Takeaways:
For mutual support and hope, find 3 people to walk this journey with you- someone newly diagnosed, somebody that is in the same place you are and someone who has been living with lupus longer than you.
As you age with lupus, think about your general health, too. Don’t forget your cancer screenings and practice heart disease risk reduction, which tend to be more commonly problematic in lupus. Eat nutritious meals, get regular activity, quit smoking, and keep your blood pressure and cholesterol under control.
Lupus-like symptoms such as joint pain, fatigue, cognitive decline and chest pain, may increase with age and not be related to lupus disease activity.
Do lupus symptoms improve with age?
Yes, aging quiets lupus in some older patients. Researchers at UCSF have shown that as we age, we turn down the activity of certain immune genes and less inflammatory proteins are produced. The cell repairing mechanism is less functional as we get older, leading to a less active immune system. Great news for lupus disease but not for our ability to fight infections, and we are less likely to respond to vaccines and we may experience more viral infections.
While lupus disease activity may decrease with age, aging comes with its own issues. Lupus-like symptoms such as joint pain, fatigue, cognitive decline and chest pain, may increase with age and not be related to lupus disease activity. Lupus patients tend to have more bone fractures and osteoporosis and steroids play a big role, but also aging.
Are lupus patients living longer? If so, what are some of the reasons for this increase in life expectancy?
Overall, people with lupus are living longer. Data shows that from 1970 to the 2000s, mortality from lupus decreased and survival increased significantly as medications such as Micofenelate, Mofetil (Cellcept), Rituximab, and Benlysta became available. New medications allow for the decrease of the dependence on steroids, which can cause high blood pressure, weight gain, bone thinning and fractures, and impacts mortality in lupus. For example, the use of hydroxychloroquine, which has several health benefits, lowers mortality by about 45%.
People with lupus are also living longer, probably due to earlier diagnosis and an increased awareness of the disease.
How does menopause impact lupus?
There are hormonal impacts from estrogen and progesterone on immune cells that impact B cells (white blood cells that are responsible for developing antibodies that attack self) and t-cells which also regulate the immune system. So changes in hormones during menopause may be the reason we see lower disease activity and milder courses at a certain age.
What are some additional challenges for people with lupus that come with aging?
Older adults with lupus have more co-morbidities which has implications for overall health and well-being.
As lupus patients age, health care providers are also working to prevent damage or co-morbid diseases such as heart disease, cancer, chronic lung disease, strokes, Alzheimer’s, diabetes and chronic kidney disease. For lupus patients, the risk of a stroke and dementia is higher than expected in lupus patients, which may be related to cardiovascular and vascular health from strokes and ministrokes that may be happening.
Furthermore, we need to be aware of how social determinants increase with age. Older patients may need assistance with transportation, may experience social isolation, there may be a change in their health insurance, may be on a fixed income, and suffer from decreased mobility. Social workers, physical therapists, rheumatologists and other specialists and caregivers can support aging adults with lupus.
Does lupus management change with aging?
Lupus disease management changes as patients age and treatment must involve different ways of dealing with age related syndromes in lupus.
In essence, the management of lupus patients as they age involves 3 buckets.
The first bucket includes lupus disease itself. As lupus patients age, they may also develop other chronic health conditions and may be taking medications for these other conditions as well. As such, careful review of all their medications is necessary so there are no drug interactions with lupus medications.
The second bucket involves managing the diseases that come with aging such as heart disease, stroke, cancer, Alzheimer’s, diabetes and chronic kidney disease.
The third bucket involves addressing social determinants of health to make sure older lupus patients have the support they need to be able to live comfortably and safely, access reliable transportation, have food security, and social support.
Resource: Living Well With Lupus: Tips for People With Lupus
How can older adults with lupus improve their quality of life?
Recommendations for enjoying a good quality of life include:
Eating healthy meals that provide the proper amount of nutrients you need.
Staying physically active by engaging in safe activities that you enjoy.
Preventing or fighting loneliness and social isolation by staying engaged. Individuals with greater social support experience less pain, depression, disability and frailty. Consider joining support groups, spending time with others and volunteering for ways to improve your quality of life.
Practicing mentally engaging activities that challenge the brain and promote deep thinking, memory, and problem-solving skills. Try reading, writing, playing board games or putting puzzles together.
Resource: Learn Ways to Better Manage Your Lupus
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