If you’ve been diagnosed with lupus, you probably know it can affect many parts of your body. But with so many symptoms to keep track of, you might wonder if hoarseness or other speech changes could be related to lupus. The short answer is yes — lupus can affect your voice. It may impact the vocal cords, speech, and how your voice sounds or feels.

Voice-Related Lupus Symptoms

“My voice goes sometimes, and when I get fatigued, my tongue feels heavy and I have difficulty talking,” one MyLupusTeam member wrote.

Symptoms of voice and vocal issues related to lupus can include:

• Hoarseness
• Change in voice quality
• Difficulty speaking or singing
• Vocal fatigue (the feeling of your voice tiring easily)
• Breathy or quiet speech
• Sore throat or dry throat
• Gravelly or rough-sounding voice

These problems are referred to as dysphonia. While there isn’t a lot of medical research on this topic, there are a few studies that link hoarseness and vocal weakness to lupus.

What Causes Voice Changes with Lupus

Lupus is an autoimmune disease, which means the disease causes your immune system to attack your own body. In lupus, the inflammation your immune system creates can cause damage to your body’s organs and tissues, including parts of the body that affect your voice and speech.

Below are some potential causes for voice changes in lupus.

Joint Issues

Joint pain and arthritis are common symptoms of lupus. Around 95 percent of people with lupus have joint pain or arthritis at some point. Believe it or not, there is a tiny joint in your throat that helps your vocal cords work properly. Like any other joint in your body, it can be affected by lupus.

Lupus can cause joint stiffness, swelling, and problems with the fluid that normally keeps your joints moving smoothly. The small joint in your throat is called the cricoarytenoid joint, and it sits in your voice box (larynx). It controls the tightening and loosening of your vocal cords. It also helps you breathe and protects your airways. Doctors believe issues with this joint could explain some why some people with lupus have vocal changes during flare-ups, especially hoarseness.

Gastroesophageal Reflux Disease

Gastrointestinal problems are common in people with lupus. Heartburn or indigestion caused by GERD (gastroesophageal reflux disease) is especially common. GERD is often caused by lupus. Inflammation weakens the muscles of your throat that help keep the contents of your stomach from traveling up into your throat.

The acid from your stomach can cause your throat to become irritated and sore, and it’s also associated with coughing and hoarseness. GERD can also cause your throat to tighten in an effort to protect your voice box from the acid, which causes muscle tension. This may feel like a lump in your throat.

Acid reflux that reaches beyond your swallowing tube (esophagus) up into your throat or breathing tube can cause different symptoms than are typical of more common forms of acid reflux. You might not even have heartburn or indigestion. Instead you might have issues with your voice. GERD could be due to lupus itself or due to medications prescribed for lupus, like steroids, immunomodulators, and NSAIDs.

Tissue Damage

A 2017 study from Brazil found a relationship between greater severity of vocal symptoms and greater levels of tissue damage across other body systems. This led the researchers to conclude that voice issues are likely to be caused by tissue damage overall.

Although standard calculations of tissue damage in lupus do not usually measure damage to the vocal cords or upper airways, the researchers hypothesized that direct damage to these parts of the body might be to blame for voice issues, because they are closely linked with other related forms of tissue damage.

Sjögren’s Syndrome

Sjögren’s syndrome harms your body’s ability to produce saliva, tears, and other moisture. This often causes you to be thirsty and your mouth and throat to feel dry. You might also have difficulty speaking or feel you need to take a sip of water to continue speaking. About 1 in 10 people with lupus have Sjögren’s. One study found that around 60 percent of people with Sjögren’s also had a voice disorder.

Hypothyroidism

When lupus occurs alongside other autoimmune disorders — such as Hashimoto’s thyroiditis, which affects how the thyroid gland works — it can also lead to hoarseness. Low thyroid function (hypothyroidism) is seen in about 15 percent to 19 percent of people with lupus.

Mental Health and Quality of Life

The feeling of losing your voice or noticing changes in how you sound can affect your quality of life. Being able to communicate and socialize is important. Voice disorders have been linked to depression, stress, and anxiety.

For some MyLupusTeam members, losing the ability to sing has been especially painful. One member shared, “I used to sing in church. Because of lupus, my vocal range is not the same anymore. Sometimes I get very depressed about it, because singing has always been a part of my identity.”

In response, another member offered encouragement: “Yes, it has affected my vocal cords. I don’t sing in front of people as much, but I still sing around the house and at church with a group. This disease takes away a lot of things, but I will not let it overpower me! I call it my new normal and try to adjust my life to it. I will not let it define who I am anymore, but some days are just hard!”

Treatment for Lupus Speech Problems

Voice problems can be frustrating or even depressing. The good news is that many treatments have been shown to help minimize or even resolve vocal symptoms.

Voice Therapy

Researchers in a study from Brazil recommended that more people with lupus be referred to voice therapy to help manage symptoms and improve quality of life. Voice therapy is a kind of exercise for your vocal cords that combines several exercises and techniques to help you better control the pitch and volume of your voice.

Your voice therapist may guide you through activities like breathing exercises, gentle stretches to help relieve tension in your throat, or sounds like humming or trilling that help your vocal cords vibrate.

Vocal Rest

One of the best treatment options for vocal disorders and strain is vocal rest — giving your voice a break by avoiding talking and singing when your voice is tired or strained. As one MyLupusTeam member reminded others: “Voice rest is important, and remember, whispering strains the vocal cords more than talking.”

Another shared their relaxation techniques as well: “I drink warm water with lemon — half a lemon — and no caffeine or heavy food before I sing, and do lots of breathing exercises.”

Medication

If you’re experiencing vocal issues, talk to your healthcare provider. They can help determine what’s causing your vocal issues and recommend treatment options that might help. For example, if you have undiagnosed GERD, treating that condition may improve your voice. Similarly, if joint inflammation in the throat is the issue, NSAIDs or steroids may help. If hypothyroidism is involved, treating your thyroid can also help resolve any hoarseness.

Talk With Others Who Understand

MyLupusTeam is the social network for people with lupus and their loved ones. On MyLupusTeam, members come together to ask questions, give advice, and share their stories with others who understand life with lupus. Are you living with difficulty speaking or vocal symptoms? What has helped you manage them? Share your experience in the comments below, or start a conversation by posting on your Activities page.