Systemic lupus erythematosus history and symptoms: Difference between revisions
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{{Systemic lupus erythematosus}} | {{Systemic lupus erythematosus}} | ||
{{CMG}}; {{AE}} {{ | {{CMG}}; {{AE}} {{MIR}} | ||
==Overview== | ==Overview== | ||
A positive history of familial [[lupus]], [[skin rashes]] (especially [[Photosensitivity|photosensitive]] [[skin rashes]]), [[arthritis]], and [[fatigue]] may be suggestive of [[systemic lupus erythematosus]]. The most common symptoms of [[SLE]] include | A positive history of familial [[lupus]], [[skin rashes]] (especially [[Photosensitivity|photosensitive]] [[skin rashes]]), [[arthritis]], and [[fatigue]] may be suggestive of [[systemic lupus erythematosus]]. The most common symptoms of [[SLE]] include constitutional symptoms like [[fatigue]], [[fever]], [[myalgia]], and [[Weight|weight changes]]. Other organ-specific symptoms mostly occur with disease progression. [[SLE]] may show a variety of symptoms in different organs depending on its complications. | ||
==History== | ==History== | ||
Obtaining the history is one of the most important aspects in making a diagnosis of [[systemic lupus erythematosus]]. It provides insight into disease course and severity, precipitating risk factors and associated [[comorbid]] conditions. Complete history will help determine the correct complication diagnosis, and helps in determining the prognosis as well. Specific histories about the symptoms (duration, onset, progression), associated symptoms, and [[drug]] usage have to be obtained. Specific areas of focus when obtaining the history | Obtaining the history is one of the most important aspects in making a diagnosis of [[systemic lupus erythematosus]]. It provides insight into disease course and severity, precipitating risk factors, and associated [[comorbid]] conditions. Complete history will help determine the correct complication diagnosis, and helps in determining the prognosis as well. Specific histories about the symptoms (duration, onset, progression), associated symptoms, and [[drug]] usage have to be obtained. Specific areas of focus when obtaining the history are outlined below: | ||
* Onset, duration and progression of symptoms | * Onset, duration and progression of symptoms | ||
* History of [[Weight change|weight changes]] (gain or loss) | * History of [[Weight change|weight changes]] (gain or loss) | ||
* [[Anorexia]] | * [[Anorexia]] | ||
* [[Arthritis]], [[Arthralgia|arthralgias]], or [[muscle pain]] | * [[Arthritis]], [[Arthralgia|arthralgias]], or [[muscle pain]] | ||
* Morning stiffness | * Morning [[stiffness]] | ||
* [[Skin rashes]] and their association to flare ups, especially after exposure to sunlight | * [[Skin rashes]] and their association to flare ups, especially after exposure to sunlight | ||
* [[Medications]] and their association to flare ups | * [[Medications]] and their association to flare ups | ||
| Line 19: | Line 19: | ||
* Sores in the mouth, nose, or other [[Mucous membrane|mucous membranes]] | * Sores in the mouth, nose, or other [[Mucous membrane|mucous membranes]] | ||
* Symptoms of other organ failure | * Symptoms of other organ failure | ||
** [[Renal failure]]: Recent | ** [[Renal failure]]: Recent peripheral [[edema]] and [[weight gain]] | ||
** [[Cardiac]] involvement: [[Tachycardia]], [[dyspnea]], [[Chest pain|chest pains]] | ** [[Cardiac]] involvement: [[Tachycardia]], [[dyspnea]], [[Chest pain|chest pains]] | ||
* History of having a pet | * History of having a pet | ||
| Line 27: | Line 27: | ||
** Other [[Rheumatologic disease|rheumatologic]] and [[autoimmune diseases]] | ** Other [[Rheumatologic disease|rheumatologic]] and [[autoimmune diseases]] | ||
** [[Hypertension]] | ** [[Hypertension]] | ||
** [[ | ** [[Diabetes]], [[immunodeficiency]] | ||
* [[Seizure|Seizures]], or other [[nervous system]] symptoms | * [[Seizure|Seizures]], or other [[nervous system]] symptoms | ||
* [[Family history]] of [[Rheumatologic disease|rheumatologic diseases]] | * [[Family history]] of [[Rheumatologic disease|rheumatologic diseases]] | ||
| Line 40: | Line 40: | ||
*[[Weight]] change | *[[Weight]] change | ||
**[[Weight gain]] due to increase in [[water retention]] and increase in appetite | **[[Weight gain]] due to increase in [[water retention]] and increase in appetite | ||
**[[Weight loss]] due to medication side effect and | **[[Weight loss]] due to medication side effect and gastrointestinal problems | ||
== Less Common Symptoms == | == Less Common Symptoms == | ||
| Line 51: | Line 51: | ||
! style="background: #4479BA; color: #FFFFFF; " |Symptom | ! style="background: #4479BA; color: #FFFFFF; " |Symptom | ||
|- | |- | ||
| rowspan="7" |[[Gastrointestinal]] | | rowspan="7" |<small>[[Gastrointestinal]]</small> | ||
| style="background: #DCDCDC; " |[[Dysphagia]] | | style="background: #DCDCDC; " |[[Dysphagia]] | ||
| | | | ||
| Line 66: | Line 66: | ||
* [[Nausea]] | * [[Nausea]] | ||
|- | |- | ||
| style="background: #DCDCDC; " |[[Intestinal | | style="background: #DCDCDC; " |[[Intestinal pseudo obstruction|Intestinal pseudo-obstruction]] | ||
| | | | ||
* [[Abdominal pain]] | * [[Abdominal pain]] | ||
| Line 99: | Line 99: | ||
* [[Abdominal pain]] | * [[Abdominal pain]] | ||
|- | |- | ||
| rowspan="7" |[[Pulmonary]] | | rowspan="7" |<small>[[Pulmonary]]</small> | ||
| style="background: #DCDCDC; " |[[Pleural disease]] | | style="background: #DCDCDC; " |[[Pleural disease]] | ||
| | | | ||
| Line 120: | Line 120: | ||
| style="background: #DCDCDC; " |[[Interstitial lung disease]] | | style="background: #DCDCDC; " |[[Interstitial lung disease]] | ||
| | | | ||
* May be asymptomatic | * May be [[asymptomatic]] | ||
* Chronic nonproductive [[cough]] | * Chronic nonproductive [[cough]] | ||
* [[Dyspnea]] | * [[Dyspnea]] | ||
| Line 196: | Line 196: | ||
* [[Hypertension]] | * [[Hypertension]] | ||
* [[Peripheral edema]] | * [[Peripheral edema]] | ||
* | * Foamy [[urine]] | ||
* [[Weight gain]] | * [[Weight gain]] | ||
|- | |- | ||
| Line 205: | Line 205: | ||
* [[Arthralgias]] | * [[Arthralgias]] | ||
* Decreased [[range of motion]] of both small and large joints | * Decreased [[range of motion]] of both small and large joints | ||
* Morning stiffness that will last less than 1 hour | * Morning [[stiffness]] that will last less than 1 hour | ||
|- | |- | ||
| style="background: #DCDCDC; " |[[Avascular necrosis]] | | style="background: #DCDCDC; " |[[Avascular necrosis]] | ||
| | | | ||
* Asymptomatic | * [[Asymptomatic]] | ||
* Mild to moderate pain in [[groin]] and lower abdomen in case of femoral head [[AVN]] | * Mild to moderate pain in [[groin]] and lower abdomen in case of femoral head [[AVN]] | ||
* Secondary pain amplification | * Secondary pain amplification | ||
Latest revision as of 19:04, 14 August 2020
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mahshid Mir, M.D. [2]
Overview
A positive history of familial lupus, skin rashes (especially photosensitive skin rashes), arthritis, and fatigue may be suggestive of systemic lupus erythematosus. The most common symptoms of SLE include constitutional symptoms like fatigue, fever, myalgia, and weight changes. Other organ-specific symptoms mostly occur with disease progression. SLE may show a variety of symptoms in different organs depending on its complications.
History
Obtaining the history is one of the most important aspects in making a diagnosis of systemic lupus erythematosus. It provides insight into disease course and severity, precipitating risk factors, and associated comorbid conditions. Complete history will help determine the correct complication diagnosis, and helps in determining the prognosis as well. Specific histories about the symptoms (duration, onset, progression), associated symptoms, and drug usage have to be obtained. Specific areas of focus when obtaining the history are outlined below:
- Onset, duration and progression of symptoms
- History of weight changes (gain or loss)
- Anorexia
- Arthritis, arthralgias, or muscle pain
- Morning stiffness
- Skin rashes and their association to flare ups, especially after exposure to sunlight
- Medications and their association to flare ups
- Infections especially mononucleosis
- Sores in the mouth, nose, or other mucous membranes
- Symptoms of other organ failure
- Renal failure: Recent peripheral edema and weight gain
- Cardiac involvement: Tachycardia, dyspnea, chest pains
- History of having a pet
- Hair loss
- Job history
- Co-morbid conditions include:
- Seizures, or other nervous system symptoms
- Family history of rheumatologic diseases
Common Symptoms
The early manifestations of systemic lupus erythematosus include common constitutional symptoms that may be seen in many other diseases as well:[1][2][3]
- Fatigue
- Fever
- Myalgia
- Joint tenderness
- Muscle weakness
- Weight change
- Weight gain due to increase in water retention and increase in appetite
- Weight loss due to medication side effect and gastrointestinal problems
Less Common Symptoms
Organ system based signs and symptoms
- Symptoms in the below table are listed based on their frequency in each organ system and the disease that is responsible for each symptom:[4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30]
References
- ↑ Tench CM, McCurdie I, White PD, D'Cruz DP (2000). "The prevalence and associations of fatigue in systemic lupus erythematosus". Rheumatology (Oxford). 39 (11): 1249–54. PMID 11085805.
- ↑ McKinley PS, Ouellette SC, Winkel GH (1995). "The contributions of disease activity, sleep patterns, and depression to fatigue in systemic lupus erythematosus. A proposed model". Arthritis Rheum. 38 (6): 826–34. PMID 7779127.
- ↑ Wang B, Gladman DD, Urowitz MB (1998). "Fatigue in lupus is not correlated with disease activity". J. Rheumatol. 25 (5): 892–5. PMID 9598886.
- ↑ Cervera R, Khamashta MA, Font J, Sebastiani GD, Gil A, Lavilla P, Mejía JC, Aydintug AO, Chwalinska-Sadowska H, de Ramón E, Fernández-Nebro A, Galeazzi M, Valen M, Mathieu A, Houssiau F, Caro N, Alba P, Ramos-Casals M, Ingelmo M, Hughes GR (2003). "Morbidity and mortality in systemic lupus erythematosus during a 10-year period: a comparison of early and late manifestations in a cohort of 1,000 patients". Medicine (Baltimore). 82 (5): 299–308. doi:10.1097/01.md.0000091181.93122.55. PMID 14530779.
- ↑ Finol HJ, Montagnani S, Márquez A, Montes de Oca I, Müller B (1990). "Ultrastructural pathology of skeletal muscle in systemic lupus erythematosus". J. Rheumatol. 17 (2): 210–9. PMID 2319520.
- ↑ Tian XP, Zhang X (2010). "Gastrointestinal involvement in systemic lupus erythematosus: insight into pathogenesis, diagnosis and treatment". World J. Gastroenterol. 16 (24): 2971–7. PMC 2890936. PMID 20572299.
- ↑ Alves SC, Fasano S, Isenberg DA (2016). "Autoimmune gastrointestinal complications in patients with systemic lupus erythematosus: case series and literature review". Lupus. 25 (14): 1509–1519. doi:10.1177/0961203316655210. PMID 27329649.
- ↑ Fawzy M, Edrees A, Okasha H, El Ashmaui A, Ragab G (2016). "Gastrointestinal manifestations in systemic lupus erythematosus". Lupus. 25 (13): 1456–1462. doi:10.1177/0961203316642308. PMID 27055518.
- ↑ Li Z, Xu D, Wang Z, Wang Y, Zhang S, Li M, Zeng X (2017). "Gastrointestinal system involvement in systemic lupus erythematosus". Lupus: 961203317707825. doi:10.1177/0961203317707825. PMID 28523968.
- ↑ Salvati F (2015). "[The involvement of pulmonary interstitial tissue in multisystemic lupus erythematosus: interdisciplinarity and role of the pneumologists]". Clin Ter (in Italian). 166 (5): 205–7. PMID 26550810.
- ↑ Torre O, Harari S (2011). "Pleural and pulmonary involvement in systemic lupus erythematosus". Presse Med. 40 (1 Pt 2): e19–29. doi:10.1016/j.lpm.2010.11.004. PMID 21194884.
- ↑ Alamoudi OS, Attar SM (2015). "Pulmonary manifestations in systemic lupus erythematosus: association with disease activity". Respirology. 20 (3): 474–80. doi:10.1111/resp.12473. PMC 4418345. PMID 25639532.
- ↑ Finucci Curi P, Pierrestegui M, Ortiz A, Ceccato F, Paira S (2015). "[Pulmonary hemorrhage in patients with systemic lupus erythematosus. Clinical manifestations and prognosis]". Med Clin (Barc) (in Spanish; Castilian). 145 (9): 375–9. doi:10.1016/j.medcli.2014.07.034. PMID 25458514.
- ↑ Mak A, Kow NY (2014). "Imbalance between endothelial damage and repair: a gateway to cardiovascular disease in systemic lupus erythematosus". Biomed Res Int. 2014: 178721. doi:10.1155/2014/178721. PMC 3984775. PMID 24790989.
- ↑ Sacre K, Escoubet B, Pasquet B, Chauveheid MP, Zennaro MC, Tubach F, Papo T (2014). "Increased arterial stiffness in systemic lupus erythematosus (SLE) patients at low risk for cardiovascular disease: a cross-sectional controlled study". PLoS ONE. 9 (4): e94511. doi:10.1371/journal.pone.0094511. PMC 3983200. PMID 24722263.
- ↑ Canpolat N, Kasapcopur O, Caliskan S, Gokalp S, Bor M, Tasdemir M, Sever L, Arisoy N (2013). "Ambulatory blood pressure and subclinical cardiovascular disease in patients with juvenile-onset systemic lupus erythematosus". Pediatr. Nephrol. 28 (2): 305–13. doi:10.1007/s00467-012-2317-3. PMID 23052654.
- ↑ Cojocaru IM, Cojocaru M, Tănăsescu R, Burcin C, Atanasiu AN, Silosi I (2008). "Detection of autoantibodies to ribosome P in lupus patients with neurological involvement". Rom J Intern Med. 46 (3): 239–42. PMID 19366083.
- ↑ Madrane S, Ribi C (2012). "[Central neuropsychiatric involvement in systemic lupus erythematosus]". Rev Med Suisse (in French). 8 (337): 848–53. PMID 22594009.
- ↑ Sivri A, Hasçelik Z, Celiker R, Başgöze O (1995). "Early detection of neurological involvement in systemic lupus erythematosus patients". Electromyogr Clin Neurophysiol. 35 (4): 195–9. PMID 7555923.
- ↑ Juncal Gallego L, Almuíña Simón C, Muíños Esparza LF, Díaz Soto R, Ramil Fraga C, Quiroga Ordóñez E (2009). "[Systemic lupus erythematosus with fulminant neurological involvement]". An Pediatr (Barc) (in Spanish; Castilian). 70 (2): 202–4. doi:10.1016/j.anpedi.2008.09.009. PMID 19217587.
- ↑ Karras A (2012). "[Renal involvement in systemic lupus erythematosus]". Presse Med (in French). 41 (3 Pt 1): 260–6. doi:10.1016/j.lpm.2011.11.006. PMID 22192934.
- ↑ Kiremitci S, Ensari A (2014). "Classifying lupus nephritis: an ongoing story". ScientificWorldJournal. 2014: 580620. doi:10.1155/2014/580620. PMC 4274910. PMID 25548784.
- ↑ Zoma A (2004). "Musculoskeletal involvement in systemic lupus erythematosus". Lupus. 13 (11): 851–3. doi:10.1191/0961203303lu2021oa. PMID 15580980.
- ↑ Gabba A, Piga M, Vacca A, Porru G, Garau P, Cauli A, Mathieu A (2012). "Joint and tendon involvement in systemic lupus erythematosus: an ultrasound study of hands and wrists in 108 patients". Rheumatology (Oxford). 51 (12): 2278–85. doi:10.1093/rheumatology/kes226. PMID 22956550.
- ↑ Grossman JM (2009). "Lupus arthritis". Best Pract Res Clin Rheumatol. 23 (4): 495–506. doi:10.1016/j.berh.2009.04.003. PMID 19591780.
- ↑ Zhu KK, Xu WD, Pan HF, Zhang M, Ni J, Ge FY, Ye DQ (2014). "The risk factors of avascular necrosis in patients with systemic lupus erythematosus: a meta-analysis". Inflammation. 37 (5): 1852–64. doi:10.1007/s10753-014-9917-y. PMID 24862229.
- ↑ Voulgari PV, Kosta P, Argyropoulou MI, Drosos AA (2013). "Avascular necrosis in a patient with systemic lupus erythematosus". Joint Bone Spine. 80 (6): 665. doi:10.1016/j.jbspin.2013.03.018. PMID 23731640.
- ↑ Parodi A, Cozzani E (2014). "Cutaneous manifestations of lupus erythematosus". G Ital Dermatol Venereol. 149 (5): 549–54. PMID 25077888.
- ↑ Szczęch J, Rutka M, Samotij D, Zalewska A, Reich A (2016). "Clinical characteristics of cutaneous lupus erythematosus". Postepy Dermatol Alergol. 33 (1): 13–7. doi:10.5114/pdia.2014.44031. PMC 4793050. PMID 26985173.
- ↑ Walling HW, Sontheimer RD (2009). "Cutaneous lupus erythematosus: issues in diagnosis and treatment". Am J Clin Dermatol. 10 (6): 365–81. doi:10.2165/11310780-000000000-00000. PMID 19824738.