What are the symptoms of lupus?

Symptoms of Lupus

Lupus presents with diverse clinical manifestations affecting multiple organ systems, including mucocutaneous, musculoskeletal, renal, and neuropsychiatric manifestations, which significantly impact morbidity and mortality. 1

Common Clinical Manifestations

Constitutional Symptoms

• Fatigue
• Fever
• Weight loss

Mucocutaneous Manifestations

• Malar (butterfly) rash
• Discoid lesions
• Photosensitivity
• Oral/nasal ulcers
• Alopecia
• Subacute cutaneous lupus lesions

Musculoskeletal Manifestations

• Arthritis (non-erosive)
• Joint pain and swelling
• Myalgia
• Myositis

Renal Manifestations

• Proteinuria
• Hematuria
• Cellular casts
• Elevated creatinine
• Hypertension

Neuropsychiatric Manifestations

• Headache
• Mood disorders
• Seizures
• Cognitive impairment
• Cerebrovascular disease
• Psychosis
• Peripheral neuropathy
• Acute confusional state/coma
• Optic neuritis
• Transverse myelitis/myelopathy 2, 1

Cardiovascular Manifestations

• Pericarditis
• Myocarditis
• Libman-Sacks endocarditis
• Accelerated atherosclerosis 1

Pulmonary Manifestations

• Pleuritis
• Pneumonitis
• Pulmonary hypertension
• Interstitial lung disease
• Shrinking lung syndrome 1

Hematological Manifestations

• Anemia
• Thrombocytopenia
• Leukopenia/lymphopenia 2, 1

Laboratory Findings

Immunological Markers

• Anti-nuclear antibodies (ANA)
• Anti-double-stranded DNA antibodies (anti-dsDNA)
• Anti-Smith antibodies (anti-Sm)
• Anti-Ro/SSA and anti-La/SSB antibodies
• Antiphospholipid antibodies
• Low complement levels (C3, C4) 2, 1

Other Laboratory Abnormalities

• Elevated erythrocyte sedimentation rate (ESR)
• Normal or mildly elevated C-reactive protein (CRP)
  • Note: Significantly elevated CRP (>50 mg/L) suggests infection rather than lupus flare 2

Clinical Pearls

1. The presentation of lupus is highly variable, with symptoms potentially affecting any organ system.

2. Early symptoms often include constitutional complaints (fatigue, fever), skin manifestations, and joint pain, which may precede diagnosis by months or years 3.

3. Symptoms often fluctuate with periods of flares and remissions.

4. Certain antibody profiles correlate with specific clinical manifestations:

   • Anti-dsDNA antibodies → renal disease
   • Anti-Ro/SSA antibodies → photosensitive rash and subacute cutaneous lupus
   • Antiphospholipid antibodies → thrombotic events and pregnancy complications 2, 1

5. Infections are a major cause of morbidity and mortality in lupus patients and may mimic disease flares. Key distinguishing features include:

   • Elevated CRP with normal ESR suggests infection rather than lupus flare
   • Presence of fever without other signs of active lupus 2, 1

6. Cutaneous manifestations of lupus may be difficult to diagnose and may require evaluation by an experienced dermatologist and skin biopsy for definitive diagnosis 2.

7. Common co-morbidities include:

   • Infections
   • Atherosclerosis
   • Hypertension
   • Dyslipidemia
   • Diabetes
   • Osteoporosis
   • Avascular necrosis
   • Malignancies (especially non-Hodgkin's lymphoma) 2, 1

Understanding these diverse manifestations is crucial for early diagnosis and appropriate management of lupus, as prompt intervention can significantly improve outcomes and reduce organ damage.