Systemic lupus erythematosus history and symptoms

Systemic lupus erythematosus Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Systemic lupus erythematosus from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
Diagnostic Criteria
History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
X Ray
CT
MRI
Echocardiography or Ultrasound
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Primary Prevention
Secondary Prevention
Lupus and Quality of Life
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Systemic lupus erythematosus history and symptoms On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Systemic lupus erythematosus history and symptoms All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
National Guidelines Clearinghouse
NICE Guidance
FDA on Systemic lupus erythematosus history and symptoms
on Systemic lupus erythematosus history and symptoms
Systemic lupus erythematosus history and symptoms in the news
Blogs onSystemic lupus erythematosus history and symptoms
Directions to Hospitals Treating Systemic lupus erythematosus
Risk calculators and risk factors for Systemic lupus erythematosus history and symptoms

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Raviteja Guddeti, M.B.B.S. [2]

Overview

Systemic lupus erythematosus (SLE) one of several diseases known as the great imitator because its symptoms vary so widely it often mimics or is mistaken for other illnesses, and because the symptoms come and go unpredictably. Diagnosis can be elusive, with patients sometimes suffering unexplained symptoms and untreated SLE for years.

A positive history of familial lupus, skin rashes (especially photo-sensitive skin rashes), arthritis, and fatigue may be suggestive of systemic lupus erythematosus. The most common symptoms of SLE include .

History

Obtaining the history is the most important aspect of 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 extremity edema and weight gain
  • Cardiac involvement: Tachycardia, dyspnea, chest pains
• History of having a pet
• Hair loss or thinning
• Job history
• Co-morbid conditions include:
  • Other rheumatologic diseases
  • Hypertension
  • diabetes, immunodeficiency
• Seizures, convulsions, 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 may other diseases as well.

• Constitutional symptoms
  • Fatigue
  • Fever
  • Myalgia
  • Muscle 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 gastro-intestinal problems
  • Common initial and chronic complaints are fever, malaise, joint pains, myalgias and fatigue. Because they are so often seen with other diseases, these signs and symptoms are not part of the diagnostic criteria for SLE. When occurring in conjunction with other signs and symptoms, however, they are considered suggestive.

Less Common Symptoms

Organ system based signs and symptoms

• Symptoms are listed based on their frequency in each organ system

Organ system	Disease	Sympton
Gastrointestinal involvement	Dysphagia	Retrosternal chest pain Heartburn Regurgitation Odynophagia
	Peptic ulcer disease	Epigastric pain Food-provoked epigastric discomfort and fullness Early satiety Nausea
	Intestinal pseudo-obstruction	Abdominal pain Bloating Distension
	Protein-losing enteropathy	Profound edema Hypoalbuminemia Severe diarrhea
	Acute pancreatitis	Severe persistent epigastric pain often radiating to the back
	Mesenteric vasculitis	Abdominal pain Food aversion Weight loss Nausea Vomiting Diarrhea Due to chronic mesenteric ischemia
	Primary peritonitis	Abdominal bloating or distention Nausea and vomiting Diarrhea Constipation or the inability to pass gas Anorexia
Pulmonary involvement	Pleural disease	Cough Dyspnea Fever
	Acute pneumonitis	Fever Cough (sometimes with hemoptysis) Dyspnea
	Pulmonary hemorrhage	Dyspnea Cough Hemoptysis
	Interstitial lung disease	May be asymptomatic Chronic nonproductive cough Dyspnea Decreased exercise tolerance
	Thromboembolic disease	Dyspnea Sharp chest pain that may become worse with deep breathing or coughing
	Pulmonary hypertension	Dyspnea Palpitations Fatigue Impaired exercise tolerance Weakness Syncope Edema Increased abdominal girth
	Shrinking lung	Dyspnea Pleuritic chest pain (episodic)
Cardiac involvement	Valvular disease	Tachycardia Syncope Dyspnea Peripheral edema
	Nonbacterial thrombotic endocarditis	Fever and chills Arthralgias Persistent cough
	Acute pericarditis	Sharp, stabbing chest pain with a sudden start Positional pain that decreases when sitting up and leaning forward
	Myocarditis	Tachycardia Fever and chills
	Coronary heart disease	Chest pain Dyspnea Nausea and vomiting
Neurological involvement	CNS small vessle vasculitis	Cognitive dysfunction Headache Neuropathies
	Stroke	Speech disturbance Weakness on one-half of the body
	Seizures	Tonic-clonic seizure
	Psychosis	Hallucinations Visual Auditory
Genitourinary	Nephrotic syndrome	Hypertension Peripheral edema Foamy urine Weight gain
Musculoskeletal	Arthritis	Mostly symmetrical Arthralgias Decreased range of motion of both small and large joints Morning stiffness that will last less than 1 hour
	Avascular necrosis	Asymptomatic Mild to moderate pain in groin and lower abdomen in case of femoral head AVN Secondary pain amplification
	Osteoporosis	Loss of height Sudden back pain
Skin disorder	Cutaneous lupus erythematosus	Malar rash Generalized maculopapular rash Discoid rash Bullous lesions Raynaud's phenomenon Pyoderma gangrenosum Ulcerative cutaneous condition Erythema multiforme Nail fold infarcts
	Photosensitivity	Common theme for skin lesions associated with SLE
	Oral and/or nasal ulcers	Usually painless
	Nonscarring alopecia	May occur at some point during the course of their disease