Systemic lupus erythematosus history and symptoms

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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.

History and symptoms

Gastrointestinal involvement:

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/ physical examination reveals tachypnea, tachycardia, basilar crackles (may be late inspiratory), and hypoxemia
	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/ phE=pulmonary hypertension (loud second heart sound) or cor pulmonale (eg, peripheral edema, ascites, hepatomegaly)/
	Shrinking lung	Dyspnea Pleuritic chest pain (episodic)
Cardiac involvement	Valvular disease	most often valve thickening, nodules, and regurgitation, and less frequently vegetations or stenotic lesions, is noted echocardiographically, and the presence of valvular lesions may increase the risk of serious complications
	Nonbacterial thrombotic endocarditis (Libman-Sacks, verrucous endocarditis)	may occur in patients with SLE and is associated with antiphospholipid antibodies (aPL).
	Pericardial disease	is noted in approximately one-half of patients with SLE at some time in the course of their disease. Diagnostic pericardiocentesis is suggested for those in whom purulent pericarditis is suspected and for those who do not respond to treatment with nonsteroidal antiinflammatory drugs (NSAIDs) and/or glucocorticoids.
	Acute pericarditis	Symptomatic often responds to an NSAID; those who do not tolerate or cannot take NSAIDs may use prednisone (0.5 to 1 mg/kg/day in divided doses)
	Myocarditis	in SLE can cause resting tachycardia, cardiomegaly, heart failure, conduction abnormalities, and/or arrhythmias. myocarditis, we suggest initial treatment with high-dose glucocorticoids (Grade 2C). A typical regimen is methylprednisolone 1000 mg intravenously daily for three days.
	Coronary heart disease
Neurological involvement	Cognitive dysfunction
	Stroke	mechanisms are heterogenous in SLE and include arterial and venous thrombosis, cardiogenic embolism, and small vessel infarcts
	Seizures
	Psychosis	Hallucinations visual Auditory
	Headache
	Neuropathies
Genitourinary	Nephrotic syndrome	Hypertension Peripheral edema Foamy urine Weight gain
Musculoskeletal	Arthritis	arthralgias effusions Decreased range of motion of both small and large joints Morning stiffness
	Avascular necrosis	Asymptomatic Mild to moderate pain in groin and lower abdomen Mainly occur in patients treated with corticosteroids
	Bone fragility fractures
	Secondary pain amplification
	Osteoporosis	Loss of height Sudden back pain
Skin disorder	acute cutaneous lupus erythema (ACLE) (also known as “the butterfly rash”)	Localized ACLE (ie, malar rash, butterfly rash) Generalized ACLE Toxic epidermal necrolysis-like ACLE Erythema in a malar distribution over the cheeks and nose (but sparing the nasolabial folds), which appears after sun exposure
	discoid lesions	more inflammatory and which have a tendency to scar
	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
	Subacute cutaneous lupus erythematosus (SCLE)	Annular SCLE Papulosquamous SCLE Drug-induced SCLE Less common variants: erythrodermic, poikilodermatous, erythema multiforme-like (Rowell syndrome), and vesiculobullous annular SCLE
	Chronic cutaneous lupus erythematosus (CCLE)	Discoid lupus erythematosus (DLE) Localized DLE Generalized DLE Hypertrophic DLE Lupus erythematosus tumidus (LE tumidus) Lupus profundus (also known as lupus panniculitis) Chilblain lupus erythematosus (chilblain LE) Lichenoid cutaneous lupus erythematosus-lichen planus overlap syndrome (LE-LP overlap syndrome)

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.

Common Symptoms

• 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

Constitutional symptoms	Fatigue	the most common complaint 11085805 multidimensional phenomenon due to different factors 7779127 does not correlate with disease activity 9598886	frequently associated with depression, sleep disturbances, and concomitant fibromyalgia
	Fever	a manifestation of active disease-lupus flare, especially within short-term evolution of the disease 14530779 Can be hard to differentiate the cause of fever from other inflammatory and infection diseases Leukopenia or normal range of leukocytes in the setting of fever is more suggestive of lupus activity rather than infection
	Myalgia	may be first complaint and initial reason for the patient to seeks medical attention May happen as a result of treatment with glucocorticoids or glucocorticoid withdrawal	perivascular and perifascicular mononuclear cell infiltrates in 25 percent of patients muscle atrophy, microtubular inclusions, mononuclear infiltrate, fiber necrosis, and, occasionally, vacuolated muscle fibers 2319520
	Muscle tenderness
	Muscle weakness
	Weight change	Weight loss due to: Decreased appetite Side effects of medications (particularly diuretics) Gastrointestinal symptoms related to lupus (e.g. gastroesophageal reflux, abdominal pain, peptic ulcer disease, or pancreatitis) Weight gain due to: Hypoalbuminemia: Result in salt and water retention (e.g. due to nephrotic syndrome or protein losing enteropathy) Increased appetite associated with the use of glucocorticoids