From the Guidelines
Systemic Lupus Erythematosus (SLE) typically presents with a variety of symptoms that can develop gradually or suddenly, including extreme fatigue, fever, joint pain, and a characteristic butterfly-shaped rash across the cheeks and nose, as outlined in the 2019 update of the EULAR recommendations for the management of SLE 1.
Common Onset Symptoms
- Extreme fatigue
- Fever without an obvious cause
- Joint pain and swelling, particularly in the hands, wrists, and knees
- A characteristic butterfly-shaped rash across the cheeks and nose
- Photosensitivity, developing skin rashes after sun exposure
- Hair loss
- Mouth sores
- Raynaud's phenomenon, with fingers turning white or blue when cold
- Chest pain with deep breathing due to pleuritis or pericarditis
- Cognitive symptoms like headaches, confusion, or memory problems
- Blood abnormalities such as anemia, low white blood cell count, or low platelet count
- Kidney involvement, manifesting as swelling in the legs or around the eyes These symptoms often fluctuate in severity and may mimic other conditions, making early diagnosis challenging, as noted in the study by Fanouriakis A, et al. 1.
Organ-Specific Manifestations
The diverse presentation of SLE reflects its nature as an autoimmune disease affecting multiple organ systems, with the immune system attacking the body's own tissues and causing widespread inflammation, highlighting the importance of early recognition and treatment to prevent long-term damage and improve quality of life, as emphasized in the 2019 EULAR recommendations 1.
From the Research
Onset Symptoms of SLE
- The most common initial symptoms of Systemic Lupus Erythematosus (SLE) are arthritis/arthralgia (74.5%) and rashes (61.8%) 2.
- Other onset symptoms of SLE include oral ulcers, malar rash, photosensitive rash, and cytopenias 3, 2.
- The median time from symptom onset to SLE diagnosis is 24 months, with only 28.4% of patients achieving an "early" diagnosis within 6 months 2.
- Certain symptoms, such as oral ulcers and malar rash, are associated with a delayed diagnosis 2.
Clinical Presentation
- SLE is a multisystemic autoimmune disease with variable clinical manifestations, including musculoskeletal, dermatological, and renal involvement 4.
- Patients with SLE may present with nonspecific symptoms, such as malaise and fatigue, which can make diagnosis challenging 3.
- The clinical presentation of SLE can vary depending on the age of onset, with younger patients potentially experiencing more severe disease 4.
Diagnostic Considerations
- Antinuclear antibody (ANA) testing is a key diagnostic tool for SLE, but it is not specific for the disease and must be interpreted in the appropriate clinical context 3.
- Other autoantibody tests, such as anti-double-stranded DNA (dsDNA) and anti-extractable nuclear antigen (ENA), may be helpful in diagnosing SLE 5.
- The use of multianalyte assay panels, such as AVISE Lupus, may improve the diagnosis and treatment of SLE compared to standard ANA testing 6.