How Lupus Affects the Aging Process

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Lupus (systemic lupus erythematosus or SLE) and aging can affect each other. Lupus can influence the normal aging process and the normal aging process can impact your symptoms and quality of life with lupus. What should you know?

Lupus and Aging

You probably know that lupus is a life-long illness, and you know how you feel today. But how will the disease treat you as you grow older?

Let's take a look at some of the most important ways in which aging may affect and change your symptoms of lupus, and how lupus impacts the normal aging process. We will begin by discussing some of the problems you may face as you get older with lupus, but will also discuss some of the positive aspects of aging with the disease. Getting older with lupus is not all negative.

Problems Associated With Lupus and Aging

It makes sense that lupus and aging may affect each other. After all, there are immunological similarities between lupus and aging at the clinical, cellular, and molecular level. Features such as an increased risk of infection and an increased incidence of tumors are common to both lupus and aging. But how do these features translate into real life? What might you expect as you age with lupus?

Symptom Severity May Worsen With Age

Many people are relieved to hear that lupus-related symptom activity 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 due to pain but due to an increased risk of side effects related to pain treatments. Non-steroidal anti-inflammatory medications such as Advil (ibuprofen) are more likely to cause kidney dysfunction or gastrointestinal bleeding, and Tylenol (acetaminophen), when it even helps, may not be the best choice if you have abnormal liver function. What may have been controllable when you were younger with a single pain-related treatment may now require multiple modalities.

Fatigue can also be progressive, as sedentary behavior related to the accumulation of lupus damage aggravates fatigue already present.

Damage Related to Lupus Over the Years

Damage accumulates over the years and can lead to the destruction of joints 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 surgery or orthopedic surgery can add further clinic visits, pain, and costs onto your already full schedule of caring for yourself with lupus.

Osteoporosis Is Common

With age, progressive bone loss may result in osteopenia or osteoporosis. There is an increased risk of osteoporosis with lupus 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). Bone loss has been seen in some people after only one week of steroid use. 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 has other health benefits for people with lupus as well. If your doctor hasn't drawn your vitamin D level, ask for it. Sources of vitamin D include sunlight and some foods, but for low levels (or low normal levels) vitamin D3 supplementation may be recommended. Medications for bone loss are also available, and in addition to increasing bone density, can also help lower your risk of fractures. Due to the elevated risk of fractures with lupus, some doctors may recommend using medications if you have osteopenia as well as osteoporosis.

Hormone Replacement Therapy May Raise Health Risks

Hormone replacement therapy (HRT) has fallen into disfavor in recent years due to an increased risk of breast cancer and cardiovascular disease. 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 doctors. 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 women is different, and all of these factors must be carefully weighed in making your decision about hormone replacement therapy. Keep in mind that there are alternative methods of managing hot flashes that may be very effective for some people. Since women who have had breast cancer (or are at high risk) should not use HRT, there has been a lot of research on physical measures as well as herbal and pharmaceutical medications designed to reduce menopausal symptoms.

Positive Associations

We tend to focus on the negative aspects of aging as well as how aging negatively affects chronic medical conditions. The truth, however, is that there are positive aspects to aging with the disease as well and sometimes focusing on these things—the so-called silver linings—makes coping a bit easier. After all, we are learning that gratitude in life is associated with happiness and well-being far more than success, wealth, or even health.

  • Symptom Activity Tends to Improve With Age: As a person ages, lupus activity—or the degree of inflammation and auto-immunity present—typically declines. This may lead to adjustments in treatment, including a possible reduction in medication. 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 involve more than taking your medications. Even without lupus, people tend to age better when attention is paid to lifestyle issues such as diet and exercise. Taking some time to review your lifestyle and make any needed changes is well worth the effort.

For starters, and if you haven't thought specifically about your diet and lupus, learn how to eat properly with lupus. A diet rich in fruits and vegetables and low in pro-inflammatory foods is a good choice. You may also wish to add anti-inflammatory foods to your diet. While there are no specific foods that have been shown to alter the course of lupus, the spice turmeric (curcumin) seems to have a protective effect against lupus nephritis—at least in mice.

Stress not only leaves us feeling "stressed out" but causes the release of stress hormones which can have negative effects on many parts of the body. There are many simple stress management techniques that are beneficial whether you're living with lupus or not.

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

Some people with lupus find that as they age they finally have time to pursue a lupus support group. These groups can be a wonderful source of support while at the same time giving you access to the latest findings in lupus research. After all, nobody is as motivated to learn about new treatments and thoughts than those living with the disease every day. If you are uncertain about where to start, take a moment to learn about how to find a lupus support group, either in your community or online anywhere.

A Word From Verywell

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

The risk of fractures related to osteoporosis is much higher among people with lupus than the general population, and everyone should have a bone density scan performed at some time before they reach the age of 65 (and much sooner for some people). If you develop bone loss, there are medications available that can reduce fracture risk. That said, 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, as with people of any age with lupus, prolonged remission can sometimes be achieved, even in the elderly.

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