What are the symptoms of lupus?

Symptoms of Systemic Lupus Erythematosus

Lupus presents most commonly with constitutional symptoms (fever, fatigue), mucocutaneous manifestations (rash, mouth ulcers, alopecia), and musculoskeletal complaints (joint pain, myalgia), which typically represent the earliest disease manifestations. 1, 2

Constitutional Symptoms

• Fever occurs during disease flares and must be distinguished from infection 1
• Fatigue is among the earliest and most common complaints in lupus patients 2

Mucocutaneous Manifestations

• Lupus-specific skin lesions are classified into four categories: acute cutaneous lupus, subacute cutaneous lupus, chronic cutaneous lupus (discoid), and intermittent cutaneous lupus 1, 3
• Photosensitive rash is particularly associated with anti-Ro antibodies and subacute lupus 3
• Mouth ulcers represent a common early symptom 2
• Alopecia (hair loss) frequently occurs 2

Musculoskeletal Symptoms

• Joint pain (arthralgia) and myalgia are among the earliest presenting complaints 2
• Joint swelling may occur, typically without warmth of the joints, distinguishing it from infectious arthritis 3
• These manifestations respond rapidly to small or moderate doses of corticosteroids 3

Renal Manifestations

• Proteinuria, hematuria, or impaired renal function indicate kidney involvement, which occurs in approximately 40% of lupus patients 1, 4
• Hypertension is common, especially when renal involvement is present 1
• Renal disease relapses occur in up to 45% of patients 1

Cardiovascular Manifestations

• Pericarditis and other cardiac manifestations may occur 1
• Increased risk of atherosclerosis and cardiovascular disease is associated with lupus 1

Neuropsychiatric Manifestations

• Headache is the most common neuropsychiatric symptom 1
• Mood disorders frequently occur 1
• Seizures may develop 1
• Cognitive impairment can be present 1

Hematologic Manifestations

• Anemia may be associated with organ involvement and disease progression 1
• Thrombocytopenia can indicate renal disease and worse prognosis 1
• Leukopenia and lymphopenia may increase infection risk 1

Laboratory Abnormalities as Symptomatic Indicators

• Low complement levels (C3, C4) often correlate with disease activity 1
• Antiphospholipid antibodies may indicate increased risk for thrombosis and pregnancy complications 1
• C-reactive protein is typically not elevated unless infection or serositis is present 1

Important Clinical Caveats

• Symptoms may worsen during pregnancy, particularly in patients with lupus nephritis and antiphospholipid antibodies 1
• The disease course is variable, with some patients experiencing mild rashes and arthritis while others suffer debilitating fever, fatigue, and severe organ-threatening disease 5
• Constitutional, mucocutaneous, and musculoskeletal symptoms typically precede major organ involvement, making early recognition critical for timely diagnosis and referral 2, 6