Time

Physiological damage from lupus accumulates over time, and it can lead to joint destruction and chronic pain. You may need physical therapy to deal with stiffness, or joint replacements to cope with eroded cartilage in your knees or hips. Physical therapy or orthopedic surgery mean additional clinic visits, more pain, and higher healthcare costs.

Osteoporosis Is Common

With age, progressive bone loss may result in osteopenia or osteoporosis. Having lupus puts you at an increased risk of osteoporosis, for several reasons. One of these is that some of the medications for lupus, such as corticosteroids (for example, prednisone) can rapidly accelerate bone loss (glucocorticoid-induced osteoporosis). The sedentary lifestyle that living with lupus often demands also raises the risk. Finally, there appears to be a direct link between lupus and bone loss.

Fractures due to bone loss are more common with lupus, especially spinal (vertebral) fractures. In fact, women with lupus may be up to five times more likely to experience an osteoporosis-related fracture than those without the disease. The risk for men with lupus is elevated as well.

Whether you develop osteoporosis depends on many factors, and your weight, genetics, and whether or not you smoked all play a role. A bone density test is recommended for all women over the age of 65, and earlier in life if risk factors—such as lupus—are present.

Fortunately, there are ways to reduce your risk. Making sure you get adequate vitamin D is helpful and carries other health benefits as well for people with lupus. If your healthcare provider hasn't checked your vitamin D level, ask for it to be done. Sources of vitamin D include sunlight and some foods, but for low levels or low-normal levels, a vitamin D3 supplement may be recommended. Medications for bone loss, in addition to increasing bone density, can also help lower your risk of fractures. Because you have a higher risk of fractures if you have lupus, your healthcare provider may recommend using medications not only if you have osteoporosis, but if you are diagnosed with osteopenia (reduced bone mass which may develop into osteoporosis).

Hormone Replacement Therapy May Raise Health Risks

Hormone replacement therapy (HRT) has a controversial history because of its presumed connections to breast cancer and cardiovascular disease risks. That said, there are still many women who take these medications with estrogen plus or minus progesterone.

Postmenopausal women with lupus who are considering HRT should discuss the benefits and risks with their healthcare providers. In studies, HRT has been associated with an increased risk of mild to moderate lupus flares, but no increase in severe flares. On the other hand, some women find that HRT significantly improves their menopausal symptoms and improves quality of life.

An important consideration is that women with lupus have an increased risk of cardiovascular disease and blood clots, and HRT may further increase that risk.

Each woman is different, and you must weigh all of these factors in making your decision about hormone replacement therapy. If you are interested in alternative methods of managing hot flashes and other menopausal symptoms, proceed with care and educate yourself: More research is needed to determine the overall safety and effectiveness of herbal and over-the-counter remedies. Women who have had breast cancer (or are at high risk) should not use HRT, but they should also avoid supplements containing soy and isoflavones, which affect the body's estrogen levels and may be harmful.

The Brighter Side

We tend to focus on the negative aspects of aging and how it negatively affects chronic medical conditions. The truth, however, is that there is positive news about aging with lupus, and sometimes focusing on these aspects—the so-called silver lining—makes coping a bit easier.

• Symptom Activity Tends to Improve with Age: As a person ages, lupus activity—or the degree of inflammation and autoimmune response present—typically declines. This may lead to adjustments in treatment, which may include reducing the amount of medication you take. This improvement is fairly consistent over time and appears to be unaffected by menopausal status.
• Older People Are Less Likely to Develop Lupus Nephritis: When lupus affects the kidneys, it is referred to as lupus nephritis. Some studies have found that older people are less likely to suffer from kidney diseases associated with lupus, though we don't entirely know why. Other studies, however, suggest that the severity of lupus nephritis may worsen with age. For those who do encounter kidney issues, at any age, the treatment is the same.
• Lupus Can Go Into Remission at Any Age: Lupus remission can occur at any age. An Italian study published in 2015 found that 37 percent of people with lupus who got standard treatment went into remission for at least five years. There is not yet a clear definition of remission in lupus, but in this study, those considered to have prolonged remission had no clinical or laboratory signs of the disease and were no longer taking either corticosteroids or immunosuppressant medications.

Taking Care of Yourself with Lupus as You Age

Living with lupus and feeling as good as you can involves more than simply taking your medications. Even without lupus, people tend to age better when they maintain a healthy diet and get regular exercise. It's well worth the effort to take time to review your life and make any needed changes to keep yourself as healthy as you can be.

For starters—and if you haven't thought specifically about your diet and lupus—find out how to eat in a way that decreases your lupus symptoms. Lupus is a systemic disease, so a diet rich in fruits and vegetables and low in pro-inflammatory foods is a good choice. No specific foods have been shown to alter the course of lupus; however, two foods to avoid are garlic and alfalfa sprouts. Scientists believe that three substancs in garlic—allicin, ajoene, and thiosulfinates—increase immune system activity, which may cause flare-ups; and alfalfa sprouts contain an amino acid called L-canavanine that may have a similar effect.

Stress can cause the release of so-called stress hormones that can negatively affect your health. Ask your healthcare provider or conduct some research on the many simple stress management techniques that can benefit you whether or not you're living with lupus.

Falls are a leading cause of injury and death as people age, and we already know that people with lupus are more likely overall to fracture a bone (especially the spine and hips) when they fall. Preventive measures such as eliminating throw rugs, keeping items off the stairs, avoiding icy sidewalks, and turning on the lights when you get up to go to the bathroom at night may all reduce your risk. Take a moment to review measures you can take to reduce your risk of slips and falls.

Of course, regular healthcare visits are important to manage any of your potential risk factors. Since the risk of heart disease is increased with lupus, your healthcare provider may pay special attention to risk factors such as high blood pressure, increased cholesterol, and insulin resistance or diabetes. Certain types of cancer are more common in people with lupus, and since cancer risk increases with age, it's important to follow guidelines for early detection.

Some people with lupus find that as they age, they have more time to get involved in a lupus support group. These groups not only provide a wonderful source of support, but they can also help you access the latest lupus research. After all, nobody is as motivated to learn about new treatments and ideas than those living with the disease. If you are uncertain about where to start, check your local hospitals, or go online to sites such as Lupus Foundation of America or Lupus Research Alliance.

A Word From Verywell

Lupus and aging are associated in several ways, and understanding these issues allows you to be your own advocate in health and medical care. With age, symptom activity with lupus often declines, but symptoms you already have may grow more severe. The accumulation of damage over years may result in the need for joint replacements or other treatments.

The risk of osteoporosis-related fractures is much higher among people with lupus than in the general population. Whether or not you live with lupus, you should have a bone density scan performed some time before age 65—much sooner if your healthcare provider thinks it's warranted. Several medications can reduce fracture risk if you do develop bone loss. Practicing caution and thinking about fall prevention is probably equally helpful.

Along with a reduction in symptom activity, the risk of lupus nephritis may decline with age. And people of any age with lupus can achieve prolonged remission.