When someone suffers from an illness, one of the prominent symptoms seen is fatigue. In the case of short-term infections, the fatigue usually subsides after a couple of days, and we can resume our normal routine with ample energy. If the fatigue lasts longer and becomes drastically harder to function, it can indicate a more serious disease.
Lupus is a systemic autoimmune disease with a variety of manifestations that may affect any organ system in the body. Fatigue is one of the most frequently reported problems among lupus patients. Symptoms can be multisystem, but fatigue is one uncommon symptom that is universal in all patients, related to both mild and severe forms of the disease. Fatigue is sometimes the biggest issue that takes away the patient’s satisfaction in life.
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It has been noted that lupus can involve musculoskeletal systems. More than 90% of patients have joint-related symptoms. Joint symptoms are frequently the initial presentation of the disease. Patients will mostly state that they suffer from joint pain rather than arthritis. However, mild inflammation may be noted. Typically, the inflammation will be treated by several joints, especially the small joints of the hands, knees, and wrists, but any joint can be affected.
Patients typically rate joint pain as mild. Joint destruction is not common. The pain patients feel can be extremely uncomfortable. Consequentially, lupus patients may develop fibromyalgia and generalized pain. Muscle and joint pain can be multi-focal and is a significant burden for the patients.
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The disease process involves the skin or mucous membranes. Most lupus patients observe some skin manifestations at a certain stage of the disease. Skin symptoms are highly variable and diverse. It is possible to experience symptoms associated with scarring and atrophy. Other presentations include patients developing skin blistering and skin lesions secondary to vasculitis. The presence of skin rashes in several parts of the body is a typical symptom related to lupus.
It can present as a macular or papular rash. It can also appear as rosacea, seborrhoeic dermatitis, or psoriatic lesions. The rash would develop on the face, neck, or other parts of the body. It may present with scarring or non-scarring alopecia from time to time. This explains why the disease tends to need aggressive treatment to reduce scarring and dyspigmentation.
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Lupus patients also have skin that is far more sensitive to light than others. It means, the abnormal skin reaction to exposition to ultraviolet A/B radiation and visible light can produce adverse health effect. Photodermatoses are symptoms that are localized in sun-exposed skin sites (primarily face, neck and hands). Skin irritated by light can be red and painful. Different skin lesions can appear, for example in the form of blisters.
The skin’s sensitivity could be prolonged for weeks to even months, putting patients at risk of skin damage for a prolonged period of time. The systemic and skin symptoms of these patients also aggravate after exposure to the sun. Photophobia plays an important role in patients’ quality of life. As such, it is best for patients to stay away from direct lights, wear covering clothes, and utilize sunscreen. Sufficient photoprotection is a key step in managing symptoms in patients with lupus.
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Fever is also an important systemic symptom of lupus. It happens in over 50 percent of individuals. Fever is due to active disease but can also result from infections or drug reactions. One frequent presentation in the history of lupus is episodic fever. In the case of an exacerbation of the disease, the temperature rises periodically and then drops to normal values.
Persistent fever, on the other hand, can also occur during this process and may be a sign that the disease is targeting the central nervous system. These patients are in an immunocompromised state, so infections need to be ruled out first during diagnosis. However, doctors are unable to find the source of the fever and mistakenly attribute it to a rare fever of unknown origin in patients who have not been diagnosed with lupus.
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Anemia and other hematological system abnormalities are prevalent findings among patients with lupus. All three types of cells present in human blood may decline in the clinical picture of lupus. Anemia is a condition when there are too few red blood cells in the blood, and leukopenia is the term for too few white blood cells. A low platelet count is called thrombocytopenia. If all three types of blood cells are decreased, we call that condition pancytopenia.
Anemia in lupus occurs through several different mechanisms. Additionally, lymphopenia is frequently moderate in severity and widespread in lupus. Mild or severe thrombocytopenia can occur. Patients also may have pancytopenia, which can be linked to bone marrow fibrosis. These abnormalities lead to a multitude of symptoms, such as gum bleeding issues, nosebleeds, or internal bleeding. Some patients have an increased risk of thromboembolic disease.
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Around 10%-80% of patients present neurological and psychiatric symptoms. The disease process may involve the central nervous system. The most frequent CNS symptom is refractory headaches. Patients will relate the complaints in different ways. Some people develop tension headaches alongside it. Nevertheless, most patients report migraine headaches complicated by a chronic course.
While the prevalence of this symptom resembles that of the general population, the headaches significantly affect these patients more. Someone with lupus can experience a type of headache that is not relieved with pain medication; often, this is a very intense headache that lasts a long time. As such, this symptom can be particularly bothersome for patients. Vascular problems, such as cerebral venous sinus thrombosis, can cause lupus headaches.
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Hematuria means that there is blood in the patient’s urine. So, people who have lupus may see this symptom. This multisystem disease frequently results in lupus nephritis. The inflammation can be developed at the initial stage of the disease. However, the patient could see that the color of their blood was abnormal (pinkish-red). However, it may occur that blood in the urine appears only under the microscope, which the patients cannot be aware of this anomaly.
In fact, apart from hematuria in the context of renal problems, other classic clinical manifestations such as hypertension can also be present. An important abnormality in lupus is the presence of protein in the urine. It can vary from mild subrenal proteinuria, to diffuse progressive glomerulonephritis that results in a chronic renal damage. A renal biopsy should be performed in all patients with evidence of renal involvement.
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The symptoms of lupus can vary widely. Pulmonary manifestations may also occur. It is associated with dyspnoea and episodic pleuritic chest pain as per the history given by the patients. These patients can have an insidious decline in lung volume. Therefore, pulmonary function tests are frequently performed in patients with any pulmonary signs or symptoms. However, the diagnosis can be a troublesome issue with lupus.
In the more extreme cases, lupus can result in a number of pulmonary diseases. Throughout the disease course, pneumonia, pleuritis, pleural effusion, alveolar hemorrhage, and other complications can happen. Pneumonia, and various other illnesses are uncommon, but they can be serious. It means that in order to bring treatment we need an accurate diagnosis. In addition to pulmonary problems, there may be other important symptoms.
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Lupus can cause various symptoms and cardiovascular complications. And pericarditis is pretty common. Pericarditis represents an inflammatory condition followed by a collection of fluid inside the sac. Palpitations are then felt by the patient with symptoms that hurt. Patients experience chest pain behind the sternum or in the heart area.
In the later stages of lupus, when the disease has crossed over into the cardiovascular system, the patient may experience a host of complications. Although myocarditis is uncommon, it can be serious. Coronary arterial disease is another risk for these patients as well. It is most likely due to rapid disease progression but can be a consequence of coronary vessel inflammation. In particular, it can also be a source of early mortality from lupus — even in a relatively young patient.
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By far, the most common symptoms of lupus are skin symptoms. This means that it is worth watching for any irregularities in it. One of them may be a change in color on the surface of the hands or feet due to something. Due to cold, psychological stress, or other irritating factors, the skin of the hands and feet may begin to decolorize, blush, fade blue, and then redness. In medicine, it’s known as Raynaud’s symptom (when related to a specific condition) or syndrome (when it’s considered a disease).
An over-reaction of the blood vessels characterizes the condition. Other symptoms include numbness, tingling, or pain in the hands and feet. The symptom is seen in multiple diseases, yet it frequently occurs in the context of lupus. New skin-coloration alterations reported by the patient could represent the first symptom of the disease. They will assist in confirming systemic lupus erythematosus through laboratory blood tests.
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Another important symptom that lupus can lead to is a seizure. It is considered a neurological symptom that can reappear during the flares of the disease. Lupus disease process can involve the central nervous system either via direct neuronal damage, damage to the cerebral vasculature, or, more often, by pathogenetic mechanisms indirectly induced by immune mechanisms.
Arterial thromboembolic disorders responsible for focal neurological problems—such as stroke or cognitive impairment—can also cause seizures. Seizures are perhaps the most important clinical manifestation of systemic lupus erythematosus. Even in the early stages of the disease, seizures can manifest. This makes early detection of this crippling disease possible.
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Edema may happen during the process of lupus. Lower limbs may swell up in the patient. Lumps can also appear in other places in the body. These symptoms suggest that the disease process may be affecting the kidneys. The body, therefore, excretes less urine and sodium, resulting in not only edema but also hypertension. When swelling becomes worse, this may mean the kidneys cannot filter well as they are inflamed. Lupus damages the kidneys, so the sooner the disease can be recognized, the better.
Patients may also have a second type of edema, in addition to it. In the course of lupus, inflammatory periorbital edema can occur, but it is rare. Leg edema is much more prevalent in the actual patient population; thus, it is worth keeping this specific sign in mind.
14.Additional warning signs should be loss of weight. While many might be happy when told they have lost weight, keep in mind that, at times, it is a key symptom of illness. Now, if someone experiences an inexplicable loss of weight, they may suspect certain cancers, but this symptom can also be present in lupus. Patients generally present with signs of weight loss that preceded the disease diagnosis. It is an involuntary behavior and could be linked to loss of appetite.
Some other reasons for the weight loss can be due to the medication side effect, especially diuretics. Concomitant gastrointestinal diseases may be another cause of weight loss in lupus. Any portion of the GI tract may be involved in this disease process, and it can lead to abdominal pain and other symptoms. That means patients consume less food, leading to long-term weight loss. An inadequate diet does not supply significant vitamins and minerals and can be dangerous.
