Servicewomen have higher rates of lupus

According to the Defense Medical Surveillance System, 1,127 active-duty service members were diagnosed with the most common type of lupus, systemic lupus erythematosus, between 2000 and 2022. That number remained relatively consistent over the 23-year period, with a peak in 2009. Female service members were far more likely to be diagnosed with lupus, accounting for nearly 7 out of 10 cases. The rate was also higher among non-Hispanic Black women and Hispanic women. 

This mirrors the population at large, said Anca Askanase, M.D., founder and clinical director of the Lupus Center and the Director of Rheumatology Clinical Trials at Columbia University Irving Medical Center.

“Lupus affects nine women to every man, much like the majority of autoimmune diseases. It affects women during their reproductive years, with the peak [being] between 15 and 45,” Askanase said. “Both the prevalence and the severity of the disease are higher in people of African American descent and Hispanic [people] and Asians. The reasons for these disparities are not very clear. There’s concern that some are related to economic inequalities and systemic racism. There is a lot of interest in better understanding the root cause.”

Because there is no single blood test that can accurately diagnose lupus, diagnoses are often delayed, Askanase said. “It’s the nature of lupus that makes it hard to arrive at the diagnosis. Sometimes doctors can’t see what they’ve never seen. Sometimes it flares and it’s obvious. Sometimes it’s [dormant].”

Can you remain in the military with lupus?

One of the most common triggers for flare-ups is stress — and military life comes with its own unique set of stressors, including separation from family and friends, frequent relocations, disruptions to sleep, and even combat trauma. 

In the Army, Walker was working a full-time job in finance. She also had to spend days drilling out in the hot sun. She recalled one day out on the range when she was trying to qualify on a specific weapon. Her hands were so swollen she couldn’t handle the rifle properly. Every time she fired a shot, it recoiled, hitting her in the face, which in turn also swelled.

By the time Walker decided to go to the ER, she was short of breath. Doctors discovered her lungs had begun to fill up with blood. She spent days intubated in the ICU and more than a month in the hospital. After her release, she went to the Soldier Recovery Unit at Fort Carson, Colorado, to focus on getting better while she and the military explored whether she was fit enough to return to active duty. 

She learned all she could about lupus and discovered that her military service had exposed her to some of the most common triggers for flare-ups — stress and sun exposure in particular.

“I had to make the hardest decision of my life. I wouldn’t get to see my dream of serving 20 years in the military like my father come true,” Walker said.

After five years on active duty, she was medically discharged on May 12, 2024, and quickly found a job working for the military as a budget analyst at Fort Carson.

“My life now is much more calm,” said Walker, who today manages her lupus with medications and by avoiding common triggers.

When her older sister, an Army nurse, was recently diagnosed with lupus, Walker was able to share with her all that she learned. Walker’s sister continues to serve on active duty, proof that lupus doesn’t have to end your military career, she said. 

“If you enjoy being in the Army and can control the lupus, then what’s stopping you?” Walker said. “I say whatever makes you happy, figure out what that is, and go for it.”

Askanase, who has specialized in lupus for more than 15 years, has the same advice. “I don’t think people should decide not to be a part of a profession just because they are diagnosed with lupus,” she said. “There is room for people of all abilities to bring value and to be productive.”