Living well with lupus

Are people with lupus more prone to infections?

There is some evidence that people with lupus are more likely to get infections than completely healthy people. The most common infections are in the respiratory tract (colds, sore throats, sinusitis, bronchitis, and pneumonia), the urinary tract (bladder or kidney infections), and the skin (boils, cellulitis, and infected cuts).

If a person with lupus is taking corticosteroid medication every day, particularly more than 10 mg/day, the risk of infection goes up considerably. Sometimes -- but not always --  every-other-day treatment  can control active lupus as well as when it is taken every day. So if the corticosteroid doses can be taken once in the morning every other day -- instead of every day -- there is not much, if any, increase in the risk for infections.

Other medications used for moderate to severe lupus activity, such as azathioprine (Imuran®), mycophenolate mofetil (CellCept), methotrexate (Rheumatrex), leflunomide (Arava), tacrolimus (Prograf®), belimumab (Benlysta®), rituximab (Rituxan®), and cyclophosphamide (Cytoxan®), also have the potential to increase the risk for infections. Herpes zoster outbreaks (shingles) -- with painful blisters along the course of a nerve -- can occur in people on immunosuppressive medications.

In general, the more severe the lupus is, the higher the risk for infection, partly because of being sick and partly because of the treatments. In contrast, the antimalarials (hydroxychloroquine, Plaquenil®, is the most commonly prescribed)  are not associated with major risks for infections.

There are strategies to reduce your risk for infection.

  • Keep your vaccinations up to date, including Pneumovax to prevent the commonest cause of pneumonia.
  • Take a flu shot every year.
  • Most women can tell accurately that a bladder infection is present, and you should ask your doctor to diagnose and treat this promptly when symptoms begin which may be able to prevent a worse infection.
  • If you are taking high doses of immunosuppressive drugs and/or prednisone, you might want to discuss with your doctor the pros and cons of taking additional medications to prevent special kinds of infections, such as pneumocystis pneumonia.
  • If you have frequent urinary tract infections, there are antibiotics taken once at bedtime and agents that change the acid in the urine that are effective at reducing urinary tract infection rates.
  • If you suffer from outbreaks of herpes virus lesions/ulcers in your mouth, on your lips, or in genital areas, discuss preventive anti-viral treatment with your doctor.
  • If you have been exposed to tuberculosis, you should have a PPD skin test (tuberculin) and consider taking six months of anti-tuberculosis antibiotics if the test is strongly positive.
  • Finally, if it is possible to avoid people with bad colds or other communicable infections, you should do so. Washing hands can prevent the transmission of these infections. Of course, you cannot protect yourself from participating in life, so use your common sense.

Medically reviewed on July 20, 2013

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