Symptoms of lupus affect mainly women between 35 and 45 presenting as non specific joint pains, often in the hands with tendons being affected also. Morning stiffness can be considerable.
Associated with this there may be profound fatigue, which cannot be explained otherwise. There might be mouth ulcers, rarely also ulcerations in the nose or vagina. Light hypersensitivity occurs frequently.
This occurs mainly in the face, the neck and upper chest area with the development of often roundish (maculopapular) skin lesions. Here is a picture link to a site showing the butterfly rash in the face. Here is a link to a picture of another example of skin involvement with systemic lupus, a condition called discoid lupus (thanks to library.med.utah.edu for this image).
Unfortunately, as the ANA titer increases, more systemic features may develop. In 25-50% of patients with lupus systemic disease such as kidney disease develops. Fortunately, if this is spotted by urinary tests with dipstick measurements of protein, and treated only less than 5% will go on to end stage kidney failure. Brain lupus (medically termed “cerebral lupus”) is extremely rare, but when present can be very confusing: such diverse clinical conditions as psychosis, epilepsy, organic brain syndrome and severe headaches can all be different manifestations of the same disease process. Even strokes and personality changes do occur occasionally.
Signs and symptoms of lupus
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generalized arthritis : pronounced morning stiffness, but little to find
skin manifestations : facial butterfly rash, skin lesions in face, neck, chest
rapid hair loss : important diagnostic sign, hair regrows with remission of lupus
ulcerations in the mouth, nose or vagina : in mouth most commonly, often self limiting
fatigue : common with flare-up of lupus; with chronic lupus due to depression
major organ disease : in a minority lupus affects kidneys, central nervous system, lungs and heart
pleurisy ( =fluid in chest cavity) : pleuritic pain may mimic pneumonia or pulmonary embolism
pericarditis (=fluid in sac around heart) : lack of energy with physical exertion
CNS involvement : severe headaches, epilepsy, personality changes, stroke, psychosis
enlarged lymph glands and spleen : particularly common in children and blacks
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Here is a link that shows you graphically the multiple areas of the body where lupus can occur.
As indicated above other vital organs such as the heart and the lungs can also be affected by immune complexes with high ANA titers. There can be breathing problems when water in the lungs develops (effusion in the chest cavity). This condition is called pleurisy. Similarly there can be a buildup of fluid in the pericardial sac, called pericarditis. This can be life threatening, if it leads to cardiac tamponade, a condition where the fluid is under pressure and the heart has a hard time pumping blood. On rare occasions a vasculitis of the coronary arteries can develop (Ref. 2, p.426), which can lead to a sudden heart attack in a young patient, which normally (without lupus) would be very unusual event.
References:
1. ABC of rheumatology, second edition, edited by Michael L. Snaith , M.D., BMJ Books, 1999. Chapter 15.
2. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 50.
3. BP Tsao et al. Curr Rheumatol Rep 2001 Jun;3(3):183-190.
4. D Alarcon-Segovia Isr Med Assoc J 2001 Feb;3(2):127-130.
5. CC Mok Semin Arthritis Rheum 2001 Jun;30(6):426-435.
6. Goldman: Cecil Textbook of Medicine, 21st ed.(©2000)W.B.Saunders
7. Ferri: Ferri’s Clinical Advisor: Instant Diagnosis and Treatment, 2004 ed., Copyright © 2004 Mosby, Inc.
8. Rakel: Conn’s Current Therapy 2004, 56th ed., Copyright © 2004 Elsevier
