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Lupus (SLE)

Lupus is a long-term autoimmune disease in which the immune system attacks the body’s own tissues, from the joints and skin to the kidneys, heart, lungs, blood and brain. About 9 in 10 people with it are women. There is no cure, but treatment can control it, and most people with lupus can live normal lives.

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What is lupus?

Systemic lupus erythematosus (SLE), usually just called lupus, is a long-term autoimmune disease: the immune system attacks the body’s own healthy cells and tissues, causing inflammation and damage (CDC). It can affect the joints, skin, kidneys, heart, lungs and brain (MedlinePlus). SLE is the most common and most serious type of lupus, and it ranges from mild to life-threatening (CDC). It is not contagious (NHS).

The cause is unknown; environment, genes and hormones may all play a part (CDC). Suspected triggers include viral infections, sunlight, certain medicines and smoking (MedlinePlus). There is no cure, but it can be treated, and an earlier diagnosis helps (CDC). Treatment has improved, people with lupus are living longer, and most can live normal lives (ACR).

Who gets lupus?

  • CDC estimates that about 204,000 people in the U.S. have SLE. About 9 in 10 are women, and women of childbearing age (15 to 44) have the highest risk. Anyone can develop lupus, including children (CDC); about 1 in 5 people with SLE develop it as children or teens (ACR).
  • Black or African American, Hispanic, Asian, and American Indian and Alaska Native people are affected more than White people. Black and American Indian and Alaska Native women are 2 to 3 times more likely than White women to develop lupus and tend to have more severe disease (CDC). African American and Hispanic women are more likely to have severe forms (MedlinePlus).
  • Black people with lupus die more than 10 years younger, on average, than White people with lupus (CDC). Lack of access to care and late diagnosis can worsen lupus (CDC).

Symptoms

Symptoms differ from person to person (MedlinePlus). The most common is fatigue — feeling extremely tired (CDC), often a tiredness that doesn’t go away no matter how much you rest (NHS). Others include:

People with lupus may also have other autoimmune conditions (CDC); our Sjögren’s syndrome guide is coming soon. Fibromyalgia often overlaps too: a 2025 review of 56 studies found it in about 16% of people with SLE, a higher rate than in people without lupus (Mistry et al., 2025). See our Fibromyalgia guide.

Flares

A flare is a period when symptoms get worse; flares can be mild or severe, and new symptoms can appear at any time (MedlinePlus). They often last a few weeks, sometimes longer, before settling into remission, and why they come and go is not known; some people’s symptoms stay constant (NHS). Sunlight can trigger a flare (ACR), and stress can make symptoms worse (NHS). Learning your own warning signs can help you head off a flare or make it milder (MedlinePlus).

How lupus affects the organs

  • Kidneys (lupus nephritis). As many as 5 in 10 adults and 8 in 10 children with lupus have kidney disease. It is more likely in African American, Hispanic and Asian American people. Signs include foamy urine, swelling of the legs, feet or ankles, and high blood pressure; it is found with urine and blood tests and a kidney biopsy. Treatment works well, but 10 to 30 percent of people with lupus nephritis develop kidney failure (NIDDK). See our Kidney guide.
  • Heart. Lupus can inflame the heart muscle (myocarditis), the heart valves or the lining around the heart (pericarditis) (MedlinePlus).
  • Lungs. Inflammation of the lining around the lungs (pleurisy) can make breathing painful (MedlinePlus).
  • Blood. Lupus can cause anemia and clotting problems (CDC). Low platelets can cause tiny red spots of bleeding under the skin (petechiae) (MedlinePlus Genetics). Some people have antiphospholipid antibodies (ACR); antiphospholipid syndrome, which makes blood clot more easily, is more common in people with lupus (NHS). See our Blood Clots guide.
  • Brain and nerves. Inflammation can cause numbness and weakness in the limbs, seizures, stroke, and trouble thinking and remembering (MedlinePlus Genetics).

Heart and blood-vessel risk

People with lupus are more likely to develop coronary artery disease and atherosclerosis (MedlinePlus). In a well-known 1997 study of 498 women with lupus, those aged 35 to 44 were over 50 times more likely to have a heart attack than women of similar age in the Framingham Offspring Study; two-thirds of the heart events happened before age 55 (Manzi et al., 1997). People with lupus nephritis are also at high risk of heart and blood-vessel problems (NIDDK). That is why your doctor may also treat cholesterol and blood pressure (MedlinePlus). See our Heart guide.

How lupus is diagnosed

There is no single test, and lupus is often mistaken for other conditions, so diagnosis can take time (MedlinePlus). A rheumatologist usually makes the diagnosis using your symptoms, an exam, X-rays and lab tests (CDC). Tests may include:

  • ANA (antinuclear antibody). A positive ANA is found in nearly all people with lupus; other antibodies, such as anti-double-stranded DNA, anti-Smith and antiphospholipid antibodies, may also be checked (ACR). A positive ANA on its own doesn’t mean you have lupus: many healthy people test positive, especially women over 65, and some medicines can cause a positive result (MedlinePlus).
  • Other blood and urine tests, such as a complete blood count and complement tests, plus skin or kidney biopsies when needed (MedlinePlus).

The 2019 EULAR/ACR classification criteria require a positive ANA at least once as the entry point, then add weighted points from seven clinical areas (such as skin, joints, kidneys, blood and nervous system) and three immune-test areas; a score of 10 or more classifies a person as having SLE (Aringer et al., 2019). Once lupus is confirmed, expect regular blood tests for anemia and urine tests for the kidneys (NHS).

Cutaneous and drug-induced lupus, in brief

Cutaneous lupus affects the skin, causing rashes or sores, usually after sun exposure; its two major types are discoid and subacute cutaneous lupus (MedlinePlus). It is long-term, but medicines and reducing sun exposure can help control it (CDC). See also our Dermatomyositis guide, another autoimmune disease with a sun-sensitive rash.

Drug-induced lupus resembles SLE but is a reaction to certain medicines. Symptoms usually begin 3 to 6 months after starting the medicine and go away once it is stopped (CDC). More than 80 drugs have been linked to lupus (MedlinePlus Genetics). Never stop a medicine on your own — ask the prescriber.

Side by side

Six approaches compared

For every condition we look at the same six approaches: what each involves, what it typically costs, and what a patient can realistically expect.

ApproachWhat it involves Estimated costWhat to expect
Conventional medicine (AMA) Care led by a rheumatologist. Hydroxychloroquine (with regular eye exams), anti-inflammatory painkillers, steroids at the lowest dose that works, and immune-suppressing medicines such as mycophenolate or cyclophosphamide; the biologics belimumab and anifrolumab; voclosporin and obinutuzumab for lupus nephritis; sun protection. Drug prices: cost estimate being researched. Medicare drug coverage caps out-of-pocket costs for covered drugs at $2,100 in 2026. No cure, but treatment aims to prevent flares and organ damage, and most people with lupus can live normal lives. Infections and steroid side effects need watching.
Chiropractic No role in treating lupus; we found little research. Joint pain from lupus needs rheumatology care. Not a lupus treatment. If you go for another reason: about $55–$100 per self-pay follow-up visit. Steroids can thin the bones quickly, raising fracture risk. Tell any chiropractor about your lupus and medicines, and avoid forceful adjustments if your bones are weak.
Acupuncture Studied in small trials for pain and fatigue alongside medical care, including a 24-person pilot trial in 2008. About $90–$185 per private follow-up visit, or $50–$90 at community clinics. Medicare covers acupuncture only for chronic low back pain. Early, limited evidence; real and minimal needling helped pain about equally. Use sterile, single-use needles, especially if your immune system is suppressed.
Herbal medicine No herb treats lupus. Fish oil and vitamin D have some supportive evidence. Avoid “immune-boosting” herbs such as echinacea and alfalfa, which may worsen autoimmune disease. Not applicable — check every product with your care team first. At best a small add-on to medical care. Some herbs may trigger flares or interact with lupus medicines.
Massage therapy Gentle massage for comfort and stress relief only. Avoid rashes, sores and fragile skin, and use light pressure if your platelets are low or bones are weak. One national chain’s membership is about $70–$90 a month for one 60-minute session. May help you relax; it doesn’t treat lupus. We found no clinical trials in lupus.
MBHA Wellness Coach Daily sun protection, pacing fatigue, regular exercise, rest, quitting smoking, heart-healthy habits, flare tracking, mental health and support. MBHA coaching: cost estimate being researched. Free quit-smoking coaching at 1-800-QUIT-NOW. Supports — never replaces — your medical team. Exercise is safe in lupus and can ease fatigue and low mood.

Approach 1 of 6

Conventional medicine (AMA)

Treatment aims to prevent flares, treat them when they happen, limit organ damage and improve quality of life (MedlinePlus). The medicines you need depend on how severe your lupus is and which organs are involved (ACR). Care is often shared by a primary care provider and a rheumatologist, with other specialists as needed (MedlinePlus). Report new symptoms right away so the plan can change (MedlinePlus). We name medicines but never doses.

Hydroxychloroquine

Hydroxychloroquine is one of the main medicines listed by the American College of Rheumatology, the NHS and CDC (ACR, NHS, CDC). It is used for SLE and discoid lupus (MedlinePlus) and helps fatigue and skin and joint problems (NHS). It is usually well tolerated. Symptoms can improve in one to two months, but the full benefit can take up to six (ACR).

  • Eye exams. Rarely, it can damage the retina. ACR advises an eye exam within the first year, then every 1 to 5 years as your eye doctor advises (ACR). Report blurred vision, floaters, flashes of light or other vision changes (MedlinePlus).
  • Smoking may blunt its effect on the skin: a 2015 review of 10 studies (1,398 people with cutaneous lupus) found smokers were about half as likely to improve on antimalarial medicines (Chasset et al., 2015).

Other medicines

  • Anti-inflammatory painkillers such as ibuprofen (NHS). Long-term use of these (NSAIDs) can hurt the kidneys (NHS), so ask what’s safe for you, especially with lupus nephritis.
  • Steroids — tablets, injections and creams — for kidney inflammation and rashes (NHS). Your doctor may adjust the dose often to keep you on the lowest dose that works (MedlinePlus). Steroids can cause rapid bone loss, even within the first six months, so ask about calcium, vitamin D, bone density scans and bone-protecting medicines (ACR).
  • Immune-suppressing medicines such as mycophenolate (ACR) and, for lupus nephritis, cyclophosphamide (NIDDK). Mycophenolate raises the risk of serious infection and must not be taken in pregnancy because of a high risk of miscarriage and birth defects (MedlinePlus). Rituximab, a biologic, is also used (CDC).
  • Belimumab (Benlysta), first approved by the FDA in 2011, is now approved for people aged 5 and older with active SLE or active lupus nephritis who are receiving standard therapy. Its label warns of serious infections and of depression and suicidal thoughts, and says live vaccines shouldn’t be given with it (FDA label).
  • Anifrolumab (Saphnelo), FDA-approved in 2021, is for adults with moderate to severe SLE receiving standard therapy; it hasn’t been studied in severe active lupus nephritis or severe brain and nerve lupus. It raises the risk of respiratory infections and shingles (FDA label).
  • Voclosporin (Lupkynis), FDA-approved in 2021, is used with mycophenolate and steroids for adults with active lupus nephritis. It carries a boxed warning for cancers and serious infections, needs regular kidney-function and blood-pressure checks, and should not be taken with grapefruit (FDA label).
  • Obinutuzumab (Gazyva) was approved by the FDA in 2025 for adults with active lupus nephritis receiving standard therapy (FDA approval letter).

Sun protection is treatment too

Sunlight can trigger rashes and even a serious flare (ACR); the NHS also advises avoiding long periods under fluorescent lights (NHS). See the Wellness Coach section for daily sun habits.

What it costs

  • Lupus medicines, infusions and tests: cost estimate being researched.
  • Help paying: with Medicare drug coverage, out-of-pocket costs for covered Part D drugs are capped at $2,100 in 2026 and $2,400 in 2027 (Medicare.gov).

Find a medical doctor in our directory

Approach 2 of 6

Chiropractic

Chiropractic care has no role in treating lupus, which is driven by the immune system (CDC). We found little research on chiropractic for lupus.

  • Steroid-thinned bones. Steroids can cause rapid bone loss and a much higher rate of fractures (ACR). Serious problems after spinal manipulation are very rare, but they may be more likely in people whose health problems raise their risk of injury, so tell the practitioner about your conditions and medicines (NCCIH). MBHA suggests avoiding forceful (high-velocity) adjustments if you take long-term steroids or have osteoporosis, and asking your rheumatologist first.
  • Neck manipulation. It has been linked to rare tears in neck arteries that can cause a stroke (NCCIH). One published case described such a tear in a pregnant woman with lupus right after chiropractic treatment (Morton, 2012).
  • Joint pain is a lupus symptom (MedlinePlus); new or worse joint pain belongs with your rheumatologist.

Cost and coverage: a self-pay follow-up visit typically costs about $55 to $100, and a first visit about $90 to $200 (The Pricer). Medicare covers only spinal adjustments to correct a subluxation (Medicare.gov).

Find a chiropractor in our directory

Approach 3 of 6

Acupuncture

Acupuncture doesn’t treat lupus itself, and the research is small.

  • In a 2008 pilot trial, 24 people with SLE had 10 sessions of acupuncture, “minimal” (shallow) needling, or usual care. About 40% of those given either kind of needling had at least a 30% improvement in pain, compared with none in the usual-care group; benefits were similar for real and minimal needling, and there were no serious side effects (Greco et al., 2008).
  • A 2023 review of seven trials (514 people) found acupuncture added to drug treatment did better than drugs alone on several measures, but the authors cautioned that the studies were few and of uneven quality (Zhao et al., 2023).

Safety: done improperly, acupuncture can cause infections, punctured organs and nerve injury, and complications have come from nonsterile needles; the FDA requires needles to be sterile and labeled for single use (NCCIH). Immune-suppressing medicines make infections more likely and more serious (MedlinePlus), so make sure your acupuncturist uses new sterile needles, and skip sessions during an infection. Lupus can lower platelets, which causes bleeding under the skin (MedlinePlus Genetics); if your platelets are low, ask your doctor before needling.

Cost: about $90 to $185 per private follow-up and $125 to $230 for a first private visit, or $50 to $90 at community clinics (The Pricer). Medicare covers acupuncture only for chronic low back pain (Medicare.gov).

Find an acupuncturist in our directory

Approach 4 of 6

Herbal medicine

No herb or supplement treats lupus. Research has not clearly shown that complementary therapies help, so talk to your provider before trying any (MedlinePlus).

Herbs that may make autoimmune disease worse

  • “Immune-boosting” herbs. A 2025 review of 469 studies found 15 herbs with the strongest evidence of stimulating the immune system — including alfalfa, ashwagandha, astragalus, chlorella, echinacea, garlic, ginseng, licorice and spirulina — and warned they may trigger or worsen autoimmune skin disease (Weiner et al., 2025). Case reports link such herbs to the onset or flares of lupus (Bax et al., 2021).
  • Echinacea is promoted as stimulating the immune system, and there are theoretical reasons it might interact with immunosuppressants (NCCIH). Asian ginseng may worsen autoimmune disorders, and cat’s claw might make the immune system more active (NCCIH).
  • Alfalfa sprouts can cause a lupus-like disease in monkeys, and alfalfa tablets have been linked to lupus flares, possibly because of an amino acid called L-canavanine (Alcocer-Varela et al., 1985). A 1983 report in the New England Journal of Medicine described a lupus flare associated with alfalfa (Roberts and Hayashi, 1983).

Fish oil and vitamin D

Interactions

St. John’s wort may interact with prednisone (MedlinePlus) and has documented interactions with the immunosuppressant cyclosporine (NCCIH). Grapefruit must be avoided with voclosporin (FDA label). Supplements can interact with medicines, and some contain ingredients not on the label (NCCIH).

Show every supplement to your rheumatologist or pharmacist first, and never stop or change a lupus medicine on your own. We don’t list doses.

Approach 5 of 6

Massage therapy

Massage doesn’t treat lupus, and we found no clinical trials of massage in lupus — only a report of one woman whose pain and sleep improved with daily acupuncture plus massage, which can’t show what massage alone does (Mooventhan and Nivethitha, 2014). Finding ways to relax can help you cope with lupus (MedlinePlus), and stress can make symptoms worse (NHS), so gentle massage may be a comfort.

The risk of harm appears low, but rare serious problems — blood clots, nerve injury and bone fractures — have been reported, some with vigorous or deep-tissue massage or in people at higher risk (NCCIH). MBHA suggests:

Cost: one national chain’s membership is about $70 to $90 a month for one 60-minute session (The Pricer).

Find a massage therapist in our directory

Approach 6 of 6

MBHA Wellness Coach

Taking an active role in your treatment helps (MedlinePlus). An MBHA Wellness Coach can help you build habits — alongside, never instead of, your medical team.

Another approach

Planning a pregnancy

Many people with lupus have healthy pregnancies, but lupus can flare during pregnancy and raise the risk of complications such as miscarriage (ACR). See a doctor before trying to get pregnant to discuss the risks and whether your medicines need changing (NHS). Our Pregnancy guide is coming soon.

Another approach

Questions to ask at your next visit

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This page is for education only and is not medical advice. Costs are typical U.S. ranges and estimates; yours will depend on your provider, location and insurance. Talk with your doctor before starting, stopping or combining any treatment. In an emergency, call 911. See our disclaimer.

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