What are the common symptoms of a moderate Systemic Lupus Erythematosus (SLE) exacerbation?

From the Guidelines

Moderate Systemic Lupus Erythematosus (SLE) exacerbation typically presents with symptoms such as increased fatigue, low-grade fever, worsening joint pain and swelling, and skin manifestations like new or worsening rashes. These symptoms can be attributed to the intensification of the autoimmune inflammatory process characteristic of lupus, where the immune system attacks healthy tissues throughout the body 1. Some common symptoms of a moderate SLE exacerbation include:

• Increased fatigue
• Low-grade fever
• Worsening joint pain and swelling
• Skin manifestations such as new or worsening rashes (particularly the butterfly-shaped malar rash across the cheeks and nose)
• Muscle pain
• Hair loss
• Mouth or nasal ulcers
• Increased sensitivity to sunlight
• Mild to moderate chest pain from pleuritis or pericarditis
• Headaches
• Cognitive difficulties ("lupus fog")
• Increased anxiety or depression Laboratory findings typically show elevated inflammatory markers (ESR, CRP), decreasing complement levels (C3, C4), and increasing anti-dsDNA antibody titers 1. Patients may also develop mild anemia, leukopenia, or thrombocytopenia. Moderate kidney involvement might manifest as protein or blood in the urine without significant kidney function decline. According to the most recent guidelines, treatment typically involves increasing corticosteroid doses, adding or adjusting immunosuppressive medications, and implementing lifestyle modifications including strict sun protection and stress management 1. It is essential to note that photoprotection should be advised for the prevention of flares, and psychosocial interventions should be considered for improving health-related quality of life (HRQoL), anxiety, and depressive symptoms in patients with SLE 1. Aerobic exercise should also be considered for increasing aerobic capacity and reducing fatigue and depressive symptoms in patients with SLE 1. Overall, the management of moderate SLE exacerbation requires a comprehensive approach that addresses the physical and psychological aspects of the disease.

From the Research

Common Symptoms of Moderate SLE Exacerbation

• Fever
• Cytopenia
• Rash
• Arthritis
• Proteinuria, which may be indicative of lupus nephritis 2

Organ Involvement

• Mucocutaneous
• Musculoskeletal
• Hematologic
• Kidney systems 2

Treatment Approach

• Hydroxychloroquine is the cornerstone of treatment because it reduces disease flares and other constitutional symptoms 3
• Low-dose glucocorticoids can be used to treat most manifestations of lupus 3
• The use of immunosuppressive and cytotoxic agents depends on the body systems affected 3

Disease Management

• Patients with mild disease that does not involve major organ systems can be monitored by their family physician 3
• Patients with increased disease activity, complications, or adverse effects from treatment should be referred to a rheumatologist 3