Lupus Symptoms: What to Know
Lupus is a systemic autoimmune disease. This means that the body perceives its organs and tissues as foreign and begins to attack itself.
It is considered systemic because it can affect many different organs and body systems – the skin, the joints, the lungs, the brain, the heart, and the kidneys, for example.
Lupus has many symptoms, many of which mimic other disorders. Because of this, lupus often takes a long time to diagnose or is misdiagnosed.
12 Lupus Symptoms to Know
Here we’ll discuss some of the more common symptoms of lupus and how each of these lupus symptoms are typically treated.
Please note that every person with lupus is different, meaning that although these are some of the more common symptoms, no two people have the same lupus symptoms.
Fatigue
Fatigue is one of the most common symptoms that is associated with lupus. In fact, it affects up to 90 percent of people. Experts are unsure why people with lupus also suffer from fatigue, but one theory is that many people also have a concurrent diagnosis of fibromyalgia – up to one-third of people have fibromyalgia!
Other conditions can also cause fatigue – anemia, depression, and side effects of medications. All of these can occur concurrently with lupus.
Treatment: The most obvious way to treat fatigue associated with lupus is to treat the underlying cause. Other ways to boost energy include regular exercise, ensure that you are getting enough sleep and realizing that you may need more than the standard eight hours, and conserving energy by prioritizing activities.
Hair Loss
Hair loss is one of the first symptoms that are noticed. It occurs as a result of inflammation that occurs on the skin of the scalp. This symptom is nicknamed “lupus hair" because of the thin, brittle, ragged hair that results.
Hair loss that occurs on the scalp typically occurs gradually, but some people lose hair in large clumps. It typically affects the hair of our heads, but it can even affect our eyelashes, eyebrows, beards, and the hair on the rest of our bodies.
Treatment: Typically, the “real" treatment for “lupus hair" is the treatment for lupus itself. Once treatment for lupus begins, hair loss typically results in hair regrowth. However, if lesions develop on the scalp, hair loss can be permanent.
Chest Pain
Lupus can cause chest pain for a number of reasons, such as coronary artery disease, myocarditis, and endocarditis, but one of the most common is pericarditis. Because lupus attacks many of the organs of the body, it also attacks the pericardium, which is the thin sac surrounding the heart.
Mild cases of pericarditis resolve on their own, but more severe cases cause the following symptoms:
- Stabbing chest pain directly behind or to the left of the breastbone
- Shortness of breath
- Low-grade fever
- Malaise
- A dry cough
- Lower extremity swelling
Treatment: Sometimes, pericarditis is one of the first indicators of lupus. Treatment of both pericarditis and lupus, in general, is imperative. Anti-inflammatory drugs will be prescribed in order to reduce the inflammation of the pericardium. In severe cases, corticosteroids may also be prescribed. In rare cases, surgery may be indicated.
Rashes
The hallmark symptom of lupus is the butterfly-shaped rash on the nose that extends to the cheeks; it is also known as a malar rash. This rash occurs suddenly, as a result of exposure to sunlight, or prior to a flare-up. It affects 50 percent of people with lupus.
Lupus can also cause rashes and lesions on other areas of the body. Because people with lupus are often sensitive to the sun, these lesions can occur wherever there is sun exposure. Lupus may even cause hives, although this is rare. Some people may note discolorations of their fingers and toes.
Treatment: Treatment of lupus rashes typically involves treatment of lupus in general. This may involve anti-inflammatory medications, anti-malarial medications (which may help with joint and skin conditions), steroids, and immunosuppressive agents.
Fever
Another one of the first symptoms of lupus is a low-grade fever. This fever occurs for no apparent reason.
A fever that is associated with lupus hovers between 98.5 F (36.9 C) and 101 F (38.3 C). This fever may wax and wane, so many people do not think to see a physician. However, this fever may be an indication of inflammation or a flare-up.
Treatment: You can treat your fever with over-the-counter medications as discussed with your physician. Not every person with lupus experiences fevers; this may be because they are already prescribed large doses of nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, and aspirin, which mask a fever. Contact your physician for higher than normal fevers, which can indicate an infection.
Kidney Inflammation
Kidney inflammation, also called nephritis, may occur about five years after lupus develops. This is because chronic inflammation makes it more difficult for the kidneys to filter the waste and toxins from the blood, resulting in inflammation of the kidneys.
Nephritis symptoms are subtler than the physical symptoms of lupus. These symptoms include:
- High blood pressure
- More concentrated urine, as well as blood in the urine
- Swelling in the lower extremities
- Pain in your side
- Having to urinate more than usual at night
Once lupus is diagnosed, kidney function is monitored to ensure that inflammation does not occur. Untreated nephritis can lead to end-stage renal disease.
Treatment: There are actually five different types of nephritis associated with lupus. The treatment will be tailored to the individual’s circumstances. However, common medications used to treat nephritis include corticosteroids, immunosuppressive medications, and medications used to prevent blood clots and antihypertensive medications.
Painful Joints
Because lupus causes generalized inflammation of the body, the joints are also affected. This inflammation causes pain and stiffness – and the inflammation of the joints may even be visible!
Joint pain that is associated with lupus may be mild at first but may become more painful as the disease progresses. The pain may also wax and wane.
Treatment: Your physician will first suggest that you treat your pain with over-the-counter pain medications. NSAIDs can be particularly helpful because they reduce inflammation. A daily antimalarial medication is also helpful – an example is Plaquenil. Severe pain may be treated with corticosteroids and methotrexate.
Gastrointestinal Symptoms
Gastrointestinal symptoms are fairly common with lupus. Examples include heartburn, gastroesophageal reflux disease (GERD), Crohn’s, and colitis.
As with other body systems that are affected by lupus, the disease itself is what is causing the symptom. This means that the generalized inflammation is wreaking havoc on the GI system. However, sometimes the medications that are prescribed may be causing some of these symptoms.
Treatment: In general, your treatment will depend on the specific symptom/disease that you are suffering from. You can treat some of these gastrointestinal symptoms with over-the-counter antacids. You can also perform self-care measures, such as eating smaller, more frequent meals, avoiding beverages containing caffeine, and sitting upright after meals. For symptoms that persist, you should contact your physician.
Mouth Sores
Mouth sores are exceptionally common in people with lupus – they affect anywhere from 40 to 50 percent of all patients. Although not life-threatening or as painful as other lupus symptoms, they are just as bit as uncomfortable, troublesome, and annoying as other symptoms.
Lupus mouth sores are typically found on the roof of the mouth, although they can also be found on the lips, on the gums, and on the inside of the cheeks. They are bright red in color, with a white “halo" around the edge, and they may have white lines that radiate from the ulcer. These sores are typically not terribly painful, but some people may still experience discomfort.
Treatment: Treatment of mouth sores is aimed at reducing inflammation; a typical treatment is a topical steroid or even an injection into the lesion. Antimalarial medications are helpful for very resistant lesions. People with lupus who are susceptible to mouth ulcers should aim for prevention of ulcers recurring. Here are some tips from Kaleidoscope Fighting Lupus on the prevention of mouth sores:
- Reduce stress levels by doing relaxing activities such as yoga, meditating, reading, and swimming.
- Avoiding foods that may aggravate ulcers.
- Consume a balanced diet.
- Brush teeth gently with a soft toothbrush.
- See a dentist regularly.
- Take all lupus medications as prescribed and see your physician regularly.
Anemia
It has been suggested that approximately half of people with lupus also are anemic. Anemia is defined as “a condition where the red blood cell count, iron count or hemoglobin is less than normal due to illness, inflammation, iron deficiency or loss of blood." There are several types of anemia, and it is the most common type of blood disorder found in people with lupus.
So, why is anemia so common in people with lupus? Experts are not completely sure, but they surmise that it is due to one of the following reasons:
- Inflammation may cause a reduction in the ability to produce red blood cells.
- The kidneys are responsible for the production of erythropoietin, which stimulates the bone marrow to make red blood cells. If the kidneys are inflamed, they may not be making enough erythropoietin.
- NSAIDs are used often for pain. Chronic NSAID use can lead to iron deficiency anemia due to bleeding. They can also cause bone marrow suppression in rare instances.
- Azathioprine (Imuran) and cyclophosphamide, medications that treat lupus, can cause loss of bone marrow.
Treatment: Treatment of anemia will depend on the type of anemia and the cause. Types of anemia are listed below:
- Iron-deficiency anemia: the most common type of anemia, it is caused by a shortage of iron in the body.
- Anemia of chronic disease: certain diseases can cause anemia because they interfere with the production of red blood cells – HIV/AIDS, leukemia, rheumatoid arthritis, Crohn’s disease, myelofibrosis, and of course, lupus.
- Aplastic anemia: a life-threatening type of anemia, it is caused by the body not producing enough red blood cells.
- Sickle cell anemia: this type of anemia is inherited. Red blood cells change into a sickle shape and eventually due, which causes anemia.
- Vitamin deficiency anemia: when the body lacks vitamins such as B12 and folate, it is unable to produce red blood cells, resulting in anemia. This is typically the result of malnutrition.
Muscle Aches
Muscle aches, also known as myalgia, are common in people with lupus. In fact, about two-thirds of people with lupus complain of some type of muscle ache. Fortunately, not every muscle will hurt – the most common myalgias that people complain of are the muscles between the neck and elbow and the hip and knee.
It is worth mentioning that even though muscle pain is felt, this does not mean that the muscles are weakening. Occasionally, the muscles can become red and inflamed, but this is less common than simply feeling pain.
Treatment: Muscle pain is typically treated based on symptoms. Using an over-the-counter pain remedy such as ibuprofen, naproxen, or aspirin can relieve pain as well as inflammation. Using a heat pack of ice pack can also relieve pain – using whatever feels best is suggested. Elevating legs can also provide some relief. According to Lupus LA, the best long-term remedy is exercise – “The more you use the joints and muscles—and the more strength you build in your body—the less likely you are to be laid low by debilitating aches and pains."
Depression and Anxiety
Depression and anxiety are exceptionally common in people with lupus.
In a 2016 by BMC Psychiatry, researchers evaluated 59 studies, which included 10,828 patients with systemic lupus erythematosus (SLE). They found that of these patients, 24 percent suffered from major depression and 37 percent suffered from anxiety. The study concluded that rheumatologists needed to screen their patients for depression and anxiety and refer them to mental health providers for treatment if their screening indicated a need.
Are depression and anxiety a direct cause of lupus? Possibly!
It is thought that the disease process itself may contribute to the development of depression and anxiety. The medications used to treat the disease may even contribute to depression and anxiety.
However, depression and anxiety can also be a side effect of the disease – meaning they can develop because of feeling hopeless from your condition, as well as physical limitations, pain, and uncertainty about the future.
Treatment: It is likely your rheumatologist is screening you for depression and anxiety. You should be honest during these screenings so that you can get help if indicated.
You should also reach out to your healthcare providers if you begin to develop what you think may be depression or anxiety. Your physician may prescribe medications that can help. Your physician should also suggest speaking with a mental health provider.
You can help yourself by doing the following:
- Improve your lifestyle habits by getting exercise, getting enough rest, limiting alcohol intake, and eating a balanced diet.
- Learn stress-management techniques such as meditation, yoga, and progressive muscle relaxation.
- Seek support from a lupus support group, talking to a trusted family member or friend, or a clergy member.
- Do activities that you enjoy.
The Bottom Line…
Lupus is fraught with symptoms. Why? Because it is autoimmune in nature. It is systemic, meaning that it may eventually affect every body system and organ in the body.
However, no two people are alike, and every case is different. Some cases of lupus are more severe than others. While this list may read like a worst-case scenario, there are some people who may suffer from only a symptom or two – and others who may suffer from every symptom in this article.
It is also interesting to note that many of the symptoms are treated in much the same way – with corticosteroids, immunosuppressants, and antimalarial medications. Why? Because gaining control of lupus will reduce the symptoms experienced. Other symptoms are treated simply by treating the symptomology.
If you begin to develop new symptoms, it's important to reach out to your doctor and inform them of any new symptoms. Your healthcare team will develop a treatment plan specifically for you and your symptoms.
Remember at the end of the day, taking the best care of yourself is the best thing you can do. Always make it a priority to practice self-care, do not push yourself, and remember that lupus doesn't define who you are as a person.