Lupus, a chronic autoimmune disorder that causes inflammation, creates a wide range of signs and symptoms.
The first signs of lupus can vary from person to person, and the variety of symptoms can make it tough to spot.
Some of its most common symptoms — such as fatigue, headaches, joint pain, swelling, and fever — occur with a lot of other illnesses too. Lupus can imitate conditions like rheumatoid arthritis, blood disorders, and fibromyalgia.
So, what are the signs it might be lupus and not something else?
Here’s what to know about the most common early signs of lupus, to help you better identify and learn about symptoms that might indicate the disease.
Cutaneous Rash
Estimates suggest that between 40 and 70 percent of people with lupus will notice that their symptoms get worse in the sun or in some types of artificial light.
One main type of lupus, cutaneous lupus erythematosus, is limited to skin symptoms, including a rash and lesions.
People with cutaneous lupus most commonly develop a discoid rash. It appears as round, raised, red patches, usually above the neck. Discoid rashes can cause scarring, but they usually aren’t itchy or uncomfortable.
Another subtype of cutaneous lupus is subacute cutaneous lupus, and people with it will develop thick, scaly, red lesions that usually don’t itch or scar.
Malar Rash (Butterfly Rash)
About 50 percent of people with systemic lupus erythematosus (SLE) experience a malar rash, also called a butterfly rash. It spreads across the bridge of the nose and cheeks and is a telltale sign of the disease because its appearance is so distinctive.
A malar rash can be flat or raised, and it can itch or burn, causing pain. It can also appear on other parts of the face.
Fatigue
Up to 90 percent of people with lupus experience fatigue. Fatigue may be brought on by the disease itself or from medication or associated physical or mental factors.
Fever
Unexplained fever (a temperature of more than 100 degrees Fahrenheit) is another common sign of lupus. Some lupus medications can increase the risk of infection, which can also bring on a fever.
Sore and Stiff Joints
Most people with lupus will experience joint inflammation at some point.
Inflammation associated with lupus can cause stiffness, swelling, pain, and warmth of the joints, most commonly in the:
Fingers
Hands
Wrists
Elbows
Ankles
Toes
Raynaud’s Syndrome
Raynaud’s syndrome is a condition in which the small blood vessels in the fingers and toes spasm, limiting circulation. It affects about one-third of people with lupus and can cause color loss in the fingers and toes, which first turn white or blue, followed by red with rewarming.
People with Raynaud’s are extremely sensitive to cold temperatures and, in those conditions, will often notice a loss of circulation and loss of color in their digits much more quickly than people without the condition.
Headaches
Some people with lupus may experience headaches caused by inflammation of the blood vessels in the brain, also known as vasculitis. It could also cause thrombosis, which is characterized by blood clots within these blood vessels.
Mouth or Nose Sores
People with SLE may experience mouth or nose sores. Let your doctor know about any sores you notice.
Hair Loss
The inflammation of the skin associated with lupus can sometimes result in hair loss. Once lupus is treated, the hair may grow back. But discoid rash may cause scarring on the scalp and permanent hair loss.
Some of the medications used to treat lupus may also cause the hair to fall out, though this is sometimes temporary.
There are four main types of lupus.
Systemic Lupus Erythematosus
Systemic lupus erythematosus, or SLE, is the most common form of lupus. It can potentially involve any major organ system of the body, especially the kidneys, skin, and joints.
Cutaneous Lupus
This form of lupus mainly affects the skin. There are several subtypes:
Acute cutaneous lupus
Chronic cutaneous lupus erythematosus (also known as discoid lupus erythematosus)
Subacute cutaneous lupus erythematosus
Drug-Induced Lupus
This form of lupus is distinct from SLE and can happen after taking certain prescription drugs, such as:
Antitumor necrosis factor drugs, which are prescribed for conditions like psoriatic arthritis and rheumatoid arthritis
Hydralazine, which is occasionally used for high blood pressure
Isoniazid, which is used for tuberculosis
Minocycline, which is prescribed to treat acne
Procainamide, which is occasionally used for irregular heart rhythms
Neonatal Lupus
Neonatal lupus is a rare form of lupus that affects babies of mothers with certain antibodies that affect the baby.
With early diagnosis and treatment, many of the symptoms of lupus can be managed. But a variety of complications can arise from lupus, causing an array of additional symptoms.
Some of these complications include the following conditions.
Lupus Nephritis
Lupus nephritis, inflammation of the kidneys, is one of the most common complications of lupus. People with lupus nephritis are at a higher risk of developing kidney failure, requiring dialysis or a transplant.
Symptoms of lupus nephritis include:
High blood pressure
Swelling of the hands, ankles, feet, legs, or face
Changes in urination (blood or foam in urine, increased nighttime urination frequency, pain or trouble urinating)
High levels of creatinine in the blood
Blood Disorders
Lupus can cause problems with the blood, too, including anemia, or low red blood cell count. Anemia can cause symptoms such as dizziness and fatigue.
Thrombocytopenia is another blood disorder that may develop, resulting in lower platelet counts. Symptoms of thrombocytopenia can include bruising easily, nosebleeds, and petechiae (blood appearing as red pinpoints under the skin).
Atherosclerosis
Atherosclerosis, or clogging of the arteries, is the most common form of cardiovascular disease among people with lupus. It can lead to complications like stroke and heart attack.
Pericarditis
Pericarditis, or inflammation of the sac that surrounds the heart, can be an early complication of lupus. Symptoms include a sharp pain in the chest, shortness of breath, or pain with deep breaths.
Myocarditis
Inflammation of the heart, called myocarditis, can cause chest pain. Other symptoms include irregular heartbeat or fatigue with exertion.
Pleuritis and Pleural Effusion
Inflammation of the lining surrounding the lungs, or pleuritis, can occur in people with lupus. This can cause symptoms such as chest pain and shortness of breath. The pain can worsen when taking a deep breath, sneezing, coughing, or laughing.
Pleural effusion, or fluid around the heart and lungs, may also develop.
Central Nervous System Inflammation
Inflammation of the central nervous system can cause confusion, seizures, and psychosis. It can contribute to an increased risk of depression, headache, and stroke, as well as problems with vision in people with lupus.
Miscarriage and Preterm Labor
Women with lupus have a higher risk of miscarriage and preterm labor. Pregnant women with lupus also have a higher risk of preeclampsia — a serious condition causing increases in blood pressure and protein in the urine — and signs that the kidneys and liver may not be functioning well.
If you have lupus and do get pregnant (or if you have lupus and are trying to get pregnant), see a high-risk maternal-fetal medicine specialist who has expertise in how to best handle such pregnancies.
Be sure to talk with your rheumatologist well in advance of trying to get pregnant (at least three to six months before you start trying to get pregnant).
Talk with your doctor if you notice any of the following:
Unexplained rash
Persistent fever
Aching or fatigue that won’t go away
Lupus is an autoimmune condition with many different symptoms that commonly affect the skin, joints, kidneys, and other organ systems.
One common early sign that can be indicative of lupus is a malar rash, or butterfly rash, which spreads across the bridge of the nose and cheeks and resembles a butterfly.
Lupus can cause a range of complications, such as lupus nephritis or atherosclerosis.
