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) 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 |
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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.