Just when you think your autoimmune disease(s) are calming down and you feel better, a dramatic worsening of disease signs and symptoms can happen without warning. They are unpredictable and disruptive, and can cause a disturbing influence in your every attempt to feel well.

Taking medications, following a healthy diet and exercise program, and getting enough sleep don’t seem to stop “flares.” These are the markers of autoimmune disease activity, meaning that the signs or symptoms can usually be observed or measured in an organ or organ system. Factors that incite autoimmune disease flare-ups include stress, diet, drugs, pregnancy, changes in microbial populations, and the different seasons, just to name a few. Some of which you have no control over.

Also known as bouts, relapses, or episodes, autoimmune disease flare-ups occur when patients show a dramatic worsening of disease signs and symptoms or when they develop new ones. These manifestations occur in one or more organs of the body and can be more severe than symptoms normally observed with the diagnosed autoimmune disease.

During a flare in autoimmune diseases, such as arthritis or lupus, a person’s immune system attacks the body, leading to increased signs and symptoms of the disease. More specifically, these bouts are triggered by autoantibodies, which are specialized cells known as B and T cells, and cellular pathways that involve substances called cytokines which cause inflammation in different tissues and organs.

Common flare-up symptoms include depression, exhaustion, unusual rashes, poor sleep, fever, and increased pain. However, different autoimmune diseases feature specific “flares” that often depend on the body sites they affect.

This set of unusual symptoms leads to many questions that remain unanswered or difficult to answer. What are the potential causes and triggers for autoimmune flare-ups? What is happening in the body when flare-ups occur? What flare-ups typically occur in common autoimmune diseases? How can flare-ups be managed?

During systemic lupus erythematosus (SLE) flare-ups, people may either experience a return of the usual symptoms or develop new ones. Triggers might include emotional stress, surgical procedures, injury, and pregnancy. But each person may have their own set of triggers that don’t follow the same pattern as anyone else. The episodes are caused by autoantibodies that attack healthy tissue, leading to tissue inflammation and damage. Fever, joint pain, increased fatigue, and rashes are common symptoms, and gastrointestinal complications may also occur.

Inflammation of the kidneys, called nephritis, is one of the most severe flare-ups of lupus, with up to 20 percent of patients with SLE nephritis developing end-stage renal disease. Pregnant women with SLE and a history of kidney disease are at risk for flare-ups that may lead to pre-eclampsia, preterm birth, and fetal death. High doses of immunosuppressive therapy followed by longer courses of lower-dose therapy are often prescribed to control the disease activity of life-threatening lupus flares and to prevent relapses. However, drug administration should be closely monitored, especially during pregnancy and lactation.

Some SLE flare-ups may occur without clinical manifestations, so patients should be regularly screened by a physician for signs and symptoms. In this case, only lab work might demonstrate an increase in disease activity.

Other autoimmune disease flares, such as multiple sclerosis (MS), are marked by flare-ups caused by stress, infections, medical procedures, older age, and heat exposure. Symptoms include limb weakness, blurred vision, slurred speech, numbness, bladder issues, and memory and concentration problems.

A symptom is considered a flare-up when it lasts for at least 24 hours, though flare-ups can typically last weeks or even months at a time. Flares can also occur as soon as 30 days after an earlier bout.

Although flare-ups may clear on their own, medications such as corticosteroids and immunosuppressants are needed in more severe cases. Physical therapy may also be recommended to regain strength. Careful monitoring of lifestyle and any other changes must be monitored to help calm a flare or predict and avoid its recurrence.

Autoimmune disease flare-ups can also affect the liver and skin, as in the case of psoriasis, where skin flare-ups can alternate with periods of remission. Common triggers include medications, stress, cold weather, alcohol intake, and trauma to the skin. When a person’s mild lesions become painful and inflamed, a flare-up is probably occurring. In addition to topical, oral, and light therapies, mindfulness and meditation were recently found to be useful in managing psoriasis episodes, as well as other autoimmune flare-ups.

These are just a few examples of flare-ups in autoimmune diseases. Each seems to have its own trigger and symptoms. Recognizing flare-ups in autoimmune disease can be difficult and take trial and error, but it is essential for managing any autoimmune condition.

Patients should consult their primary care physician or specialists when experiencing changes in their normal autoimmune symptoms, especially if daily activities are affected. Exercising, eating well, resting, practicing mindfulness, and eliminating flare-up triggers will complement any therapy. Any planned major lifestyle change should be discussed with a health care provider before starting.

Nancie Wiseman Attwater is the author of A Caregiver’s Love Story.