Systemic lupus erythematosus history and symptoms: Difference between revisions
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| Line 56: | Line 56: | ||
|[[Dysphagia]] | |[[Dysphagia]] | ||
| | | | ||
* Retrosternal chest pain | * Retrosternal [[chest pain]] | ||
* Heartburn | * [[Heartburn]] | ||
* Regurgitation | * [[Regurgitation]] | ||
* Odynophagia | * [[Odynophagia]] | ||
|- | |- | ||
|[[Peptic ulcer disease]] | |[[Peptic ulcer disease]] | ||
| | | | ||
* Epigastric pain | * [[Epigastric pain]] | ||
* Food-provoked epigastric discomfort and fullness | * Food-provoked epigastric discomfort and fullness | ||
* Early satiety | * Early satiety | ||
* Nausea | * [[Nausea]] | ||
|- | |- | ||
|[[Intestinal pseudoobstruction|Intestinal pseudo-obstruction]] | |[[Intestinal pseudoobstruction|Intestinal pseudo-obstruction]] | ||
| | | | ||
* Abdominal pain | * [[Abdominal pain]] | ||
* Bloating | * [[Bloating]] | ||
* Distension | * [[Distension]] | ||
|- | |- | ||
|[[Protein losing enteropathy|Protein-losing enteropathy]] | |[[Protein losing enteropathy|Protein-losing enteropathy]] | ||
| | | | ||
* Profound edema | * Profound edema | ||
* Severe diarrhea | * Severe diarrhea | ||
|- | |- | ||
|[[Acute pancreatitis]] | |[[Acute pancreatitis]] | ||
| | | | ||
* Severe persistent epigastric pain often radiating to the back | * Severe persistent [[epigastric pain]] often radiating to the back | ||
|- | |- | ||
|[[Vasculitis|Mesenteric vasculitis]] | |[[Vasculitis|Mesenteric vasculitis]] | ||
| | | | ||
* Abdominal pain | * [[Abdominal pain]] | ||
* Food aversion | * Food aversion | ||
* Weight loss | * [[Weight loss]] | ||
* Nausea | * [[Nausea]] | ||
* Vomiting | * [[Vomiting]] | ||
* Diarrhea | * [[Diarrhea]] | ||
** Due to chronic mesenteric ischemia | ** Due to chronic [[mesenteric ischemia]] | ||
|- | |- | ||
|[[Peritonitis]] | |[[Peritonitis]] | ||
| | | | ||
* Abdominal bloating or distention | * Abdominal bloating or distention | ||
* Nausea and vomiting | * [[Nausea and vomiting]] | ||
* | * [[Constipation]] or the inability to pass gas | ||
* [[Anorexia]] | |||
* Anorexia | * [[Abdominal pain]] | ||
|- | |- | ||
| rowspan="7" |Pulmonary involvement | | rowspan="7" |Pulmonary involvement | ||
|[[Pleural disease]] | |[[Pleural disease]] | ||
| | | | ||
* Cough | * [[Cough]] | ||
* Dyspnea | * [[Dyspnea]] | ||
* Fever | * Fever | ||
|- | |- | ||
| Line 113: | Line 112: | ||
* Fever | * Fever | ||
* Cough (sometimes with hemoptysis) | * Cough (sometimes with hemoptysis) | ||
* Dyspnea | * [[Dyspnea]] | ||
|- | |- | ||
|[[Pulmonary hemorrhage]] | |[[Pulmonary hemorrhage]] | ||
| | | | ||
* Dyspnea | * [[Dyspnea]] | ||
* Cough | * [[Cough]] | ||
* Hemoptysis | * [[Hemoptysis]] | ||
|- | |- | ||
|[[Interstitial lung disease]] | |[[Interstitial lung disease]] | ||
| | | | ||
* May be asymptomatic | * May be asymptomatic | ||
* Chronic nonproductive cough | * Chronic nonproductive [[cough]] | ||
* Dyspnea | * [[Dyspnea]] | ||
* Decreased exercise tolerance | * Decreased exercise tolerance | ||
|- | |- | ||
|[[ | |[[Pulmonary emboli]] | ||
| | | | ||
* Dyspnea | * [[Dyspnea]] | ||
* Sharp chest pain that may become worse with deep breathing or coughing | * Sharp chest pain that may become worse with deep breathing or coughing | ||
|- | |- | ||
|[[Pulmonary hypertension]] | |[[Pulmonary hypertension]] | ||
| | | | ||
* Dyspnea | * [[Dyspnea]] | ||
* Palpitations | * [[Palpitation|Palpitations]] | ||
* Fatigue | * [[Fatigue]] | ||
* Impaired exercise tolerance | * Impaired exercise tolerance | ||
* Weakness | * [[Weakness]] | ||
* Syncope | * [[Syncope]] | ||
* Edema | * [[Edema]] | ||
* Increased abdominal girth | * Increased abdominal girth | ||
|- | |- | ||
|Shrinking lung syndrome | |Shrinking lung syndrome | ||
| | | | ||
* Dyspnea | * [[Dyspnea]] | ||
* Pleuritic chest pain (episodic) | * [[Pleuritic chest pain]] (episodic) | ||
|- | |- | ||
| rowspan="4" |Cardiac involvement | | rowspan="4" |Cardiac involvement | ||
|[[Valvular disease]] | |[[Valvular disease]] | ||
| | | | ||
* Tachycardia | * [[Tachycardia]] | ||
* Syncope | * [[Syncope]] | ||
* Dyspnea | * [[Dyspnea]] | ||
* Peripheral edema | * [[Peripheral edema]] | ||
|- | |- | ||
|[[Pericarditis]] | |[[Pericarditis]] | ||
| | | | ||
* Sharp, | * Sharp, stabbing [[chest pain]] with a sudden start | ||
* Positional pain that decreases when sitting up and leaning forward | * Positional pain that decreases when sitting up and leaning forward | ||
|- | |- | ||
|[[Myocarditis]] | |[[Myocarditis]] | ||
| | | | ||
* Tachycardia | * [[Tachycardia]] | ||
* Fever and chills | * [[Fever]] and chills | ||
|- | |- | ||
|[[Coronary heart disease]] | |[[Coronary heart disease]] | ||
| | | | ||
* Chest pain | * [[Chest pain]] | ||
* Dyspnea | * [[Dyspnea]] | ||
* Nausea and vomiting | * [[Nausea and vomiting]] | ||
|- | |- | ||
| rowspan="4" |Neurological involvement | | rowspan="4" |Neurological involvement | ||
|CNS small vessle vasculitis | |CNS small vessle vasculitis | ||
| | | | ||
* Cognitive | * [[Cognitive impairment]] | ||
* Headache | * [[Headache]] | ||
|- | |- | ||
|[[Stroke]] | |[[Stroke]] | ||
| | | | ||
* Speech disturbance | * [[Speech disturbances|Speech disturbance]] | ||
* Weakness on one-half of the body | * Weakness on one-half of the body | ||
|- | |- | ||
|[[Seizure|Seizures]] | |[[Seizure|Seizures]] | ||
| | | | ||
* Tonic-clonic seizure | * [[Tonic-clonic seizure]] | ||
|- | |- | ||
|[[Psychosis]] | |[[Psychosis]] | ||
| | | | ||
* Hallucinations | * [[Hallucination|Hallucinations]] | ||
** Visual | ** Visual | ||
** Auditory | ** Auditory | ||
| Line 198: | Line 196: | ||
|[[Nephrotic syndrome]] | |[[Nephrotic syndrome]] | ||
| | | | ||
* Hypertension | * [[Hypertension]] | ||
* Peripheral edema | * [[Peripheral edema]] | ||
* Foamy urine | * Foamy urine | ||
* Weight gain | * [[Weight gain]] | ||
|- | |- | ||
| rowspan="3" |Musculoskeletal | | rowspan="3" |Musculoskeletal | ||
| Line 207: | Line 205: | ||
| | | | ||
* Mostly symmetrical | * Mostly symmetrical | ||
* 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 | ||
|- | |- | ||
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|[[Cutaneous lupus erythematosus]] | |[[Cutaneous lupus erythematosus]] | ||
| | | | ||
* Malar rash | * [[Malar rash]] | ||
* Generalized maculopapular rash | * Generalized maculopapular rash | ||
* Discoid rash | * [[Discoid lupus|Discoid]] rash | ||
* Bullous lesions | * [[Bullous]] lesions | ||
* Raynaud's phenomenon | * [[Raynaud's phenomenon]] | ||
* Pyoderma gangrenosum | * [[Pyoderma gangrenosum]] | ||
** Ulcerative cutaneous condition | ** Ulcerative cutaneous condition | ||
* Erythema multiforme | * [[Erythema multiforme]] | ||
* Nail fold infarcts | * Nail fold infarcts | ||
|- | |- | ||
|[[Photosensitivity]] | |[[Photosensitivity]] | ||
|Common theme for skin lesions associated with SLE | | | ||
* Common theme for skin lesions associated with SLE | |||
|- | |- | ||
|Oral and/or nasal ulcers | |Oral and/or nasal ulcers | ||
|Usually painless | | | ||
* Usually painless | |||
|- | |- | ||
|Nonscarring alopecia | |Nonscarring alopecia | ||
|May occur at some point during the course of their disease | | | ||
* May occur at some point during the course of their disease | |||
|} | |} | ||
Revision as of 15:59, 19 July 2017
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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) is one of several diseases known as the great imitator[1] 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 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 extremity edema and weight gain
- Cardiac involvement: Tachycardia, dyspnea, chest pains
- History of having a pet
- Hair loss
- Job history
- Co-morbid conditions include:
- Other rheumatologic diseases
- Hypertension
- diabetes, immunodeficiency
- 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:[2][3][4]
- 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
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 sympton:[5][6]
| Organ system | Disease | Sympton |
|---|---|---|
| Gastrointestinal involvement | Dysphagia |
|
| Peptic ulcer disease |
| |
| Intestinal pseudo-obstruction | ||
| Protein-losing enteropathy |
| |
| Acute pancreatitis |
| |
| Mesenteric vasculitis |
| |
| Peritonitis |
| |
| Pulmonary involvement | Pleural disease | |
| Pneumonitis |
| |
| Pulmonary hemorrhage | ||
| Interstitial lung disease | ||
| Pulmonary emboli |
| |
| Pulmonary hypertension | ||
| Shrinking lung syndrome |
| |
| Cardiac involvement | Valvular disease | |
| Pericarditis |
| |
| Myocarditis |
| |
| Coronary heart disease | ||
| Neurological involvement | CNS small vessle vasculitis | |
| Stroke |
| |
| Seizures | ||
| Psychosis |
| |
| Genitourinary | Nephrotic syndrome |
|
| Musculoskeletal | Arthritis |
|
| Avascular necrosis |
| |
| Osteoporosis |
| |
| Skin disorder | Cutaneous lupus erythematosus |
|
| Photosensitivity |
| |
| Oral and/or nasal ulcers |
| |
| Nonscarring alopecia |
|
References
- ↑ Lupus: The Great Imitator
- ↑ 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.