What are the symptoms of lupus?

Symptoms of Systemic Lupus Erythematosus

Lupus presents most commonly with constitutional symptoms, mucocutaneous manifestations, and musculoskeletal complaints, which typically represent the earliest disease manifestations that should prompt diagnostic evaluation. 1

Early and Constitutional Symptoms

• Fatigue is one of the earliest and most common complaints in lupus patients, often preceding other manifestations 1
• Fever occurs during disease flares and must be carefully distinguished from infectious causes 2
• These constitutional symptoms are frequently the initial presentation that brings patients to medical attention 1

Mucocutaneous Manifestations

The skin involvement in lupus is classified into distinct categories that help guide diagnosis:

• Lupus-specific rashes include acute cutaneous lupus (such as the classic malar or "butterfly" rash), subacute cutaneous lupus, chronic cutaneous lupus (discoid lesions), and intermittent cutaneous lupus 2
• Photosensitive rashes are particularly common and closely associated with anti-Ro antibodies 3
• Mouth ulcers are a frequent mucocutaneous symptom 1
• Alopecia (hair loss) occurs commonly in active disease 1
• Skin and joint involvements represent the most commonly occurring manifestations overall 3

Musculoskeletal Symptoms

• Joint pain (arthralgia) and myalgia are among the earliest complaints 1
• Joint manifestations typically present with pain and swelling but characteristically lack warmth of the joints, distinguishing lupus arthritis from infectious or other inflammatory arthritides 3
• These symptoms respond rapidly to corticosteroids 3

Renal Manifestations

• Kidney involvement presents with proteinuria, hematuria, or impaired renal function 2
• Renal disease relapses are common, occurring in up to 45% of patients 2
• Approximately 40% of lupus patients develop lupus nephritis, with 10% progressing to end-stage kidney disease after 10 years 4
• Hypertension frequently accompanies renal involvement 2

Cardiovascular Manifestations

• Increased risk of atherosclerosis and cardiovascular disease is a major concern 2
• Pericarditis and other cardiac manifestations may occur 2
• Cardiovascular disease represents a significant cause of morbidity requiring vigilant prevention strategies 1

Neuropsychiatric Symptoms

The most common neuropsychiatric manifestations include:

• Headache 2
• Mood disorders 2
• Seizures 2
• Cognitive impairment 2
• These neurological involvements are frequent and can significantly impact quality of life 2

Hematologic Abnormalities

• Anemia may be associated with organ involvement and disease progression 2
• Thrombocytopenia can indicate renal disease and portends a worse prognosis 2
• Leukopenia and lymphopenia increase infection risk 2
• Cytopenia is included in classification criteria as an important clinical factor 4

Laboratory and Immunologic Findings

While not symptoms per se, these findings correlate with clinical manifestations:

• Low complement levels often correlate with active disease 2
• Antiphospholipid antibodies indicate increased risk for thrombosis and pregnancy complications 2
• C-reactive protein typically remains normal unless infection or serositis is present, which is a useful distinguishing feature 2
• Autoantibodies towards nuclear antigens and immune complex deposition characterize the disease pathophysiology 1

Important Clinical Pitfalls

• Symptoms may worsen during pregnancy, particularly in patients with lupus nephritis and antiphospholipid antibodies 2
• The disease course remains variable with presentations ranging from mild rashes and arthritis to debilitating fever, severe organ involvement, and life-threatening disease 5
• Multiple organ systems can be affected simultaneously, including skin, joints, kidneys, heart, and brain 5