COVID-19 and Lupus

• Individuals with lupus face a higher risk of developing severe COVID-19. 
• To reduce the risk of severe COVID-19, people with lupus should follow enhanced preventive measures.
• Avoiding triggers such as stress, sunlight, and certain medications can help prevent lupus flare-ups and potential complications.
• If you test positive for COVID-19 with lupus, contact your healthcare team to ensure appropriate management and monitoring. 

The COVID-19 pandemic has profoundly impacted global health, with certain populations experiencing more severe symptoms and complications than others. Individuals with pre-existing medical conditions, such as lupus, face a higher risk of developing severe COVID-19. 

This article explores the link between severe COVID-19 and lupus, highlighting how lupus can weaken the immune system and make individuals more susceptible to severe COVID-19.

Lupus, also known as systemic lupus erythematosus (SLE), is a chronic autoimmune disease that can affect various organs and systems in the body. It occurs when the immune system mistakenly attacks healthy tissues, leading to inflammation and damage. Lupus can affect anyone, but it’s more common in women of childbearing age. Its symptoms can vary widely, including joint pain, fatigue, skin rashes, and organs like your heart or kidneys. 1

Several factors contribute to the increased severity of COVID-19 in individuals with lupus: 2

• Immune dysfunction. Lupus causes an imbalance in the immune system, leading to an overactive immune response. This hyperactive immune state can result in a heightened inflammatory response when confronted with a viral infection such as COVID-19.
• Use of immunosuppressant agents. Many lupus patients require immunosuppressant medications to manage their symptoms. These drugs, such as corticosteroids, antimalarials, and immunomodulators, can weaken the immune system, making it harder for the body to fight off infections, including COVID-19.
• Impairment from prior disease activity. Lupus is characterized by periods of disease flare-ups and remissions. Flares are associated with increased disease activity, including inflammation and organ damage. If an individual with lupus experiences a flare-up at the time of COVID-19 infection, it can lead to more severe symptoms and complications.
• Presence of comorbidities. Individuals with lupus often have other comorbid conditions, such as kidney disease, cardiovascular disease, and respiratory issues, which can increase the risk of severe illness if they contract COVID-19.
• Overexpression of Angiotensin-Converting Enzyme Two (ACE2) receptor. The ACE2 receptor is the primary entry point for the SARS-CoV-2 virus, which causes COVID-19. Studies suggest that individuals with lupus may have an overexpression of ACE2 receptors, potentially facilitating the virus's entry into cells and increasing the likelihood of severe illness. 3

To reduce your risk of contracting severe COVID-19, individuals with lupus should follow enhanced preventive measures: 4

• Vaccination. Stay updated on COVID-19 vaccination recommendations and guidelines. COVID-19 vaccines have been shown to reduce the risk of severe illness and hospitalization.
• Hygiene practices. Practice good hand hygiene, including regular handwashing with soap and water or using hand sanitizers with at least 60% alcohol. Avoid touching your face, especially your eyes, nose, and mouth.
• Physical distancing. Maintain a safe distance from individuals who are sick or showing COVID-19 symptoms. Limit close contact with others, especially in crowded places or poorly ventilated areas.
• Double masking. To better protect yourself against new variants of the disease, it’s recommended to double mask. The CDC advises wearing a disposable mask underneath a cloth mask to improve the fit and filtration.

In addition, you want to avoid any triggers that may set off a potential flare. Some common triggers to avoid include: 5 6

• Physical or emotional stress. High levels of stress can exacerbate lupus symptoms. Find healthy coping mechanisms and practice stress management techniques to reduce the impact of stress on your condition.
• Sunlight. Sunlight and ultraviolet (UV) rays can trigger lupus flare-ups and skin rashes. Limit your exposure to sunlight, especially during peak hours, and wear protective clothing and sunscreen when outside.
• Certain drugs. Some medications, such as certain antibiotics or sulfa drugs, can potentially trigger lupus symptoms or worsen existing ones. Discuss all medications, including over-the-counter medicines and supplements, with your doctor to ensure they’re safe for you to use.
• Discontinuing your lupus medications. People may have difficulty sticking to their medication regimen for various reasons, especially if their routine is disrupted. It's essential to commit to your medication regime to keep your lupus symptoms at bay.

You should work closely with your doctor to develop a comprehensive lupus flare plan. This plan will outline steps to take in case of a lupus flare-up, including adjusting medications, seeking medical attention, and managing symptoms. Regular communication with your healthcare team will help ensure you are prepared and equipped to handle potential flare-ups and a positive COVID-19 diagnosis.

If you have lupus and test positive for COVID-19, take immediate action to reduce your risk of developing severe COVID-19. 7

• Contact your doctor. Inform your healthcare provider about your positive test result and your lupus diagnosis. They’ll guide you in monitoring your symptoms and adjusting your medication regimen if necessary.
• Self-isolate and monitor symptoms. Follow the recommended guidelines for self-isolation and monitor your symptoms closely. Seek medical attention if you experience difficulty breathing, persistent chest pain, confusion, pale or blue to gray-tinted skin, lips or nails, or any other severe symptoms.
• Maintain communication with your healthcare team: Stay in regular contact with your healthcare team throughout your COVID-19 illness. They can help manage your lupus medications, monitor your symptoms, and guide you on when it’s safe to discontinue isolation.

The link between severe COVID-19 and lupus stems from immune dysfunction, the use of immunosuppressant agents, impairment from prior disease activity, comorbidities, and overexpression of ACE2 receptors. If you have lupus and test positive for COVID-19, promptly contact your healthcare provider, self-isolate, and closely monitor symptoms. To reduce the risk of contracting COVID-19, individuals with lupus should follow preventive measures such as vaccination, good hygiene practices, physical distancing, and mask-wearing. 

By staying informed and taking necessary precautions, individuals with lupus can better protect themselves during the ongoing pandemic.

Q: Can COVID-19 trigger lupus?
A: One study found a link between lupus and the development of post-COVID. However, more research is needed to determine if COVID-19 is a risk factor for developing lupus.

Q: Why is the coronavirus more dangerous to people with lupus?
A: The coronavirus is more dangerous for people with lupus due to their weakened immune system, making it harder for their body to fight off infections. Additionally, using immunosuppressant medications to manage lupus can further compromise their ability to combat the virus, and underlying health conditions associated with lupus can increase the risk of complications from COVID-19.

Q: Is COVID-19 worse if you have autoimmune disease?
A: Yes, COVID-19 can be worse for individuals with autoimmune diseases. Autoimmune diseases occur when the immune system mistakenly attacks healthy cells and tissues in the body. This dysregulated immune response can lead to chronic inflammation and can weaken the immune system, making it more challenging for individuals to fight off infections like COVID-19. Additionally, some autoimmune diseases require medications that suppress the immune system further, increasing the risk of severe illness from COVID-19. 

Q: How do COVID-19 vaccines affect people with lupus?
A: COVID-19 vaccines are generally safe and effective for individuals with lupus. Vaccination can provide important protection against severe illness from COVID-19. However, it’s recommended that individuals with lupus consult with their healthcare providers for personalized advice and guidance on timing and suitability based on their specific circumstances