Lupus is a chronic autoimmune disease that causes inflammation throughout the body. An autoimmune disease means the body’s immune system attacks its own healthy cells and tissues. With lupus, nearly any part of the body can be affected. Common symptoms include fatigue, joint pain, rash, and fever.
Lupus can be difficult to diagnose because its signs and symptoms often mimic those of other ailments. The most distinctive sign of lupus is a facial rash that resembles the wings of a butterfly unfolding across both cheeks. Some people with lupus only develop this classic rash. For others, the rash gets worse or better over time.
The top 10 most common signs and symptoms of lupus are:
- Fatigue
- Joint pain, stiffness and swelling
- Butterfly rash on cheeks and nose
- Skin lesions that worsen with sun exposure
- Fingers turning white or blue when cold (Raynaud’s phenomenon)
- Shortness of breath
- Dry eyes
- Headaches, confusion and memory loss
- Mouth or nose ulcers
- Hair loss
While these are the most common signs, each person’s experience with lupus will be slightly different. Many other symptoms are possible with lupus as well. Let’s take a closer look at each of these top 10 signs and how they relate to lupus.
1. Fatigue
Fatigue is one of the most common and debilitating symptoms of lupus. Up to 80-90% of people with lupus report experiencing fatigue or extreme tiredness. It’s typically described as an overwhelming feeling of weakness, exhaustion or lack of energy.
The fatigue associated with lupus often comes on suddenly and can make it challenging to complete everyday tasks. Unlike normal fatigue, lupus fatigue usually doesn’t get better with rest. Symptoms may worsen during lupus flares.
Several factors are believed to cause fatigue in lupus patients, including:
- The disease process itself
- Inflammation causing muscle and joint pain
- Anemia or low red blood cell counts
- Sleep disturbances
- Depression or anxiety
- Medication side effects
Getting adequate rest, exercise and stress management can help reduce lupus fatigue. But because the fatigue is chronic, most patients need to pace themselves and change priorities to cope with it.
2. Joint pain, stiffness and swelling
Around 90% of people with lupus experience joint pain. Any joint can be affected, but the small joints in the hands and feet are most commonly involved. The joints may feel tender, achy and stiff, especially in the morning.
Joint swelling may also occur, caused by inflammation of the joint lining. The knees, wrists and fingers are areas frequently affected by joint swelling. Over time, inflammation can damage the joint itself and cause deformity.
Lupus arthritis pain and stiffness often come and go. They tend to worsen during flares when the immune system is overactive. Lupus joint problems can mimic rheumatoid arthritis.
To relieve pain and inflammation, doctors may prescribe anti-inflammatory drugs, steroids, or immunosuppressive medications. Applying heat or ice packs, resting the joints, physical therapy, and exercise can also help.
3. Butterfly rash on cheeks and nose
Between 40-70% of people with lupus develop a characteristic red facial rash over the cheeks and bridge of the nose, resembling the shape of a butterfly’s wings. It often first appears during a flare up and then subsides as the flare resolves.
Exposure to sunlight typically worsens the rash, causing increased redness, swelling and peeling. Over time, the rash may leave dark patches of color change on the skin. On darker skin tones the rash is more difficult to identify but still may itch or burn.
While the classic butterfly rash is the most recognized feature of lupus, not all patients develop this symptom. Some only have the rash temporarily. The presence of the rash along with other symptoms can help confirm an lupus diagnosis.
4. Skin lesions worsened by sun exposure
Sun sensitivity and skin lesions frequently occur with lupus. When exposed to UV rays, an existing rash may intensify and spread. Prolonged sun exposure can even trigger a flare.
Areas of skin exposed to sun develop lesions or small reddish spots. The spots do not itch or cause discomfort, but over time, sun damage can cause scarring, skin discoloration and skin thickening.
To prevent flares, it’s crucial for lupus patients to use sunscreen and wear protective clothing, hats and sunglasses outdoors. Avoiding peak sun hours is also recommended. Some medications can increase sun sensitivity as well.
5. Raynaud’s phenomenon
Raynaud’s phenomenon is a condition where small blood vessels in the fingers and toes temporarily constrict or go into vasospasm in response to cold temperatures or stress. This causes the skin color to turn white and then bluish, followed by flushing and redness as blood flow returns.
About a third of people with lupus experience Raynaud’s. The color changes most often occur in the fingers but can affect the toes, ears, nose and lips as well. Exposure to cold temperatures, smoking, anxiety and certain medications can trigger an episode.
Keeping the body warm, quitting smoking, and avoiding medications linked to Raynaud’s helps manage symptoms. If vasospasms are severe, medication may be prescribed to relax blood vessels and improve circulation.
6. Shortness of breath
Around half of lupus patients experience shortness of breath or difficulty breathing at some point. This symptom can result from multiple factors:
- Inflammation of the lungs (pleuritis) causing chest pain with deep breathing
- Fluid around the lungs or heart (effusion) putting pressure on the lungs
- Anemia lowering oxygen delivery throughout the body
- Damage to lung tissue causing shortness of breath with activity
Treating the underlying cause, such as reducing inflammation or draining excess fluid, helps improve breathing. Lung damage related to lupus usually doesn’t progress once the disease is controlled.
7. Dry eyes
Up to a quarter of lupus patients experience dry eyes or increased eye discomfort. This occurs when lupus leads to inflammation of glands in the eyelids that normally produce tears. With inadequate lubrication, patients feel grittiness, burning and itchiness in the eyes.
Artificial tears, gels and ointments help increase moisture and comfort. Plugging the tear ducts, medications to reduce inflammation, or surgery may be options if dry eyes are severe and persistent.
8. Headaches, confusion and memory loss
Many lupus patients report headaches, memory issues, and mood disorders like depression. Headaches are often linked to the disease itself, rather than being a migraine or tension headache.
Problems with memory, concentration and confusion occur in up to 80% of lupus patients. Cognitive dysfunction is believed to stem from multiple causes, including inflammation, hormonal changes, antibodies attacking brain tissue, and side effects of medications.
Headaches and cognitive problems may come and go with flares. Lupus-related headaches are often hard to treat but medications, biofeedback, acupuncture, cognitive behavioral therapy and other alternative therapies can help manage symptoms.
9. Mouth or nose ulcers
Around 30-40% of lupus patients develop mouth or nose ulcers. These painless sores appear on the inside of the cheeks, lips or nostrils as a result of inflammation. They typically last 7-14 days before healing.
Ulcers in the nose and mouth are recurring, flaring up during active disease then disappearing for a time once inflammation is controlled. Small ulcers may be tolerable, but larger or more numerous sores can make eating, swallowing, or speaking difficult.
Mouth rinses, pain relievers, topical numbing agents, and corticosteroids help manage ulcers. Antimalarial drugs may help prevent recurrence and complications like secondary infections.
10. Hair loss
Thinning hair or hair loss occurs in around 45% of lupus patients. It is usually mild and involves a thinning of hair rather than large bald patches. Hair loss tends to come and go along with flares.
Several factors can trigger lupus-related hair loss:
- Inflammation damaging the hair follicles
- Stress on the body from illness or infection
- Medications used to treat lupus
- Nutrient deficiencies like iron or zinc
- Hormonal changes
Hair typically regrows once the episode of active lupus passes. Eating nutritious foods, reducing stress, and taking supplements helps support healthy hair growth.
Diagnosing Lupus
There is no single test that definitively diagnoses lupus. Doctors must examine symptoms, medical history and lab test results to determine if lupus is the cause. Common lab tests used include:
- Complete blood count (CBC): Checks for anemia, low white blood cell, or platelet counts signaling lupus.
- Erythrocyte sedimentation rate (ESR): Elevated rates indicate increased inflammation.
- C-reactive protein (CRP): High levels mean there is inflammation somewhere in the body.
- Antinuclear antibody test (ANA): Positive results indicate an overactive immune system attacking healthy cells.
- Urinalysis: The presence of blood, protein or cellular casts points to lupus kidney complications.
- Complement test: Low levels of complement proteins suggest lupus antibodies are being overproduced.
Other antibodies tests check for antibodies related to lupus and its effects on specific body tissues and organs. If lupus is suspected, blood or urine tests are done to assess which systems are being affected.
Treatment for Lupus
While there is no cure for lupus, several medications are used to reduce inflammation and pain, prevent flares, and minimize organ damage. Commonly prescribed drugs include:
- Nonsteroidal anti-inflammatory drugs (NSAIDs) – For joint pain and swelling.
- Antimalarial drugs – Such as hydroxychloroquine to prevent flares.
- Corticosteroids – To quickly control inflammation during a flare.
- Immunosuppressants – Including azathioprine, methotrexate and mycophenolate to reduce immune system overactivity.
- Biologic drugs – Belimumab is a biologic approved for lupus treatment.
In addition to medications, doctors may recommend:
- Avoiding sunlight and UV exposure
- Following an anti-inflammatory diet
- Reducing stress
- Exercising regularly
- Quitting smoking
- Avoiding infections through washing hands and vaccination
Alternative therapies like acupuncture, massage and yoga may help ease pain and fatigue. Close work with a rheumatologist knowledgeable in lupus treatment gives patients the best chance of effectively managing this disease.
Lupus Complications
Without treatment, lupus can progress and cause damage to nearly any part of the body. Potential complications include:
- Kidney disease leading to end stage renal failure requiring dialysis or transplant
- Cardiovascular disease causing heart attack, stroke and aneurysms
- Pregnancy complications like preeclampsia, miscarriage or stillbirth
- Increased infections due to immunosuppressant therapy
- Gastrointestinal problems including ulcers or inflammation
- Seizures or psychosis
- Blood disorders disrupting clotting
Early diagnosis, disease monitoring, and effective treatment helps avoid the serious complications of lupus. But even with medical intervention, most patients have a normal life expectancy.
Living with Lupus
Learning to live with lupus takes time. Flares will periodically arise, causing disease activity and symptoms. But patients can take steps to cope with lupus in daily life:
- Get adequate rest and maintain a regular sleep schedule
- Exercise moderately when possible to increase stamina and lower stress
- Eat a balanced diet high in plant foods and low in saturated fat
- Protect skin from UV exposure by using sunscreen and protective clothing
- Reduce stress through techniques like meditation, yoga or journaling
- Ask for accommodations at school or work during flares when needed
- Join a lupus support group to share experiences and tips
- Communicate limitations and needs clearly with loved ones
While lupus imposes challenges, patients taking control of their health and involving loved ones in their care can live full, active lives.
Conclusion
Lupus is an unpredictable autoimmune disease that can be difficult to diagnose. Its most common symptoms include fatigue, joint pain, butterfly rash, photosensitivity, Raynaud’s phenomenon, shortness of breath, dry eyes, headaches, mouth ulcers and hair loss.
The symptoms of lupus vary widely among patients and flare up and subside over time. With a thorough evaluation of symptoms and lab tests, doctors can determine if lupus is the underlying cause. Early treatment helps control inflammation and prevent serious complications.
While living with lupus poses daily challenges, patients can manage the disease by protecting themselves from UV light, following an anti-inflammatory lifestyle, communicating needs to loved ones, and working closely with their rheumatology team. Even though there is currently no cure, with proper care lupus can be effectively treated.
