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In people with lupus, the immune system makes proteins called autoantibodies that can attack any organ or tissue, causing inflammation and a huge variety of symptoms. Lupus symptoms can imitate other illnesses, making the process of diagnosis more complicated. Each person with lupus experiences the disease a little differently.
Symptoms of lupus vary in each individual and can change over time. Symptoms may decrease or disappear when disease activity is low, only to reappear or worsen with subsequent disease flares. New symptoms can suddenly arise.
Which lupus symptoms a person experiences depends on where the disease is or has been active in the body. Most lupus symptoms fall within the broad categories of skin and hair symptoms, pain, generalized symptoms, neurological symptoms, and symptoms that affect the blood or urine.
Rashes are common in all types of lupus. The malar or butterfly rash (red patches on the cheeks and across the nose) is considered a typical sign of lupus. In discoid lupus, round or oval patches form on the head and upper body. In subacute cutaneous lupus, red, scaly patches and ring-shaped lesions develop. Lupus rashes are usually photosensitive (sensitive to sunlight or tanning beds) and can cause paler or darker spots and atrophy (thinning of skin). Scarring may cause hair loss, especially around the forehead. Problems with small blood vessels in the hands may cause the fingers to turn red, white, or blue when cold – this is called Reynaud’s phenomenon.
Joint pain and stiffness are extremely common symptoms of lupus. People with lupus may also experience headaches and muscle aches, chest pain caused by lung or heart inflammation, and abdominal pain caused by pancreatitis.
Fatigue and malaise (a feeling of being unwell) are among the most common lupus symptoms, experienced by 90 percent of those with lupus. Other generalized symptoms can include insomnia, hypertension (high blood pressure), edema (swelling in the extremities), weight changes, and swollen lymph nodes. As many as one-third of people with lupus have depression and anxiety, which are common in chronic conditions.
People with lupus may develop dryness in the eyes, mouth, and vagina. These symptoms may be associated with a separate but related autoimmune condition called Sjögren’s syndrome. About 10 percent of people with lupus also have Sjögren’s syndrome.
Lupus can cause cognitive dysfunction (or “cog fog”) including problems with thinking or memory. Many people with lupus experience peripheral neuropathy – numbness or tingling in the extremities. Other neurological symptoms may include vision changes, tinnitus (ringing in the ears), tremors, and balance problems. In serious cases, lupus can cause seizures, strokes, and psychotic episodes.
Lupus can lower the body’s production of blood cells, leading to abnormal bleeding and anemia (low red blood cells), which can contribute to fatigue. People with proteins called antiphospholipid antibodies (also called lupus anticoagulant) in their blood are prone to form thromboses – dangerous clots inside the blood vessels.
About 60 percent of adults with lupus and about two-thirds of children with lupus will develop lupus nephritis (lupus that affects the kidneys). Pink or brown urine or urine that is foamy or frothy may be signs of kidney damage due to lupus. Frequent urination may be a sign of kidney problems or something else.
Some of the most severe complications of lupus do not cause noticeable symptoms until they become advanced. About 25 to 30 percent of people with lupus have hypertension (high blood pressure), which can damage organs and raise the risk for life-threatening cardiovascular events such as heart attack and stroke. In fact, cardiovascular disease is the leading cause of death for people with lupus. Lupus nephritis can cause kidney failure, which may not become obvious until the kidneys are significantly damaged. Doctors order regular blood and urine tests to monitor these “silent” complications of lupus.
Lupus begins differently for each person, and early symptoms can include any of those listed here and many others. For about half of those with lupus, joint pain is among the first symptoms to be reported. Approximately 20 percent of people with lupus first go to their doctors because of rash. More rarely, people with CNS lupus may have a seizure or a psychotic episode as the first symptom. Some people experience multiple symptoms at once.
Women of childbearing age are far more likely than any other group to develop lupus. Researchers estimate that between four and 15 women have lupus for every man who has the disease.
Some doctors have suggested that men who develop lupus are less likely to experience skin rash and joint pain than women, but men may be more likely than women to develop serious lupus complications such as kidney disease and thromboses. If it is true that men develop more serious lupus complications, it may be due to delayed diagnosis because doctors are slower to suspect lupus in men. Studies are inconclusive on whether symptoms significantly differ between men and women with lupus, in part because there are far fewer men with lupus to participate in research.
Some women experience worse lupus flares before menstrual periods and during pregnancy.