Lupus and the Spleen: An Organ Worth Asking About

By Dustin Strong, CHN, ACN

A woman living with systemic lupus erythematosus (SLE) recently told me about her search for relief. She had consulted experts around the country, yet still felt as though important pieces of her experience had gone unexplored. I asked whether anyone had talked with her about the spleen. For her, it was a new question.

That conversation inspired me to share some important research. I do not know 100% whether her spleen is intimately involved in all of her symptoms, and I would never want to suggest that one overlooked organ (in isolation) explains a complex condition like lupus by itself. But the question is worth asking.

What does the spleen do?

The spleen filters blood, removes aging or damaged blood cells, and participates in immune defense. It also contains immune cells that respond to what is circulating in the bloodstream. In a condition marked by altered immune responses, those roles make the spleen relevant to the conversation.

Recent research gives us a concrete reason to pay attention. In a 2026 study of 245 people with SLE at a specialty center, 23 people—about 9%—had a blood-smear finding associated with reduced splenic filtering. That group experienced more infection-related hospitalizations, particularly pneumococcal infections. The finding does not mean that everyone with lupus has impaired spleen function, or that the spleen caused their lupus. It does show that reduced spleen function can matter in some people with SLE.

The relationship can take more than one form. A spleen may be enlarged, injured, or functioning less effectively. In some cases of lupus-related low platelet counts, the spleen’s role in removing blood cells has been important enough that splenectomy was studied as a treatment for severe cases that did not respond to other care. Those are different clinical situations; a blood count alone cannot tell us which, if any, applies to one person.

Living without a spleen changes the conversation

People can live without a spleen, and removal may be necessary for serious medical reasons. But its immune functions deserve an ongoing conversation. Both people whose spleen has been removed and people with functional asplenia—a spleen that is present but works poorly—may need specific infection-prevention measures.

For someone with lupus, this is a reason to ask thoughtful questions of their rheumatology team:

Is there any evidence that my spleen is involved?

What do my blood counts and any existing imaging tell us?

If reduced spleen function is suspected, does my infection-prevention plan need to change?

Another meaning of “spleen”

Traditional Chinese Medicine also speaks about the “Spleen,” but it uses the word for a broader functional framework rather than as a direct description of the anatomical spleen measured on a scan or blood test.

Within that framework, worry, pensiveness, and overthinking are associated with the Spleen.

I find that perspective valuable as an invitation to listen to the whole person. Someone who has spent years searching for answers may carry a tremendous amount of worry. That worry deserves compassion and support. It should never be used to imply that she caused her lupus or that thinking differently would cure it, but it is a variable worth including in the conversation. Now that begs the question...

What is the opposite of worry? 

Perhaps it is trust...not certainty that every symptom will improve spontaneously, but trust that we can keep learning and taking the next thoughtful step, and that our body is designed to heal, and perhaps we need to identify as many of the obstacles to that healing as possible.

When worry takes hold, try placing a hand over your heart, taking a slow breath, and choosing words you can believe: “I am doing what I know to support my body today.” “I am getting better at applying what I learn.” “I can care for myself and begin healing even while I am still looking for answers.” 

The thoughts we repeat can shape how we feel and what we do next. They need not promise a cure to offer us a steadier place from which to begin, but I believe that biological instruction is a much under appreciated part of healing and we would do well to explore this more.

What is fascinating is that there is research (the first a 2023 study and another from 2003) suggesting that increases in perceived stress can accompany greater lupus symptom burden and disease activity, though studies have not uniformly established that stress causes flares.

Taking emotional strain seriously is part of good care; it is not a substitute for evaluating symptoms and treating disease.

What I hope this conversation creates is room for curiosity. The spleen may be one piece of the clinical picture for some people with lupus. The burden of living with uncertainty is another piece of the human picture.

Both deserve attention.

When someone tells us she has reached another dead end, perhaps the next step begins with a better question...and with someone willing to hear the answer.