What are the symptoms of lupus?

Symptoms of Lupus

Systemic lupus erythematosus (SLE) presents with a wide range of symptoms affecting multiple organ systems, most commonly including constitutional symptoms, mucocutaneous manifestations, and musculoskeletal complaints such as fatigue, rash, mouth ulcers, alopecia, joint pain, and myalgia. 1

Constitutional Symptoms

• Fatigue is one of the earliest and most common complaints in lupus patients 1
• Fever may occur during disease flares and should be distinguished from infection 2
• General malaise and weight loss can be present 3

Mucocutaneous Manifestations

• Lupus-specific skin lesions are classified into several categories 2:
  • Acute cutaneous lupus (including the classic butterfly/malar rash)
  • Subacute cutaneous lupus (photosensitive, non-scarring lesions)
  • Chronic cutaneous (discoid) lupus (scarring lesions)
  • Intermittent cutaneous lupus
• Photosensitivity reactions occur frequently 4
• Oral/nasal ulcers are common manifestations 1
• Alopecia (hair loss) may be scarring or non-scarring 1, 4
• Skin manifestations often respond to antimalarial drugs 4

Musculoskeletal Symptoms

• Joint pain (arthralgia) and swelling are among the most common manifestations 4
• Joint involvement typically does not cause warmth and may only present with pain and swelling 4
• Myalgia (muscle pain) is common 1
• Joint symptoms typically respond rapidly to corticosteroid treatment 4

Renal Manifestations

• Kidney involvement occurs in approximately 40% of SLE patients 3
• May present with proteinuria, hematuria, or impaired renal function 2
• Approximately 10% of people with lupus nephritis develop end-stage kidney disease after 10 years 3
• Renal disease relapses are common, observed in up to 45% of patients 2

Neuropsychiatric Manifestations

• Neurological involvement (central, peripheral, autonomic) is frequent 2
• Most common neuropsychiatric syndromes include 2:
  • Headache
  • Mood disorders
  • Seizures
  • Cognitive impairment (affecting memory, attention, concentration)
  • Cerebrovascular disease
• May require immunosuppressive therapy for inflammatory manifestations 5

Hematologic Abnormalities

• Anemia may be associated with organ involvement and disease progression 2
• Thrombocytopenia can indicate renal disease and worse prognosis 2
• Leukopenia and lymphopenia may increase infection risk 2

Cardiovascular Manifestations

• Increased risk of atherosclerosis and cardiovascular disease 2
• Hypertension is common, especially with renal involvement 2
• Pericarditis and other cardiac manifestations may occur 2

Laboratory Findings

• Positive antinuclear antibodies (ANA) are present in most patients 3
• Anti-double-stranded DNA and anti-Sm antibodies are specific for SLE 3
• Low complement levels (C3, C4) often correlate with disease activity 2
• Antiphospholipid antibodies may indicate increased risk for thrombosis and pregnancy complications 2
• C-reactive protein is typically not elevated unless there is infection or serositis 2

Monitoring Disease Activity

• Disease activity fluctuates with periods of remission and relapse 6
• Symptoms may worsen during pregnancy, particularly in patients with lupus nephritis and antiphospholipid antibodies 2
• Early recognition of symptoms is crucial for prompt treatment to prevent organ damage 1

Drug-Induced Lupus

• Certain medications can trigger lupus-like symptoms 5, 7
• Symptoms typically resolve after discontinuation of the offending drug 5
• Common manifestations include arthralgia, myalgia, rash, and positive ANA 7

Early diagnosis and treatment are essential to prevent organ damage and improve outcomes. The primary goal of treatment is to achieve disease remission or low disease activity while minimizing medication side effects 3.