Symptoms of Systemic Lupus Erythematosus (SLE)
SLE is characterized by a wide range of symptoms affecting multiple organ systems, with constitutional, mucocutaneous, and musculoskeletal manifestations typically presenting as the earliest complaints.1
Constitutional Symptoms
- Fever may occur during disease flares and should be distinguished from infection 2
- Fatigue is a common early complaint that significantly impacts quality of life 1, 3
Mucocutaneous Manifestations
- Lupus-specific skin lesions are classified into several categories 2:
- Acute cutaneous lupus (malar "butterfly" rash)
- Subacute cutaneous lupus (photosensitive, non-scarring lesions)
- Chronic cutaneous lupus (discoid lesions)
- Intermittent cutaneous lupus
- Oral ulcers commonly appear on the hard palate, buccal mucosa, or tongue 1
- Alopecia (hair loss) can be scarring or non-scarring 1
- Photosensitivity with skin rashes triggered or worsened by sun exposure 3
Musculoskeletal Symptoms
- Arthralgia (joint pain) and arthritis affecting multiple joints, typically symmetrical 1, 3
- Morning stiffness in joints 3
- Myalgia (muscle pain) and myositis 1, 4
- Chronic widespread pain similar to fibromyalgia is frequently associated with SLE 4
Renal Manifestations
- Kidney involvement may present with proteinuria, hematuria, or impaired renal function 2
- Renal disease relapses are common, observed in up to 45% of patients 5
- Lupus nephritis can be asymptomatic in early stages and detected only through laboratory tests 2
Neuropsychiatric Manifestations
- Headache is one of the most frequent neurological symptoms 5, 2
- Mood disorders including depression and anxiety 2
- Seizures may occur in some patients 2
- Cognitive impairment affecting memory, attention, concentration, and word-finding abilities 5, 2
- Cerebrovascular disease 2
Cardiovascular Manifestations
- Hypertension, especially with renal involvement 2
- Increased risk of atherosclerosis and cardiovascular disease 2
- Pericarditis and other cardiac manifestations 2
- Raynaud's phenomenon (fingers turning white, blue, then red in response to cold or stress) 5
Hematologic Manifestations
- Anemia associated with organ involvement and disease progression 2
- Thrombocytopenia (low platelet count) which can indicate renal disease and worse prognosis 2
- Leukopenia and lymphopenia (low white blood cell counts) which may increase infection risk 2
Laboratory Findings
- 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 typically not elevated unless there is infection or serositis 2, 5
- Positive antinuclear antibody (ANA) test is a hallmark finding 6
- Anti-double-stranded DNA and anti-Sm antibodies are specific for SLE 3
Special Considerations
- Symptoms may worsen during pregnancy, particularly in patients with lupus nephritis and antiphospholipid antibodies 2, 7
- Disease flares can be triggered by sun exposure, infections, stress, and certain medications 1, 3
- Pain in SLE can have different causes and may be associated with fibromyalgia, requiring specific identification and management 4
Understanding these diverse manifestations is crucial for early diagnosis and appropriate management of SLE to prevent organ damage and improve quality of life.