From the Guidelines
Lupus symptoms can be effectively managed by identifying and treating the underlying autoimmune causes, with a focus on preventing organ damage and optimizing health-related quality of life, as recommended by the 2019 EULAR guidelines 1. The symptoms of lupus vary widely, but commonly include fatigue, joint pain, skin rashes (particularly the butterfly-shaped rash across the cheeks and nose), fever, and sensitivity to sunlight. Patients may also experience:
- Hair loss
- Mouth sores
- Chest pain
- Dry eyes
- Headaches
- Raynaud's phenomenon (fingers turning white or blue in cold temperatures) Internal organ involvement can lead to:
- Kidney problems
- Shortness of breath
- Heart inflammation
- Neurological symptoms like memory issues or seizures Blood abnormalities such as anemia, low white blood cell count, or low platelet count are also common. Symptoms often fluctuate, with periods of flares and remission. According to the EULAR recommendations, treatment goals include long-term patient survival, prevention of organ damage, and optimization of health-related quality of life 1. The 2019 update of the EULAR recommendations for the management of systemic lupus erythematosus emphasizes the importance of a multidisciplinary approach to care, considering individual, medical, and societal costs 1. In terms of prognosis, several clinical involvement manifestations, laboratory tests, and immunological tests can provide prognostic information for the outcome in general and involvement of major organs, as outlined in the 2008 EULAR recommendations 1. However, the most recent guidelines from 2019 should be prioritized in clinical decision-making 1.
From the Research
Lupus Symptoms
- 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
- The disease can cause a variety of symptoms, including fever, cytopenia, rash, arthritis, and proteinuria, which may be indicative of lupus nephritis 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
- Treatment of SLE aims to achieve disease remission or quiescence, defined by minimal symptoms, low levels of autoimmune inflammatory markers, and minimal systemic glucocorticoid requirement while the patient is treated with maintenance doses of immunomodulatory or immunosuppressive medications 2
Common Symptoms
- Mucocutaneous symptoms, such as rash and skin lesions 2
- Musculoskeletal symptoms, such as arthritis and myalgias 2
- Hematologic symptoms, such as cytopenia and anemia 2
- Kidney symptoms, such as proteinuria and lupus nephritis 2
- Other symptoms, such as fever, fatigue, and weight loss 2
Treatment and Management
- Hydroxychloroquine is standard of care for SLE and has been associated with a significant reduction in mortality 2
- Immunomodulatory and immunosuppressive medications, such as azathioprine, mycophenolate mofetil, and cyclophosphamide, are used to treat moderate to severe disease 2
- Biologic therapies, such as belimumab and anifrolumab, have been approved for the treatment of SLE 2
- Lifestyle interventions, such as physical exercise, diet and nutrition, and mental health interventions, can also be beneficial in managing SLE symptoms 3