From the Guidelines
Systemic lupus erythematosus (SLE) typically presents with a wide range of symptoms that can affect multiple organ systems, including extreme fatigue, joint pain and swelling, a butterfly-shaped facial rash, photosensitivity, and fever, as well as potential involvement of internal organs and neurological symptoms. The most common presentation of SLE includes symptoms such as:
- Extreme fatigue
- Joint pain and swelling
- A butterfly-shaped facial rash across the cheeks and nose
- Photosensitivity
- Fever Patients may also experience:
- Hair loss
- Mouth ulcers
- Raynaud's phenomenon (fingers turning white or blue in cold temperatures)
- Chest pain with deep breathing SLE can affect internal organs, causing:
- Kidney inflammation (lupus nephritis)
- Lung inflammation
- Heart problems
- Neurological symptoms like headaches, seizures, or cognitive dysfunction Blood abnormalities are common, including:
- Anemia
- Low white blood cell count
- Low platelet count The disease typically follows a relapsing-remitting course with periods of flares and remissions, as noted in the 2019 update of the EULAR recommendations for the management of SLE 1. SLE predominantly affects women of childbearing age, with a female-to-male ratio of approximately 9:1, and results from a complex interplay of genetic, environmental, and hormonal factors leading to immune system dysregulation, where the body produces autoantibodies that attack its own tissues and organs, as discussed in the EULAR recommendations for the management of SLE with neuropsychiatric manifestations 1. Early diagnosis is crucial and typically involves blood tests for antinuclear antibodies (ANA) and more specific antibodies, along with clinical evaluation using established diagnostic criteria, as outlined in the EULAR recommendations for the management of SLE 1.
From the Research
Typical Presentations of Systemic Lupus Erythematosus (SLE)
- Constitutional symptoms such as fatigue are common, with studies indicating that fatigue is the most common presenting feature in up to 91.8% of patients 2
- Mucocutaneous symptoms, including lupus-specific rash, mouth ulcers, and alopecia, are also typical presentations of SLE 3
- Musculoskeletal symptoms, such as joint pain and myalgia, are common, with joint pains reported in up to 90.2% of patients 2
- Renal involvement is a significant concern, with up to 75.4% of patients presenting with renal manifestations at initial diagnosis 2
Clinical Manifestations
- Skin involvement is one of the most common manifestations of SLE, with three forms of cutaneous lupus: chronic cutaneous (discoid) lupus, subacute cutaneous lupus, and acute cutaneous lupus 4
- Joint manifestations are typically not associated with warmth of the joints and may be only associated with pain and swelling 4
- Fever is a common presenting feature, reported in up to 88.5% of patients 2
Diagnostic Considerations
- The diagnostic process for SLE involves a systematic evaluation of clinical manifestations and autoantibody profiles, including anti-double-stranded DNA, anti-Sm, hypocomplementaemia, or antiphospholipid antibodies 3
- The latest classification criteria for SLE emphasize the importance of a comprehensive diagnostic approach to facilitate early referral and diagnosis for patients 3