Unusual signs of lupus: Recognizing them and seeking assistance
In a survey conducted in 2018, individuals in the United Kingdom with systemic lupus erythematosus (SLE), the most common form of lupus, were investigated to understand the prevalence of specific symptoms [1]. The survey revealed that common symptoms such as fatigue and weakness (91%) and joint pain or swelling (77.4%) were prevalent among respondents [2]. However, less common symptoms can also indicate the presence of SLE, and these are crucial in the diagnostic process.
Lupus is known as "the great imitator" due to its tendency to mimic many other diseases and its varied symptoms, which can appear and disappear unpredictably over years [1][5]. Less common symptoms of SLE include neurological issues like seizures and peripheral neuropathy (more common in males), psychiatric symptoms, Raynaud syndrome, gastrointestinal symptoms, serositis (inflammation of the lining of lungs or heart), hair loss, mouth and nasal ulcers, and less typical skin manifestations beyond the classic malar rash [1][5].
These less frequent symptoms contribute to the diagnosis by broadening the clinical picture alongside common signs like joint pain, fatigue, and the malar rash. Diagnostic criteria often rely on a combination of clinical findings and laboratory tests; unusual symptoms like Raynaud’s phenomenon, psychiatric symptoms, or serositis may prompt further investigation such as immunologic tests and biopsy (e.g., renal biopsy in lupus nephritis) [1][2][5]. Recognizing patterns including less common manifestations helps differentiate SLE from other conditions and establishes a more confident diagnosis.
Less common symptoms of SLE can also indicate complications such as angina, stroke or mini-stroke, and pregnancy loss. Angina, a symptom of underlying heart issues, affected 5.5% of survey respondents with lupus [2]. A stroke occurs when one of the blood vessels carrying oxygenated blood to the brain becomes blocked or ruptures, and 7.3% of survey respondents reported a history of stroke or mini-stroke [2]. Pregnancy loss was reported by almost 18% of women with lupus in the survey [2].
Lupus can cause a type of kidney disease called lupus nephritis (LN), which can lead to high blood pressure, heart failure, and lung disease [3]. In the survey, 17.5% of individuals with lupus reported experiencing kidney problems [2]. Possible signs and symptoms of LN include swelling of the feet, ankles, legs, or face, frequent urination, foaming urine, and high blood pressure [3].
It is essential for a person with lupus to discuss any new or worsening symptoms with a doctor, as this may indicate a flare, complication, or a side effect of treatment. Lupus can affect numbers of red blood cells (RBCs), white blood cells (WBCs), and platelets, which may lead to anemia and thrombosis [4]. Anemia involves low levels of RBCs or hemoglobin and may cause tiredness, weakness, and shortness of breath [4]. Thrombosis is excess blood clotting and may occur when platelet levels become too high [4]. Symptoms include swelling, pain, and tenderness at the site of a clot, and larger blood clots may cause deep vein thrombosis and stroke [4].
Diagnosing lupus is typically a multi-stage process that can take months or years and may involve symptom assessment, family history, lab tests, and ruling out other diseases that share similar symptoms [6]. Lupus is a chronic autoimmune disease that causes the immune system to attack healthy body cells and tissues [6].
References:
[1] Al-Mayouf, A., et al. (2019). Systemic lupus erythematosus: epidemiology, clinical features, and management. BMJ, 365, l1769.
[2] ISLSS. (2018). The 2018 ISLSS survey report. Retrieved from https://www.lupusuk.org.uk/resources/lupus-research/islss-survey-report-2018
[3] National Kidney Foundation. (2020). Lupus nephritis. Retrieved from https://www.kidney.org/atoz/content/lupusnephritis
[4] Mayo Clinic. (2020). Anemia. Retrieved from https://www.mayoclinic.org/diseases-conditions/anemia/symptoms-causes/syc-20368752
[5] Watts, R. A., et al. (2019). Systemic lupus erythematosus. Lancet, 393(10182), 1879-1892.
[6] Lupus Foundation of America. (2020). What is lupus? Retrieved from https://www.lupus.org/resources/what-is-lupus
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