For the 1.5 million Americans living with lupus, managing the autoimmune disease can already be overwhelming. With symptoms like pain, fatigue, hair loss, and heart issues, the condition demands constant attention. Yet, for some, an additional struggle is the unwanted stigma and frustration linked to weight gain, a common side effect of the medications used to treat the disease. This issue has been highlighted by high-profile figures like singer Selena Gomez, who shared on social media in February 2023 that certain lupus medications cause her to gain weight, while she loses it when she stops the treatment.
Lupus, also known as systemic lupus erythematosus, can lead to changes in weight for several reasons. While weight gain is often associated with an increase in body fat, it is not always the case. According to Dr. Kyriakos A. Kirou, a rheumatologist at the Hospital for Special Surgery in New York, fluid retention can contribute to the weight fluctuations seen in lupus patients. This can happen, for instance, in cases of lupus nephritis (kidney failure) or heart failure. However, once these conditions are managed with diuretics or other treatments, fluid retention typically resolves.
More commonly, the culprit behind weight gain in lupus patients is corticosteroids. These medications, which are used to treat moderate to severe lupus, are known to cause significant changes in weight. Dr. Diane Kamen, a professor of rheumatology at the Medical University of South Carolina, explains that while short-term use of steroids like prednisone may cause immediate fluid retention, prolonged use can redistribute fat in the body and increase appetite.
Dr. Sarah Patterson, a rheumatology expert at the University of California, San Francisco, describes steroids as a “necessary evil” in lupus treatment. Although they can be life-saving, long-term steroid use often leads to unhealthy changes in body composition. Steroids are believed to slow down metabolism and reduce muscle mass, which shifts the body’s composition away from lean tissue. For people with lupus, this shift can pose particular risks, as the negative health effects of excess body fat are felt even at a lower body mass index than in people without the condition.
Beyond corticosteroids, other medications used to manage symptoms of lupus—such as those for depression, fatigue, and muscle pain—may also contribute to weight gain. Additionally, these medications can interfere with sleep patterns, which, in turn, disrupt metabolism and make weight management even more challenging.
As patients with lupus navigate these complex side effects, the impact on their physical and emotional well-being is profound. Despite the essential role these medications play in managing lupus, the weight gain and other consequences remain an unwelcome challenge for many.
