Lupus (Systemic Lupus Erythematosus)

Lupus Symptoms

At the onset of lupus, the symptoms are commonly very general and therefore make diagnosing the disease difficult. The most common initial complaints are fatigue, fever, and muscle and joint pain. This is called a "flulike syndrome."

• Fatigue is the most common and bothersome complaint. It is also often the only symptom that remains after treatment of acute flares. A flare in lupus is an acute increase in symptoms.
  
  
• Fever during lupus flares is usually low-grade, rarely exceeding 102°F. A temperature greater than this should stimulate a search for an infection as the source of the fever. However, any fever in lupus should be considered an infection until proven otherwise.
  
  
• Muscle pain (myalgia) and joint pain (arthralgia) without or with joint swelling (arthritis) are very common with the new onset of lupus and with subsequent flares.

Although lupus is a multisystem disease, certain organs are affected more commonly than others:

• Musculoskeletal system: Joint pains are more common than arthritis in people with lupus. The arthritis of lupus is usually found on both sides of the body and does not cause damage to the joints. The most frequently involved joints are those of the hand, knees, and wrists. People with lupus, especially those needing high doses of corticosteroids (steroids, prednisone), can suffer from a certain type of low blood flow injury to a joint causing death of the bone in the joint. This is called avascular necrosis and occurs most commonly in the hips and knees. The muscles themselves can sometimes become inflamed and very painful contributing to weakness and fatigue.
  
  
• Skin and hair: The skin is involved in more than 90% of people with lupus. Skin symptoms are more common in whites than in African Americans. While the classic lupus rash is a redness on the cheeks (malar blush) often brought on by sun exposure, many different types of rashes can be seen in SLE. Discoid lupus with the red skin patches on the skin and scaliness is a special characteristic rash that can lead to scarring. It usually occurs on the face and scalp and can lead to loss of scalp hair (alopecia). It is more common in African Americans with lupus. Occasionally, discoid lupus can occur as an isolated skin condition without systemic disease. Hair loss can occur with flares of SLE even without skin rashes in the scalp. In this situation, the hair regrows after the flare is treated. Hair loss can also occur with immunosuppressive medications.
  
  
• Kidney system: The kidney is involved clinically in more than half of all people with lupus. Severe kidney disease often requires immunosuppressive therapy. All patients with newly diagnosed SLE should have the urine checked for blood and protein because kidney inflammation can be silent in the early stages.
  
  
• Heart and blood vessels: Inflammation of the sac holding the heart (pericarditis) is the most common form of heart problem in people with lupus. This causes chest pain and can mimic a heart attack. Also, growths (vegetations) can form on heart valves causing heart problems. Hardening of the arteries (atherosclerosis) can lead to angina and heart attacks in lupus patients who have required long-term prednisone therapy for severe disease. In some people with lupus, the arterial blood supply to the hand can experience intermittent interruptions due to spasm of the artery. This causes whiteness and blueness in the fingers and is called Raynaud syndrome. It is brought on by emotional events, pain, or cold temperatures.
  
  
• Nervous system: Serious brain and nerve problems and acute psychiatric syndromes occur in about 15% of patients with lupus. Potential disorders include seizures, nerve paralysis, severe depression, psychosis, and strokes. Spinal cord inflammation in lupus is rare but can cause paralysis. Depression is common in SLE. Sometimes it is directly related to active disease and sometimes to emotional difficulties in coping with a chronic illness or to the medications used to treat it, especially high doses of prednisone.
  
  

• Lungs: More than 50% of people with lupus have some sort of lung disease. Inflammation of the lining of the lung (pleurisy) is the most common problem. This can lead to chest pain and shortness of breath and can be confused with clots in the lung or lung infection (pneumonia). Collections of water in the space between the lung and the chest wall occur as well (called pleural effusions). Pneumonia can occur in lupus patients who are taking immunosuppressive medications.

• Blood and lymph system: About half of people with lupus have anemia (low red blood cell counts), and up to half can have thrombocytopenia (low platelet counts) and leukopenia (low white blood cell counts). Low platelet counts can lead to bleeding and bruising in the skin and if severe, it can cause internal bleeding. Some lupus patients are predisposed to developing blood clots in veins (leading to phlebitis) or arteries (leading to strokes or other problems). This is most likely to occur in patients who have certain autoantibodies in their blood called antiphospholipid antibodies. Patients with these clinical problems and these antibodies may need to take blood thinners (anticoagulants) for prolonged periods of time. Women with these antibodies can also suffer from a high frequency of spontaneous miscarriages.
  
  
• Stomach, intestines, liver, and associated organs: Many patients with lupus develop painless ulcers in the mouth and nose at some point in their disease. Abdominal pain in lupus can be due to inflammation of the lining of the abdomen, infection of the intestines, low blood flow to the intestines caused by a clot, or inflammation of the vessels flowing to the intestines. If the person has a lot of free-floating fluid in the abdomen, this fluid may also become infected causing severe pain. The liver is rarely involved.
  
  
• Eyes: The eyes are rarely involved in lupus, except for the retina. People with lupus often have to be screened by an ophthalmologist if they are taking the antimalarial drugs chloroquine or hydroxychloroquine.