Systemic lupus erythematosus (SLE), commonly known as “lupus,” is an autoimmune disorder with various manifestations depending on which parts of the body it affects. A patient with lupus would experience a mild condition such as a simple rash or a severe medical entity, such as neurological deficits. Research on SLE has not yet uncovered precisely how and why this autoimmune disorder starts, but some of the significant signs and symptoms a person should always be wary of are mentioned below:
Headache
Patients who have lupus are more prone to experience migraine-like headaches. One study reveals that patients with lupus have a double chance of suffering from migraine-like headaches. Consultation with your doctor is always a wise choice if you are experiencing this type of headaches. Lupus headaches can direly affect a person’s quality of life.
The most common medical causes of a lupus headache are vasculitis, inflammation of blood vessels, and raised intracranial pressure. According to recent research, there are some instances where lupus headaches are not part of the disease process and have no direct link with it. Thus, treatment modifications are not to be based on the incidence of headaches, because it is not a reliable indicator of a flare-up.
Rashes
One of the most important and characteristic symptoms in SLE is a butterfly-shaped rash. It generally appears on both cheeks and the bridge of the nose. It is clinically known as a malar rash, and prolonged exposure to sunlight can increase the chance of its appearance. Around 50 percent of lupus patients would have this characteristic rash on their body. It is generally not painful and may appear in a red, blotchy pattern. Malar rash is typically flat, but in 20% of the cases raised lesions are also observed in lupus patients.
In addition to the malar rash, another type of rash is common among lupus patient, and it is called discoid lupus (or DLE). DLE rashes look like patches and leave a white scaly scar after healing. The patch of rash is initially reddish but may progress to become a raised and thickened scarred lesion. According to research, these rashes are usually caused by an increased sensitivity of the skin cells in lupus patients.
These rashes appear after patients are exposed to sunlight, viruses, hormone changes, and extreme stress, and would require immediate medical checkup.
Loss of hair
In (SLE), hair starts getting thinner, and eventually, the patient suffers from severe hair loss, which is known as alopecia. Doctors link this hair loss to the severe inflammation of the skin in the scalp. The patient’s hair would be brittle and look a bit shabby. Hair loss can be either temporary or permanent. Temporary hair loss is due to mild lupus flares, and proper treatment would usually help the hair to grow back on patient’s scalp, but permanent hair loss is one the most devastating consequences of the disease. 50-60% of patient suffer from this symptom, and it is considered one of the earliest manifestations of this dreadful disease.
Scalp hair is mostly lost in clumps. Other areas that are commonly affected are beard, eyebrows, and eyelashes. Hair loss due to lupus can be due to the destruction of hair follicles as a result of severe inflammation. Research has revealed that discoid scarring is most commonly associated with alopecia.
Kidney inflammation
One of the most dreadful signs of lupus is inflammation of the kidney. In medical language, it is referred to as nephritis. It severely affects the normal functioning of the kidney, which is why the organism fails to purify the blood, remove harmful toxins, and perform other normal functions. Almost half lupus patients develop kidney problems that are clinically evident.
Some of the major conditions are hypertension, darker urine, blood in the urine, excessive proteins in the urine, cellular casts in the urine, flank pain, swelling of your legs and feet, and frequent urination. These symptoms are generally noticed too late, especially when the diagnosis is delayed. Renal biopsy and prompt kidney monitoring tests should be ordered by a physician to determine an appropriate treatment plan for the patient. Ignorance can further deteriorate a patient’s health, and chances of end-stage renal disease are enhanced as the diagnosis delays.
Psychosis and other neurological disorders
The brain can also be affected by lupus, just like any other organ of the body. Psychosis is the most common complaint in lupus patients. Hallucinations, mood disorders, depression, paranoia, and confusion are major psychiatric disorders that can arise in these patients. Neurological disorders occur in about 25-75% of SLE patients, and major disorders are seizures, encephalopathy, aseptic meningitis, myelopathy, neuropathy, and demyelinating diseases.
Neurological exam and ANA test can provide great help in ruling out other causes. Single positron emission computed tomography (SPECT) scans are often ordered in such circumstances in order to assess the blood flow to specific areas of the brain. Certain studies believe that cognitive therapy and proper medication can improve the symptoms of the patient and reduce the chances of aggravations and further complications. 20% of patients would also experience impairment of their memory function. CNS vasculitis can give rise to migraine-like headaches and raised intracranial pressure.
Depression and anxiety occur in 1/3rd of the lupus patients. Mental fatigue, sense of hopelessness and helplessness are significant warning signs of severe depression in lupus patients. There’s a higher prevalence of depression among lupus patients as compared to healthy population, and more research is needed to establish a relation between these two diseases.
Musculoskeletal manifestations
The onset of SLE can be sudden, with a high-grade fever, but it may also appear and progress over the course of days and months. Arthralgias (Joint pain) and acute polyarthritis are two major clinical manifestations in lupus patients. Almost 90% of patients present with these symptoms in any stage of their disease. Most patients would experience joint pain with no evidence of disease on radiographs as lupus does not cause destruction and erosion of the bone in the early stage of the disease. Both large and small joints can be affected symmetrically by the disease. Inflammation of the joint can cause swelling and stiffness, which is most noticeable early in the morning.
In an advanced stage of the disease, SLE can cause deformation and destruction of the bone resulting in deforming arthropathy. Serological tests and prompt medical checkup can help the doctor diagnose the condition as early as possible. Antinuclear antibodies (ANA) and anti-double-stranded (ds) DNA are major serological markers of the disease.
Fatigue is another major issue experienced by lupus patients. It might turn out to be extremely difficult for the patient to get out of the bed in the morning. Doctors believe that fatigue due to SLE is due to overactive nerve signals and imbalance in impulse transmission associated with fibromyalgia. 1/3rd of lupus patients have fibromyalgia, which is why widespread musculoskeletal pain is a common presenting complaint in lupus patients. Other causes of extreme fatigue in lupus patient are anemia, hormonal changes, and kidney dysfunction. Asking your doctor is the best way forward to get to the root of the symptoms and start a proper management of the disease. Adequate exercise and medication can drastically improve the quality of life of the patient.
Pleuritis and other pulmonary symptoms
Inflammation of the lung and associated vessels is another alarming consequence of the disease. The patient complains of severe chest pain during inspiration. This condition is typically referred to as pleuritic chest pain.
In the advanced stage of the disease, the lungs start shrinking as the patient’s condition worsens. This is referred to as shrinking lung syndrome. The diaphragm is also affected in 20-30% of cases. In these circumstances, it is highly advisable to look for medical assistance. Proper examination along with CT scan and chest X-Ray will rule out other entities and support a correct diagnose. It is essential to differentiate these symptoms from causes different than lupus such as cardiac failure, generally referred to as “heart attack.”
The patient normally complains of dull chest pain, dyspnea and shortness of breath, and major pulmonary disorders caused by SLE are pleural effusion, lupus pneumonitis, chronic lupus interstitial lung disease, pulmonary hypertension, and alveolar hemorrhage.
Thyroid dysfunction
The thyroid is the major endocrine organ affected by lupus. Autoimmune thyroiditis is commonly seen in lupus patients. Both hyperthyroidism and hypothyroidism can occur in the patient depending on the course of the disease. It is reported that 6% of lupus patients suffer from hypothyroidism and 1% present with overactive thyroid gland resulting in hyperthyroidism. The thyroid is an important endocrine organ which controls the metabolism of the body, and its dysfunction can lead to devastating consequences on the patient’s health. Brain, heart, lung, kidney, and liver are likely to be affected when there is thyroid dysfunction. Hypothyroidism can cause dry skin, weight gain, muscle pain, depression, and other mood changes. Hyperthyroidism can cause heat intolerance, weight loss, cardiac arrhythmias, murmurs, and osteoporosis.
Gastrointestinal manifestations
Oral ulcers are also commonly seen in SLE patients. Gastric reflux is the most common GIT complaint in lupus patients. Patients present with dyspepsia, nausea and epigastric pain. Vomiting, diarrhea, digestive problems, and constipation are other warning signs of the disease. Patients suffering from lupus are at increased risk of being affected by other gastrointestinal autoimmune disorders such as Crohn’s disease and ulcerative colitis. Inflammation of the peritoneum (lining of the abdomen), which is also referred to as peritonitis, can occur in 25% of the patients. In the advanced stage of the disease, symptoms may progress to ascites, severe abdominal pain, and lack of bowel movements.
Apart from the gastrointestinal tract, the liver is another major organ severely affected by lupus. In SLE, the liver is enlarged, and in late stages of the disease, it is common to have a drastic decrease in its functional ability. Autoimmune hepatitis is observed in many lupus cases. The patients with autoimmune hepatitis present with jaundice and elevated liver enzymes. It is important for them to immediately consult the doctor in order to prevent severe complications of the disease.
Cardiovascular symptoms
Lupus affects heart health in almost all patients. It affects all three layers of the heart, including the pericardium, myocardium, and endocardium.
In pericarditis, patients would complain of substernal pain and breathlessness. In a few instances, patients may also develop pericardial effusion. ECG is generally ordered in such cases, and auscultation is done to evaluate the patient. Fluid drainage is done in case of an effusion.
In myocarditis, the patient presents with palpitation, tachycardia, and breathlessness. Pericarditis is less common, affecting 10% of lupus patients. The most important tests to diagnose pericarditis are ECG and chest X-Ray. Myocarditis occurs as a part of lupus flare-ups, and it is detected by serological tests and other imaging studies.
In endocarditis, small nodule-like lesions are formed on the valves, and these are commonly referred as vegetations. This condition is widespread among lupus patient, and it is collectively called Libman Sach’s endocarditis. Patient presents with fever, malaise, tachycardia, and palpitations. Nodules are 1-4 mm in diameter and are “mulberry-like clusters” mostly present near the edge of the valve. The mitral and aortic valve are the most common sites of such lesions. An immediate visit to the doctor is necessary to ward off any serious consequence of the disease. The physician normally does ECG and cardiac auscultation under such circumstances. Patients with lupus are also at increased risk of developing other heart condition, like atherosclerosis and acute myocardial infarction. One study has shown that 35 to 44-year-old women with lupus have a 50% higher chance of having a heart attack than an average woman.
Apart from cardiac involvement, vascular inflammation is another serious problem faced by lupus patients. Vessels may break and bleed into the tissue as a consequence of the disease. Fever, poor appetite, blurry vision, seizures, stroke, weight loss, and mood disturbances are some significant problems associated with vasculitis.
Conclusion
Lupus is a dreadful disease that affects a wide range of organs including the skin, heart, lung, kidney, and brain, following relapsing and remitting course. It may affect each person differently, but there are some warning signs patients should always be wary of in order to prevent further complications. Immediate consultation with the doctor and proper medication can reduce the widespread damaging effects of this disease.