Symptoms
SLE symptoms may develop imperceptibly over months or years, or they may appear suddenly. Symptoms tend to be worse during winter months, perhaps because prolonged exposure to sunlight in the summer causes a gradual build-up of factors that trigger symptoms months later.
Arthritic Pain
The most common symptom is joint pain, occurring in about 90% of SLE patients. Characteristics of this symptom vary widely:
- It is often accompanied by swelling and redness.
- It can last from hours to months.
- It may be mild or severe.
- It can occur in one joint, move from one to another, or flare erratically.
- Pain often occurs in the morning and improves during the day, only to return later when the patient tires.
- The joints most affected are fingers, wrists, elbows, knees, and ankles. (Joints in the spine and neck are not affected.)
Children may experience these symptoms as growing pains, and, in all patients, they may be the only symptoms for many years.
Fever
Fever occurs in 90% of SLE patients and is usually caused by the inflammatory process of the disease, not by infection. It is low-grade except during an acute lupus crisis.
Skin Rashes
Three-quarters of SLE patients have skin inflammation and skin lesions (ulcers, rashes, or other injured areas). About half of these lesions are photosensitive; that is, they are aggravated by ultraviolet (UV) radiation from sunlight, even from light coming through a window. (UV radiation may even trigger systemic flares in SLE patients.)
A number of different skin conditions have been described in SLE patients.
Discoid Lupus Erythematosus. About 20% of patients have discoid lesions. In such cases, the condition is often known as discoid lupus erythematosus (DLE). Patients with this condition may have the following skin abnormalities:
- Discoid means coin-shaped, so these lesions are round and raised. They are also scaly. Untreated, the margins gradually extend outward as the center dries out and atrophies, causing severe scarring. If discoid lesions appear on the scalp, they can plug hair follicles and cause irreversible hair loss. Discoid lesions occasionally appear on the upper portion of the trunk and on the mucous membranes.
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Lupus, discoid - view of lesions on the chest: This close-up picture of the neck clearly shows the typical rounded appearance of discoid lupus. The whitish appearance is caused by scaling. The two dark spots are biopsy sites and are not part of the disease. |
- A butterfly-shaped rash across the face may accompany this condition. This rash causes little scarring, although spidery, branching lines of swollen capillaries (the tiniest blood vessels) may appear.
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Click the icon to see an image of systemic lupus erythematosus. |
Most patients with this condition have only a limited skin disorder. In only about 10% of cases does discoid lupus develop into full-blown SLE.
Subacute Cutaneous Lupus Erythematosus. Subacute cutaneous lupus erythematosus (SCLE) is characterized by the following:
- Very red, non-scarring, coin-shaped, or psoriasis-like lesions that are acutely photosensitive and usually occur over the arms, neck, and face.
- Joint aches and fatigue (sometimes).
- The condition is also often mild and does not affect the central nervous system or kidneys.
- Vasculitis. SLE can cause inflammation in the blood vessels (vasculitis) that may have the following effects on the skin:
- Red welts may form across large areas of the body.
- Sometimes deep red bumps may appear, particularly on the leg, where they may ulcerate.
- In some people, reddish-purple lesions appear on the pads of fingers and toes or near the nails of fingers and toes.
- Lesions caused by vasculitis may ulcerate or blister if they erupt on mucous membranes in the mouth, nose, or vagina and can be painful if they occur on the throat.
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Click the icon to see an image of vasculitis. |
Other Symptoms
Other symptoms include the following:
- Fatigue.
- Loss of appetite, nausea, and weight loss.
- Chest pain.
- Bruising.
- Menstrual irregularities.
- Disturbances of thought and concentration, and personality changes.
- Hair loss. Hair loss (known as alopecia) or easy breakage that is not caused by discoid lesions may also occur in about half of SLE patients during severe flares or after pregnancy or severe illness. In such cases, hair grows back.
- Sleep disorders, such as restless legs syndrome and sleep apnea.
- Dryness of the eyes and mouth.
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