Lupus

No two cases of lupus are exactly alike. Signs and symptoms may come on suddenly or develop slowly, may be mild or severe, and may be temporary or permanent. Most people with lupus have mild disease characterized by episodes — called flares — when signs and symptoms get worse for a while, then improve or even disappear completely for a time.

The signs and symptoms of lupus that you experience will depend on which body systems are affected by the disease. The most common signs and symptoms include:

• Fatigue and fever
• Joint pain, stiffness and swelling
• Butterfly-shaped rash on the face that covers the cheeks and bridge of the nose
• Skin lesions that appear or worsen with sun exposure (photosensitivity)
• Fingers and toes that turn white or blue when exposed to cold or during stressful periods (Raynaud’s phenomenon)
• Shortness of breath
• Chest pain
• Dry eyes
• Headaches, confusion and memory loss

When to see a doctor

See your doctor if you develop an unexplained rash, ongoing fever, persistent aching or fatigue.

Lupus is a chronic inflammatory disease that occurs when your body’s immune system attacks your own tissues and organs. Inflammation caused by lupus can affect many different body systems — including your joints, skin, kidneys, blood cells, brain, heart and lungs.

Lupus can be difficult to diagnose because its signs and symptoms often mimic those of other ailments. The most distinctive sign of lupus — a facial rash that resembles the wings of a butterfly unfolding across both cheeks — occurs in many but not all cases of lupus.

Some people are born with a tendency toward developing lupus, which may be triggered by infections, certain drugs or even sunlight. While there’s no cure for lupus, treatments can help control symptoms.

Symptoms of lupus 

Symptoms of systemic lupus erythematosus (SLE) can vary widely from person to person. Some people may only experience a few mild symptoms, whereas others may be more severely affected.

Main symptoms

The three main symptoms of SLE are fatigue, joint pain and rashes.

Fatigue

Fatigue is one of the most common symptoms of SLE. You may feel very tired even though you get plenty of sleep. Carrying out everyday tasks, such as housework or office work, can leave you feeling exhausted.

Many people with SLE find that fatigue is the most distressing and disruptive aspect of SLE because it has a negative impact on their work and social life.

Joint pain

If you have SLE, you are likely to experience joint pain in your hands and feet. You may find the pain changes from one set of joints to another quite quickly, and is usually worse in the morning.

Unlike some other conditions that affect the joints, SLE is unlikely to cause your joints to become permanently damaged or deformed.

Rashes

Many people with SLE develop rashes on their skin – most commonly on the face, wrists and hands. A rash over the cheeks and the bridge of the nose is particularly common and is known as a “butterfly rash” or “malar rash”.

Rashes caused by SLE may get better after a few days or weeks, but can last longer or even be permanent.

Rashes caused by SLE can sometimes be itchy or painful, and they may get worse if they are exposed to sunlight. This is known as “photosensitivity”.

Other symptoms

SLE can also cause a wide range of symptoms. However, you’re unlikely to have all of the symptoms listed below, and many people with the condition will only experience the main symptoms.

Other features of SLE may include:

• a fever (high temperature)
• swollen lymph glands (small glands found throughout your body, including in your neck, armpits and groin)
• recurring mouth ulcers
• hair loss (alopecia)
• high blood pressure (hypertension)
• headaches and migraines
• stomach (abdominal) pain
• chest pain
• depression 
• dry eyes
• memory loss
• seizures (fits)
• problems thinking clearly and difficulty telling the difference between reality and imagination (psychosis)
• shortness of breath
• Raynaud’s phenomenon – a condition that limits the blood supply to your hands and feet when it is cold
• ankle swelling and fluid retention (oedema)

What are the common symptoms of lupus?

Because lupus can affect so many different organs, a wide range of symptoms can occur. These symptoms may come and go, and different symptoms may appear at different times during the course of the disease.

The most common symptoms of lupus, which are the same for females and males, are:

• Extreme fatigue (tiredness)
• Headaches
• Painful or swollen joints
• Fever
• Anemia (low numbers of red blood cells or hemoglobin, or low total blood volume)
• Swelling (edema) in feet, legs, hands, and/or around eyes
• Pain in chest on deep breathing (pleurisy)
• Butterfly-shaped rash across cheeks and nose
• Sun- or light-sensitivity (photosensitivity)
• Hair loss
• Abnormal blood clotting
• Fingers turning white and/or blue when cold (Raynaud’s phenomenon)
• Mouth or nose ulcers

Many of these symptoms occur in other illnesses. In fact, lupus is sometimes called “the great imitator” because its symptoms are often like the symptoms of rheumatoid arthritis, blood disorders, fibromyalgia, diabetes, thyroid problems, Lyme disease, and a number of heart, lung, muscle, and bone diseases.

Systemic lupus erythematosus facts

• Systemic lupus erythematosus (SLE) is an autoimmune disease.
• SLE is characterized by the production of unusual antibodies in the blood.
• The cause(s) of SLE is (are) unknown, however, heredity, viruses, ultraviolet light, and drugs all may play some role.
• Lupus symptoms and signs include

• • butterfly rash on the face,
  • appetite loss,
  • hair loss,
  • fever,
  • fatigue,
  • photosensitivity,
  • Raynaud’s phenomenon,
  • pleuritis,
  • pericarditis.

What is systemic lupus erythematosus? What are the types of lupus?

Lupus is an autoimmune disease characterized by acute and chronic inflammation of various tissues of the body. Autoimmune diseases are illnesses that occur when the body’s tissues are attacked by its own immune system. The immune system is a complex system within the body that is designed to fight infectious agents, such as bacteria and other foreign microbes. One of the ways that the immune system fights infections is by producing antibodies that bind to the microbes. People with lupus produce abnormal antibodies in their blood that target tissues within their own body rather than foreign infectious agents. These antibodies are referred to as autoantibodies.

Because the antibodies and accompanying cells of inflammation can affect tissues anywhere in the body, lupus has the potential to affect a variety of areas. Sometimes lupus can cause disease of the skin, heart, lungs, kidneys, joints, and/or nervous system. When only the skin is involved by rash, the condition is called lupus dermatitis or cutaneous lupus erythematosus. A form of lupus dermatitis that can be isolated to the skin, without internal disease, is called discoid lupus. When internal organs are involved, the condition is referred to as systemic lupus erythematosus (SLE).

Introduction 

Lupus is a complex and poorly understood condition that affects many parts of the body and causes symptoms ranging from mild to life-threatening.

Types of lupus

There are some types of lupus that just affect the skin – such as discoid lupus erythematosus and subacute cutaneous lupus erythematosus. Some medications can also cause lupus-like side effects.

However, the term “lupus” is most often used to describe a more severe form of the condition called systemic lupus erythematosus (SLE), which can affect many parts of the body, including the skin, joints and internal organs.

Symptoms range from mild to severe, and many people will have long periods with few or no symptoms before experiencing a sudden flare-up, where their symptoms are particularly severe.

Even mild cases can be distressing and have a considerable impact on a person’s quality of life.

The rest of this article will focus on SLE.

Signs and symptoms

SLE can cause a wide range of symptoms, depending on the areas of the body that are affected. The most common symptoms are:

• fatigue (extreme tiredness)
• rashes – particularly on the face, wrists and hands
• joint pain and swelling

As the symptoms of SLE can be similar to a number of other conditions, many of which are more common, it can be difficult to diagnose.

If you have persistent or troublesome symptoms that you think could be caused by SLE, you should see your GP so they can try to determine the cause.

Read more about the symptoms of lupus and diagnosing lupus. 

What causes lupus?

SLE is an autoimmune condition, which means it is caused by problems with the immune system. For reasons not yet understood, the immune system in people with SLE starts to attack and inflame healthy cells, tissue and organs.

As with other more common autoimmune conditions, such as rheumatoid arthritis, it is thought a combination of genetic and environmental factors may be responsible for triggering SLE in certain people.

How lupus is treated

There is currently no cure for SLE, but there are different medications that can help relieve many of the symptoms and reduce the chances of organ damage.

These medications include:

• hydroxychloroquine – a medicine that has historically been used to treat malaria, but can also help treat some symptoms of SLE
• corticosteroids – anti-inflammatory medications
• immunosuppressants – a group of medicines that suppress your immune system

Treatment for lupus depends on your signs and symptoms. Determining whether your signs and symptoms should be treated and what medications to use requires a careful discussion of the benefits and risks with your doctor. As your signs and symptoms flare and subside, you and your doctor may find that you’ll need to change medications or dosages. The medications most commonly used to control lupus include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs). Over-the-counter NSAIDs, such as naproxen sodium (Aleve) and ibuprofen (Advil, Motrin IB, others), may be used to treat pain, swelling and fever associated with lupus. Stronger NSAIDs are available by prescription. Side effects of NSAIDs include stomach bleeding, kidney problems and an increased risk of heart problems.
• Antimalarial drugs.Medications commonly used to treat malaria, such as hydroxychloroquine (Plaquenil), also can help control lupus. Side effects can include stomach upset and, very rarely, damage to the retina of the eye.
• Corticosteroids.Prednisone and other types of corticosteroids can counter the inflammation of lupus but often produce long-term side effects — including weight gain, easy bruising, thinning bones (osteoporosis), high blood pressure, diabetes and increased risk of infection. The risk of side effects increases with higher doses and longer term therapy.
• Immunosuppressants.Drugs that suppress the immune system may be helpful in serious cases of lupus. Examples include azathioprine (Imuran, Azasan), mycophenolate (CellCept), leflunomide (Arava) and methotrexate (Trexall). Potential side effects may include an increased risk of infection, liver damage, decreased fertility and an increased risk of cancer. A newer medication, belimumab (Benlysta), also reduces lupus symptoms in some people. Side effects include nausea, diarrhea and fever.

Diagnosing lupus is difficult because signs and symptoms vary considerably from person to person. Signs and symptoms of lupus may vary over time and overlap with those of many other disorders. No one test can diagnose lupus. The combination of blood and urine tests, signs and symptoms, and physical examination findings leads to the diagnosis.

Laboratory tests

Blood and urine tests may include:

• • • Complete blood count.This test measures the number of red blood cells, white blood cells and platelets as well as the amount of hemoglobin, a protein in red blood cells. Results may indicate you have anemia, which commonly occurs in lupus. A low white blood cell or platelet count may occur in lupus as well.
    • Erythrocyte sedimentation rate. This blood test determines the rate at which red blood cells settle to the bottom of a tube in an hour. A faster than normal rate may indicate a systemic disease, such as lupus. The sedimentation rate isn’t specific for any one disease. It may be elevated if you have lupus, another inflammatory condition, cancer or an infection.
    • Kidney and liver assessment. Blood tests can assess how well your kidneys and liver are functioning. Lupus can affect these organs.
    • Urinalysis. An examination of a sample of your urine may show an increased protein level or red blood cells in the urine, which may occur if lupus has affected your kidneys.
    • Antinuclear antibody (ANA) test. A positive test for the presence of these antibodies — produced by your immune system — indicates a stimulated immune system. While most people with lupus have a positive ANA test, most people with a positive ANA do not have lupus. If you test positive for ANA, your doctor may advise more-specific antibody testing.

Imaging tests

If your doctor suspects that lupus is affecting your lungs or heart, he or she may suggest:

• • • Chest X-ray. An image of your chest may reveal abnormal shadows that suggest fluid or inflammation in your lungs.
    • Echocardiogram. This test uses sound waves to produce real-time images of your beating heart. It can check for problems with your valves and other portions of your heart.

Biopsy

Lupus can harm your kidneys in many different ways, and treatments can vary, depending on the type of damage that occurs. In some cases, it’s necessary to test a small sample of kidney tissue to determine what the best treatment might be. The sample can be obtained with a needle or through a small incision.