Symptoms of Lupus

Lupus is a mysterious disease, one with a multitude of smaller signs and symptoms—fatigue, achy joints, hair loss, headaches, and more—that are often overlooked or misinterpreted as harbingers of a different disease, leading to misdiagnosis. But when one of the most common symptoms is accompanied by a more suggestive sign or complication, lupus starts to become clear.

lupus symptoms
Illustration by Joshua Seong. © Verywell, 2018.

Frequent Symptoms

Though symptoms can come and go and manifest differently in every individual, the most common symptoms of lupus include:

  • Achy joints with stiffness and swelling
  • Extreme fatigue
  • Unexplained rashes that may turn to sores or lesions, then scar
  • Butterfly (malar) rash across nose and cheeks
  • Anemia
  • Hair loss
  • Pleurisy (pain in your chest with deep breathing)
  • Ulcers inside your mouth and nose
  • Photosensitivity (being sensitive to the sun or light, which may cause or worsen rashes)
  • Headaches
  • Weight loss or gain
  • Abnormal blood clotting
  • Raynaud's disease (your fingers turn blue or white when they're cold)

Here's a look at these symptoms in more detail, as well as the systems in the body they affect.

Dermatological Symptoms

If you have lupus, you may notice various lesions or rashes developing on your skin. These abnormal skin areas signal what's called skin or cutaneous lupus.

Chronic cutaneous (discoid lupus), subacute cutaneous (scaly patches with distinct borders occurring on sun-exposed areas, but less on the face), and acute cutaneous (flattened areas of red, like a sunburn, on the face) are the three types of skin lupus.

Mucosal ulcers in your nose or mouth are another common complaint accompanying lupus. Like other symptoms, the ulcers can come and go as the disease flares.

Renal (Kidney) Symptoms

You may have no indication of kidney problems, but some related symptoms are weight gain, high blood pressure, and swelling in your face, legs, and/or fingers.

Cardiopulmonary (Heart and Lung) Symptoms

Cardiopulmonary symptoms can include shortness of breath and pain in your chest when you take a deep breath.

Musculoskeletal Symptoms

Joint pain and swelling are primary symptoms of lupus that appear in more than 90 percent of people with systemic lupus erythematosus (SLE), usually occurring in connective joints such as your elbows, wrists, knees, and ankles. Lupus joint pain also tends to occur on both sides of the body at once, for example in both knees, or both ankles.

Unlike rheumatoid arthritis, lupus joint pain is less disabling and usually not deforming to the hands and feet.

Hematological Symptoms

Three blood disorders commonly found in lupus patients include:

  1. Anemia (low red blood cell count): This can be caused by inflammation, kidney disorders, or as a side effect of lupus medications.
  2. Thrombosis (excess clotting): This can lead to clots traveling to the lungs, heart, or brain.
  3. Leukopenia (low white blood cell count): This occurs in around 50 percent of lupus patients and usually indicates that the disease is active.

Other blood disorders that can appear with lupus include:

  • Lymphopenia (low level of specific white blood cells)
  • Thrombocytopenia (low platelet count)

Less Common Symptoms

Other less common symptoms of lupus include:

  • Dizziness
  • Depression
  • Confusion
  • Seizures

Complications

Complications from the inflammation lupus causes can affect any number of areas in your body, including your skin, heart, lungs, kidneys, blood, and brain. Lupus can also raise your risk for other problems.

Skin

There are skin diseases and complications that can occur in lupus and in other autoimmune diseases. These include:

  • Hair loss
  • Calcinosis (calcium deposits on the skin)
  • Livedo reticularis (a red, network-like pattern in the skin caused by congested blood vessels)

Heart and Lungs

There are several inflammatory heart and lung issues that can affect lupus patients. By far, the most common include:

  • Inflammation of the lining of the heart (pericarditis)
  • Inflammation of the lining of the lung (pleuritis)

Less common complications include:

  • Inflammation of heart tissue (myocarditis)
  • Inflammation of the blood vessels in the heart (coronary vasculitis)
  • Inflammation of the lung itself (pneumonitis)

Kidneys

Inflammation of the kidneys in lupus patients is called lupus nephritis. Lupus nephritis can lead to kidney failure in some people and is a serious, initially silent, complication affecting lupus patients.

Blood

As noted above, lupus can lead to anemia and blood clotting problems, but it can also cause inflammation in the lining of your blood vessels, called vasculitis. This appears as red bumps or spots on your lower legs.

Brain

Lupus can affect your central nervous system, leading to memory problems, difficulty expressing yourself, and confusion. Other potential effects are headaches, problems with your vision, behavior changes, dizziness, psychosis, and even seizures or stroke.

Infection

Because lupus is an autoimmune disorder, you're more susceptible to pick up infections and have complications from them due to both the disorder and the treatments for it. This is particularly true of respiratory, skin, and urinary infections.

Bones

When part of a bone's blood supply is cut off, that area of the bone dies and eventually collapses (avascular necrosis). Osteoporosis, a disease in which your bones become weak and brittle, is another common complication of lupus.

Cancer

The risk is small, but having lupus may increase your chance of developing cancer.

Pregnancy

If you get pregnant while you have lupus, you're more likely to have a miscarriage, high blood pressure during your pregnancy, and pre-term birth. Having your disease under control before you get pregnant helps reduce this risk, so if you think you might have lupus, see your doctor before you become pregnant.

When to See a Doctor

You should see your doctor if you think you have symptoms of lupus, particularly unexplained fatigue, unexplained joint pain, and skin rashes. You should also see your doctor if you experience any of these symptoms, even if you have already been diagnosed with lupus:

  • Chest pain
  • Shortness of breath
  • Less frequent urination and/or smaller amounts than normal
  • Blood in your urine
  • Fever over 100.5 degrees without recent exposure to a cold or the flu
  • Numbness or tingling in your hands or feet
  • Dizziness
  • Muscle fatigue
  • Swelling in your lower legs or feet
  • Noticeable behavioral changes, like anxiety or depression
  • Loss of appetite
  • Loss of hair
  • Skin rashes
  • New mouth or nose sores
  • Any worsening of previously known symptoms

When to Call 911

Whether or not you've been diagnosed with lupus, you also need to be aware of when the best course of action is to call 911 or visit an emergency room. These symptoms include the following:

  • Crushing chest pain accompanied by sweating or nausea
  • Sudden shortness of breath and difficulty breathing
  • Signs of stroke, including :​
    • Numbness, tingling, weakness, or paralysis of all or part of one side of your body
    • Sudden vision changes—blurring, double vision, etc.
    • Seizures
    • Difficulty speaking or understanding speech
    • Sudden nausea or vomiting
    • Sudden, severe headache, different from previous headaches
    • Sudden dizziness, staggering, or fainting
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