Lupus - Symptoms

Lupus is a complex autoimmune disease characterized by a wide range of symptoms that can vary greatly, potentially affecting the skin, joints, and internal organs. The severity of symptoms differs among individuals; some patients may experience only mild discomfort, while severe cases can be life-threatening. Early recognition of symptoms is crucial for diagnosis and treatment, but due to similarities with other diseases, diagnosis is often delayed.

The manifestation of lupus symptoms is highly unpredictable, often intensifying during active phases (flares) and gradually subsiding during remission. This recurrent nature can lead patients to underestimate the seriousness of their condition. Common symptoms include skin rashes, joint pain, and fatigue, but more serious internal organ involvement can cause organ damage. Understanding the diversity and pattern of symptom changes helps patients and healthcare providers intervene early.

The symptoms of lupus may vary based on gender, age, and genetic factors; for example, up to 90% of patients are women, predominantly of reproductive age. The complexity of symptoms also reflects racial differences, such as skin rashes appearing as pigmentation in darker-skinned populations rather than erythema. Healthcare professionals need to interpret symptoms comprehensively through clinical observation, immune index testing, and imaging studies to understand the underlying pathology.

Early Symptoms and Signs

Early symptoms of lupus are often subtle and may be mistaken for common fatigue or cold. Typical early signs include persistent fatigue that does not improve even after adequate sleep. Mild fever (around 37.5°C to 38°C) may recur, but patients often self-medicate with antipyretics, delaying medical consultation.

Early skin-related signs include redness or itching after sun exposure, and some patients may develop painless ulcers on fingertips or around the nails. Joint symptoms may include symmetrical joint pain, especially affecting small joints of the hands and knees, but X-rays often appear normal, creating a clinical feature of "joint pain with unremarkable imaging results."

• Unexplained weight loss exceeding 3 kg per month
• Chronic hair loss on the scalp or cheeks, possibly with folliculitis
• Raynaud's phenomenon: fingers turning white and then purple in response to cold

Common Symptoms

Skin and Mucous Membrane Manifestations

Skin symptoms are the most visible features of lupus, with about 80% of patients developing a "butterfly rash" across the nose and cheeks. Photosensitivity is very common, with rashes spreading and burning sensations after sun exposure. Other typical skin symptoms include:

• Discoid rash: raised, round red patches often found on the ears and the back of the hands
• Painless ulcers in the mouth or nasal cavity, which may recur
• "Shawl sign": scaly rash extending from the neck to the shoulders

Joint and Muscular System

Approximately 90% of patients experience polyarthritis, mainly affecting the proximal interphalangeal joints and wrists, but the arthritis usually does not cause permanent deformity. Muscle pain may concentrate in the neck and pelvic girdle, and severe cases can impair daily activities. Notably, joint symptoms may completely resolve during remission but may be accompanied by morning stiffness during active phases, typically shorter than the morning stiffness seen in rheumatoid arthritis.

Internal Organ Involvement

Organ damage is a key indicator of disease severity. Kidney involvement may manifest as proteinuria or hematuria, with severe cases leading to renal dysfunction. Pulmonary symptoms include pleuritis causing chest pain and pulmonary hypertension leading to dyspnea. Cardiovascular involvement may cause angina or palpitations due to vasculitis, while neurological involvement can lead to dizziness, cognitive decline, or seizures.

Disease Progression and Symptom Variability

The course of lupus features alternating active and remission phases, with symptom intensity often exacerbated suddenly by environmental triggers such as ultraviolet light, infections, or stress. Chronic disease progression may lead to tissue fibrosis, such as chronic nephritis or pulmonary fibrosis. Neurological symptoms may worsen gradually in late stages, affecting cognition and emotional regulation.

Dynamic changes in symptoms require attention to the following turning points:

• Acute flare: high fever, multi-organ failure signs
• Remission: significant symptom reduction but not complete resolution
• Chronic progression: irreversible organ damage accumulates

Individual Variations in Symptoms

Children may initially present with renal symptoms, while elderly patients may primarily exhibit neuropsychiatric symptoms. Male patients are more likely to experience renal involvement and hematologic abnormalities. Variations in symptoms are also related to antibody profiles; for instance, patients positive for anti-double-stranded DNA antibodies often have severe renal damage.

When to Seek Medical Attention

Seek immediate medical help if you experience warning signs such as persistent high fever over 38.5°C with chills, difficulty breathing or hemoptysis, unexplained worsening of skin ulcers, confusion, or seizures. Sudden worsening of chronic symptoms, such as joint swelling with fever, also warrants urgent evaluation.

Patients are advised to keep a symptom diary to record flare frequency and triggers. If three or more symptoms worsen simultaneously, or if existing symptoms do not improve with treatment, additional consultations or repeat immunological testing should be considered. Regular monitoring of blood indices (such as C3, C4 complement levels) can help predict disease progression.

Frequently Asked Questions

It is recommended to use hot or cold compresses to relieve acute pain, along with NSAIDs prescribed by your doctor. Low-impact exercises such as swimming or yoga can help improve joint flexibility, but overexertion should be avoided in inflamed areas.

In addition to physical sunscreens containing zinc oxide, wearing long-sleeved clothing, wide-brimmed hats, and sunglasses is advised. If lesions are located in sun-exposed areas, doctors may adjust treatment plans, such as increasing the frequency of corticosteroid ointments or immunomodulators.

Immunosuppressants can reduce immune function. Patients should regularly monitor blood counts, avoid contact with sick individuals, and receive annual influenza and pneumonia vaccines. Immediate medical attention is necessary if fever, persistent cough, or other infection signs occur.

It is recommended to wait until the disease is stable for at least 6 to 12 months before considering pregnancy, and to consult a specialist for medication adjustments. During pregnancy, close monitoring of antiphospholipid antibodies and other markers is essential to reduce risks of miscarriage and preeclampsia.

There are no specific fasting restrictions, but a low-salt diet is recommended to reduce edema. Increasing intake of antioxidant-rich foods such as dark vegetables and berries is advised, while foods high in aluminum (like antacids) should be avoided. Patients with severe disease should follow medical advice to control protein intake to prevent excessive renal burden.