From the Guidelines
Lupus red flags include unexplained fever, extreme fatigue, joint pain and swelling, butterfly-shaped rash across the cheeks and nose, photosensitivity, hair loss, mouth ulcers, chest pain with deep breathing, and unexplained kidney problems, as outlined in the 2019 update of the EULAR recommendations for the management of systemic lupus erythematosus 1. These symptoms can indicate a potential flare or complication of lupus, and prompt medical attention is necessary to prevent organ damage and improve long-term outcomes. Other concerning signs are:
- Raynaud's phenomenon (fingers turning white or blue in cold)
- Cognitive dysfunction
- Seizures
- Unexplained blood abnormalities like anemia, low white blood cell count, or low platelet count Patients should seek immediate medical attention if experiencing severe chest pain, difficulty breathing, severe headache, confusion, or vision changes, as these may indicate serious complications like lupus-related heart or brain involvement. Lupus is an autoimmune disease where the immune system attacks healthy tissues, causing inflammation throughout the body, and early recognition of these red flags is crucial for timely diagnosis and treatment, as prompt intervention can prevent organ damage and improve long-term outcomes, as recommended by the European League Against Rheumatism–European Renal Association–European Dialysis and Transplant Association (EULAR/ERA–EDTA) 1. The disease can affect multiple organ systems simultaneously, which explains its diverse presentation, and lupus symptoms often fluctuate, with periods of flares and remission, making ongoing monitoring essential, as outlined in the european league against rheumatism recommendations for monitoring patients with systemic lupus erythematosus in clinical practice and in observational studies 1. Regular assessments, including disease activity, organ damage, and quality of life, are necessary to manage the condition effectively and prevent complications. In addition to these symptoms, patients with lupus should be monitored for cardiovascular risk factors, osteoporosis, and infection risk, and receive recommended vaccinations, as outlined in the european league against rheumatism recommendations for monitoring patients with systemic lupus erythematosus in clinical practice and in observational studies 1. Overall, prompt recognition and management of lupus red flags are critical to improving patient outcomes and reducing morbidity and mortality associated with the disease.
From the Research
Lupus Red Flags
Lupus red flags are symptoms or signs that indicate a potentially life-threatening or organ-threatening condition in patients with systemic lupus erythematosus (SLE). Some of these red flags include:
- Neuropsychiatric symptoms such as seizures, psychosis, or stroke 2
- Gastrointestinal symptoms such as abdominal pain, nausea, or vomiting 2
- Hematologic symptoms such as anemia, thrombocytopenia, or leukopenia 2
- Renal symptoms such as hematuria, proteinuria, or renal failure 2, 3, 4
- Pulmonary symptoms such as pleuritis, pneumonitis, or respiratory failure 2
- Cardiovascular symptoms such as pericarditis, myocarditis, or coronary artery disease 2, 4
Organ-Threatening SLE
Organ-threatening SLE requires prompt and adequate treatment to prevent irreversible organ damage and improve prognosis. Treatment strategies for organ-threatening SLE include:
- High-intensity immunosuppressive therapy to control disease activity 4
- Use of cyclophosphamide, azathioprine, or other immunosuppressive agents to reduce inflammation and prevent organ damage 3, 5
- Management of disease-related and treatment-related comorbidities, such as infections and atherosclerosis 4
Life-Threatening SLE
Life-threatening SLE requires immediate medical attention and treatment. Some of the life-threatening conditions associated with SLE include: