From the Guidelines
Lupus is a complex autoimmune disease characterized by a wide range of signs and symptoms that can affect multiple body systems, including the skin, joints, kidneys, and nervous system, with common symptoms such as extreme fatigue, joint pain and swelling, and a butterfly-shaped rash across the cheeks and nose 1. The disease can present with various clinical manifestations, including discoid lesions, arthritis, serositis, renal psychosis, or seizures, which can provide prognostic information for the outcome in general and involvement of major organs 1. Some of the key symptoms of lupus include:
- Extreme fatigue
- Joint pain and swelling
- A butterfly-shaped rash across the cheeks and nose
- Skin lesions that worsen with sun exposure
- Fever
- Headaches
- Sensitivity to sunlight
- Hair loss
- Fingers that turn white or blue when cold (Raynaud's phenomenon)
- Shortness of breath
- Chest pain
- Dry eyes
- Internal manifestations such as kidney inflammation, blood disorders like anemia or low platelet counts, and neurological problems such as memory issues or confusion
- Mouth sores, unexplained weight changes, and general malaise These symptoms often fluctuate, with periods of flares when symptoms worsen and remissions when they improve, making lupus challenging to diagnose, as symptoms mimic many other conditions 1. The disease results from an overactive immune system attacking healthy tissues, and symptoms reflect which body systems are being affected, with treatment goals including long-term patient survival, prevention of organ damage, and optimization of health-related quality of life 1. If experiencing multiple symptoms, especially the characteristic butterfly rash, joint pain, and fatigue, medical evaluation is important for proper diagnosis and treatment, as SLE care is multidisciplinary, based on a shared patient-physician decision, and should consider individual, medical, and societal costs 1.
From the Research
Signs and Symptoms of Lupus
- Lupus is a chronic inflammatory autoimmune disease with a wide range of clinical presentations resulting from its effect on multiple organ systems 2
- The disease is characterized by antinuclear antibodies (ANAs) that form immune complexes, which can mediate pathogenesis by tissue deposition or cytokine induction 3
- Patients with lupus experience a loss of self-tolerance as a result of abnormal immunological function and the production of autoantibodies, leading to the formation of immune complexes that may adversely affect healthy tissue 2
- Key features that warrant investigation for lupus include unexplained multisystem inflammatory disease, symmetric joint pain with inflammatory features, photosensitive rash, and cytopenias 4
Types of Lupus
- There are four main types of lupus: neonatal, discoid, drug-induced, and systemic lupus erythematosus (SLE), the type that affects the majority of patients 2
- SLE is a prototypic autoimmune disease characterized by ANAs that form immune complexes, which can mediate pathogenesis by tissue deposition or cytokine induction 3
Diagnosis and Testing
- The antinuclear antibody (ANA) test is positive in nearly every case of SLE, but it is not specific for this disease and must be interpreted in the appropriate clinical context 4
- ANA staining patterns and more specific autoantibody testing may be helpful in diagnosis of suspected SLE or ANA-associated disease 4
- For patients with nonspecific symptoms, such as malaise and fatigue, ANA testing is of limited value 4