Lupus: Symptoms and Early Signs

Lupus is a chronic autoimmune disease: the immune system attacks the body's own tissues, including the joints, skin, kidneys, heart, lungs, and brain. There are many manifestations, and they differ from person to person. Let us examine the mechanism and the early signs that help raise suspicion of lupus.

What is lupus and why does it have many faces

Lupus is an autoimmune condition: the body's defenses mistakenly attack healthy cells and cause inflammation that affects the joints, skin, kidneys, heart, lungs, and brain. The disease is not contagious, and the exact causes are unknown; heredity, viral infections, sun exposure, certain medications, smoking, puberty, childbirth, and menopause are discussed.

There are several forms. The most common is systemic lupus erythematosus (SLE). Cutaneous lupus causes a rash and ulcerations after sun exposure. Drug-induced lupus begins after 3–6 months of taking a medication and usually resolves after it is discontinued. Neonatal lupus is rare, occurs in newborns, and is due to maternal antibodies.

Imagine that immunity is a guard at the entrance checking everyone against a pass sample. In lupus, the sample is corrupted, and the guard stops recognizing its own. The posts are different — which is why in one person everything starts with the joints, and in another with a rash on the face.

Early signs of lupus

The onset is often vague: unexplained rises in temperature, weakness, headaches, muscle pain, and rapid fatigue. Individually these are nonspecific, but together with more characteristic manifestations they increase the likelihood of SLE. Early complaints look like this:

• fatigue that does not go away after rest;
• joint and muscle pain, morning stiffness;
• a rash after sun exposure, more often on the bridge of the nose and cheeks;
• mouth sores, hair loss;
• unexplained fever, enlarged lymph nodes in the neck, armpits, or groin.

Skin and joint symptoms

The skin reacts in 65% of patients and often first. The "butterfly rash" — a red maculopapular rash on the cheeks and bridge of the nose — occurs in 30–50%. Discoid lesions are thick red scaly patches that later lead to atrophy of the skin of the face, limbs, and trunk. Scarring alopecia and ulcers of the mouth, nose, and vagina are possible.

Joints hurt in most patients, more often the small joints of the hands and wrists: arthralgias, less often symmetric polyarthritis with morning stiffness and muscle pain. Unlike rheumatoid arthritis, the bone is not destroyed, but in 20% the deformities become irreversible. In men, the onset is often sacroiliitis.

Internal organ involvement and general symptoms

The kidneys are affected by lupus nephritis — the most serious organ manifestation; sometimes the only sign is painless blood or protein in the urine. Nephrotic syndrome occurs in 50% of those affected; acute renal failure with early diagnosis occurs in no more than 5%. The heart responds with pericarditis, myocarditis, and noninfectious endocarditis; the vessels with Raynaud's syndrome with pallor and blueness of the fingers in the cold and under stress.

The lungs produce pleuritis, which makes breathing painful. The blood — thrombocytopenia with hemorrhagic spots, leukopenia, anemia. The nervous system — headaches, memory impairment, anxiety, depression, seizures. Enlarged glands, weight loss, chest and abdominal pain, leg swelling, and dry eyes are added. The course is undulating: flares last for weeks, then the symptoms subside; in some people they are constant.

Symptoms in women: why they are affected more often

Women are affected far more often than men; the risk is higher in women of African, Caribbean, Asian, and Chinese origin, and severe forms occur in Black and Latina women. Pregnancy with lupus can have complications, so it is discussed with a doctor in advance.

How the diagnosis is confirmed and when to see a doctor

There is no single test for lupus, and it is confused with similar diseases, so the diagnosis is not made immediately. The doctor asks about symptoms, examines the patient, and orders blood tests (ANA, antibodies, complete blood count, complement), a urine test, and, if necessary, a biopsy and organ imaging. The diagnosis is confirmed by a combination of typical symptoms and laboratory findings.

The reason to see a doctor is recurring unexplained symptoms: early detection and treatment improve control of the disease, and regular blood and urine checks are needed.

Lupus by itself is not a reason to call an ambulance; 103 or 112 — if seizures, confusion, or chest pain on breathing appear.

This material is for reference: it helps to recognize symptoms but does not replace a doctor's consultation.

This content is for reference and does not replace a doctor's consultation. Medical disclaimer