Lupus is a severe autoimmune disease that is very complex and has many different varieties for each patient. There are various patterns and organs that may be damaged as a result of the disease, but the most prevalent health condition in lupus is a widespread inflammation that affects organs and tissues. There are different types of lupus according to the pattern of alterations, signs, and symptoms.
The most common type of lupus is systemic lupus erythematosus. As the name implies, it is a systemic alteration affecting many different regions of the body at the same time. Then, we have cutaneous lupus, which primarily manifests in the skin, and has discoid lupus erythematosus as the most common subtype. Other types are neonatal lupus, drug-induced lupus, and many more.
The cause of lupus is not entirely understood, but we do know how the disease starts. It has a strong genetic predisposition, but some environmental factors also contribute to the onset of the disease. The body starts creating antibodies against healthy tissues and blood vessels. Inflammation starts and becomes even worse when the patient experiences flares that usually appear in emotional settings or result from environmental triggers.
Signs and symptoms of lupus
1. Fatigue
Fatigue is not only about feeling tired because all of us have felt that way. Instead, we call fatigue a pathologic state of exhaustion that does not improve after a good night’s rest and other measures. It is common in many different health problems but is pretty severe in certain diseases such as lupus.
Fatigue is a prevalent symptom in most types of lupus, especially systemic lupus erythematosus. Newly diagnosed patients and those who undergo active flares of systemic lupus erythematosus often complain about feeling overly tired and weak. A rheumatologist should carefully assess this symptom because many cases of lupus have a concomitant disease, such as fibromyalgia. It is necessary to know whether fatigue is caused by an active flare, lifestyle habits, depression, medications, or any other cause.
2. Fever
Increased body temperature is one of the earliest signs of systemic inflammation. It happens when we undergo an infection because the body raises its alarms, and our immune cells create inflammatory cytokines. Upon reaching the brain, these inflammatory cytokines stimulate a series of changes that include the thermoregulation of the whole body. Thus, the brain sends signals to the muscles and blood vessels to create and maintain body heat as a way to increase body temperature and contribute to eliminating bacteria.
In lupus inflammatory reaction, the exact mechanism is triggered and does not need an infection. The body creates antibodies and activates an inflammatory response against healthy tissues, and the inflammatory mediators reach the brain with the same effect. However, in these cases, it is essential to investigate whether or not fever is caused by an overlapping infection or a reaction to medications, and only a skilled physician or a rheumatologist will be able to manage these symptoms appropriately.
3. Joint pain
In most cases, joint pain is the initial symptom that forces patients into the doctor’s office. Most patients with systemic lupus erythematosus have joint pain and may also have muscle pain. Some have concomitant arthritis affecting their hands, knees, and wrists. These symptoms are often asymmetrical, meaning that one side is taken while the other might not.
Unlike rheumatoid arthritis, joint pain caused by lupus is not always associated with significant swelling in the articulations. It does not cause deformation in the articulations in the majority of cases. However, it is possible to find some deformities after a while, but it is caused by chronic inflammation of the ligaments, tendons, and the joint capsule.
4. Enlarged organs and lymph nodes
Patients with different types of lupus often have swollen lymph nodes. They might not be initially evident, but a skilled doctor will be able to detect them in different parts of the body. Another common finding is hepatosplenomegaly. In other words, patients have an enlarged liver and spleen. In some cases, the pancreas is also affected by the disease and patients have chronic pancreatitis with chronic abdominal pain. The latter is a dangerous condition that should be addressed as rapidly as possible to prevent complications
5. Weight changes
Patients with lupus often undergo weight changes, and weight loss is the most common, at least in the early stages of the disease. This weight loss is caused by an alteration in the energy metabolism, and loss of appetite also contributes to the problem. In some instances of lupus, patients develop mouth sores, and medications may give them stomach problems, and all of them contribute to inadequate nutrition and weight loss.
Weight gain might also be the case, especially in lupus patients with ongoing treatment. Their treatment includes corticosteroids, and fluid retention is one of the side effects of these medications. Similarly, lupus patients with an alteration to the kidneys would also display fluid retention and swelling, increasing their weight out of water content.
6. Malar rash
This is a classic finding in lupus and a very important sign to consider. The malar bone is located in the area of the cheeks, and an erythematous rash starts to appear in that same spot. It covers the cheek and crosses the face via the nasal bridge as in a butterfly with open wings sparing the nasolabial area. This malar rash is usually painful because the area becomes hypersensitive and itchy and may last for a few days or weeks.
7. Sunlight sensitivity
Photosensitivity or sunlight sensitivity is a skin reaction that appears right after exposing yourself to the sunlight. Patients with skin manifestations of systemic lupus erythematosus experience exacerbations or become worse when they are exposed to the sun. In other cases, they show a skin rash in the areas exposed to sunlight, as in the neck, face, and forehands. These symptoms last for one or two days, and they are a key diagnosis to detect cutaneous manifestations of this disease. However, other patients may also experience photosensitivity for many different reasons. If you find any unusual rash that is triggered by sun exposure, it should be examined by a dermatologist before using any cream or home remedy to fix it.
8. Discoid skin lesions
Discoid lupus erythematosus is one of the most common types of cutaneous manifestations of lupus. It is a type of skin rash consisting of discoid lesions in areas previously exposed to the sun. These lesions may be raised and look like a plaque, often leaving a scar. It is common to find them in the face, scalp, ears, and beard, which are usually associated with hair loss.
Patients with discoid lupus are experiencing a cutaneous type of lupus. Still, they are at risk of developing systemic lupus erythematosus, which does not only include lesions in the skin but many other organs. Thus, it is essential to take measures if you see this type of lesion and treat your condition with a specialist to prevent more aggressive forms of lupus.
9. Renal disease symptoms
In many cases of lupus, patients experience a severe involvement of their kidneys and may end up with acute or chronic renal failure. There are many variations and degrees of renal diseases in lupus, and some develop asymptomatically over the course of many years until the damage becomes irreversible.
Symptoms of a possible renal failure include hypertension that is difficult to control with medications, blood in the urine, fluid retention with swelling in the lower extremities, weight gain, and alterations of lipid levels in the blood. Notify your doctor if you find any of these in combination with a diagnosed type of lupus or any suspicion of this disease.
10. Seizures
There are many causes of seizures, and it is difficult to determine whether or not they are caused by lupus. However, some patients affected by this disease start to experience seizures during the course of systemic lupus erythematosus. It is possible to develop generalized or partial seizures, which are probably secondary to an alteration in the brain’s microvasculature or caused by a metabolic change in lupus patients with kidney or liver failure.
Seizures in lupus can be the only neurologic manifestation or can be accompanied by others, such as stroke, encephalopathy, dementia, psychosis, and cognitive impairment. In either case, these complicated cases should be assessed by a multidisciplinary team of doctors, including rheumatologists and neurologists, to determine the cause and provide a successful treatment.
11. Psychiatric symptoms
Other neurologic problems usually experienced by patients with lupus include cognitive changes, dementia, and psychosis. The most common is dementia, and the second most common is cognitive impairment. All of these result from the activation of inflammatory cascades in the brain’s vasculature. This leads to an activation of macrophages and leukocytes in the blood vessels and the deposition of immune complexes in the small arteries and veins of the central nervous system.
As a result, there’s permanent damage in the blood vessels with impaired blood flow to various parts of the brain. That is why stroke is more common in patients with lupus, as well as cerebral edema and other neurologic manifestations.
12. Shortness of breath
There are several pulmonary manifestations in systemic lupus erythematosus, and most of them result in shortness of breath. This symptom is called dyspnea, and it has many different causes. In severe cases, a pulmonary embolism leads to severe shortness of breath and pain, and in other instances, alveolar hemorrhage, a lung infection, or pneumonitis might compromise the normal function of the respiratory tree and make it difficult to breathe properly.
In every case, talk to your doctor as soon as possible if you have been diagnosed with any type of lupus or suspect the diagnosis and start experiencing severe respiratory problems. It might be due to a simple infection. Still, other diagnoses should be considered as well, and by reaching an early diagnosis, you could be contributing a great deal to solving a severe problem.
13. Chest pain
Similar to shortness of breath, chest pain may also appear as a respiratory symptom in severe cases such as pulmonary embolism or milder cases such as pulmonary infections. A doctor should carefully examine chest pain because systemic lupus erythematosus patients have a higher risk of cardiovascular problems, such as heart failure, coronary vasculitis, and coronary artery disease. All of these complications of systemic lupus erythematosus should be adequately assessed, and the first step is to talk to your doctor about your symptoms.
14. Serositis
This is the clinical term for the inflammation of serous membranes such as the pleura and the pericardium. The former covers the lungs, while the latter is the outer layer of the heart. In lupus patients, they experience serositis symptoms without an actual infection. Pleural effusions or pericardial effusions can compromise the normal function of the heart and the lungs. As mentioned above, these patients experience chest pain, and their symptoms improve when they sit forward. On the stethoscope, doctors can hear a distinct sound called pleural rub or pericardial rub, and pericarditis can also be detected by electrocardiography. Peritoneal serositis is also possible when the affected serous membrane is the inner lining of the abdominal cavity. In such cases, the leading symptom would be abdominal pain.
15. Coughing up blood
It is not the most common respiratory symptom in lupus but deserves a highlight because it is a significant warning sign that should not be neglected. If you are diagnosed with lupus and start coughing up blood, rush to the emergency room and call your doctor immediately. Although rare, alveolar hemorrhage in lupus is a severe and life-threatening complication.
16. Nausea
Patients with lupus may also experience gastrointestinal symptoms, but they are not commonly caused by the disease itself. Instead, they result from medications and may have infectious causes as well. One of the most common complaints is nausea, especially in patients under non-steroidal anti-inflammatory drugs.
17. Frequent miscarriages
A history of frequent miscarriages is a very important clue to suspect systemic lupus erythematosus. These patients typically get pregnant without any problem but experience recurrent pregnancy losses. It could be several early miscarriages or a late pregnancy loss, and it is often caused by a hematologic problem with immune cells and antibodies.
18. Blood alterations
Systemic lupus erythematosus may have a wide range of blood alterations, from anemia to leukopenia. Patients with a weak immune system may have a reduction in their circulating levels of leukocytes or lymphocytes. Anemia may contribute to general malaise and fatigue. And thrombocytopenia may lead to frequent bleeding and blood clotting problems.
19. Naso-oral ulcers
Another manifestation of the disease is the formation of ulcers in the nasal and oral cavity. They are located in the palate, the buccal mucosa, the Tonge, or different parts of the nose. Ulcers are lesions that do not heal properly for several weeks. They are usually painful, cause significant discomfort, and may even reduce the patient’s appetite. Other causes that should be ruled out are vasculitis, inflammatory bowel disease, and herpesviruses.
20. Alopecia
Patients with lupus often suffer from hair fragility or a diffuse thinning of the hair. This is known as alopecia when hair loss is dramatic and leaves the patient with a visible reduction of hair volume or hairless areas on the scalp. The type of alopecia found in lupus is called non-scarring alopecia because it doesn’t leave a scar.
21. A final word about prevention
Is it possible to prevent a disease deeply influenced by our genetics? In most cases, it is. In the case of lupus, there’s an interplay of genetic and environmental factors contributing to the onset of the disease. Yet, it is not fully understood whether or not lifestyle changes reduce your overall risk of suffering from systemic lupus erythematous. What we do know is that it is possible to prevent the progression of the disease.
As we mentioned previously, there are various types of lupus, and systemic lupus erythematosus is one of the most severe types because it involves many different tissues and organs throughout the body. It is possible to prevent the progression from lupus with cutaneous manifestation to a systemic form of the disease. By starting an early treatment and keeping your doctor’s recommendations, you can prevent a discoid lupus erythematosus from turning into a systemic lupus erythematosus. Thus, if you have discoid lesions, pay close attention to them and follow your doctor’s advice to the letter.
Besides preventing flare-ups, your treatment for lupus is meant to improve your immune system and prevent organ and tissue damage that is likely to appear in patients with systemic lupus erythematosus. As you have seen, lupus symptoms are quite variable and may include almost every organ in your body. We have covered the most essential signs and symptoms above, but there are many more in different body systems. If you have any doubt, recently experienced concerning symptoms, or suspect something is wrong with your body, talk to your doctor about what you’re feeling and get medical help immediately if your symptoms are severe or deeply concerning.