From the Guidelines
Lupus is a multisystem autoimmune disease characterized by a wide range of signs and symptoms, including extreme fatigue, joint pain and swelling, a butterfly-shaped rash, skin lesions, fever, headaches, and sensitivity to sunlight, as well as potential kidney problems, blood disorders, and neurological issues 1. The signs and symptoms of lupus can vary greatly between individuals, but common symptoms include:
- Extreme fatigue
- Joint pain and swelling
- A butterfly-shaped rash across the cheeks and nose
- Skin lesions that worsen with sun exposure
- Fever
- Headaches
- Sensitivity to sunlight
- Hair loss
- Fingers and toes that turn white or blue when cold (Raynaud's phenomenon)
- Shortness of breath
- Chest pain
- Dry eyes Lupus can affect multiple organ systems, potentially causing:
- Kidney problems
- Blood disorders like anemia or low platelet counts
- Neurological issues such as memory problems, confusion, or seizures Some patients develop mouth sores, and many experience periods of symptom flares followed by periods of remission. Since lupus mimics many other conditions, diagnosis typically requires a combination of blood tests, physical examination, and medical history review, considering individual, medical, and societal costs, and should be based on a shared patient-physician decision 1. The treatment goals for lupus include long-term patient survival, prevention of organ damage, and optimization of health-related quality of life, which can be achieved through a multidisciplinary approach, including medications like antimalarials, corticosteroids, immunosuppressants, and lifestyle modifications 1.
From the Research
Signs and Symptoms of Lupus
- Systemic lupus erythematosus (SLE) is a chronic autoimmune disease characterized by inflammation and immune-mediated injury to multiple organ systems, including the mucocutaneous, musculoskeletal, hematologic, and kidney systems 2
- Clinical factors that may be indicative of lupus include fever, cytopenia, rash, arthritis, and proteinuria, which may be indicative of lupus nephritis 2
- Immunologic measures, such as SLE-specific autoantibodies and low complement levels, are also used to diagnose lupus 2
- Approximately 40% of people with SLE develop lupus nephritis, and an estimated 10% of people with lupus nephritis develop end-stage kidney disease after 10 years 2
- Lupus is more prevalent in African American women and women in other ethnic minority groups 3
- The disease can cause a wide range of clinical presentations resulting from its effect on multiple organ systems, including neonatal, discoid, drug-induced, and systemic lupus erythematosus (SLE) 4
Common Manifestations of Lupus
- Lupus nephritis is the most common target-organ manifestation and requires individualized care to minimize toxicity 3
- Musculoskeletal, hematologic, and severe cutaneous lupus frequently require immunosuppression and/or biologic therapy 5
- Neuropsychiatric manifestations of lupus also require immunosuppression and/or biologic therapy 5
- Patients with lupus experience a loss of self-tolerance as a result of abnormal immunological function and the production of autoantibodies, which lead to the formation of immune complexes that may adversely affect healthy tissue 4
Treatment and Management of Lupus
- Hydroxychloroquine is standard of care for SLE and has been associated with a significant reduction in mortality 2
- Treatments in addition to hydroxychloroquine are individualized, with immunosuppressive agents, such as azathioprine, mycophenolate mofetil, and cyclophosphamide, typically used for treating moderate to severe disease 2
- Biologic therapies, such as belimumab, voclosporin, and anifrolumab, are also used to treat lupus, particularly in patients with refractory disease 2, 5