Systemic lupus erythematosus is an autoimmune disease that reinterprets the role of the immune system and turns it against the body it is supposed to protect. The lupus disease cycle begins with tissue attacks and ends with widespread inflammation of organs. It affects the skin, the joints, the kidneys, the brain and the heart. With varying symptoms, it has been labeled “the great imitator”.
Extensive inflammation is common in traditional autoimmune diseases, such as rheumatoid arthritis and fibromyalgia, and in syndromes, such as the chronic fatigue syndrome and hypothyroidism. It becomes a dual challenge for the patient and the doctor at the same time. The dual challenge nature of lupus can be seen in a delayed diagnosis. Even a healthy inactive lupus can do a lot of damage to the organs, and that is exactly why a quick diagnosis is so critical.
Once the early symptoms of lupus are recognized, a defensive treatment plan with appropriate medication can be drawn up to prepare for and deal with inevitable lupus flare ups.
Unexplained Fatigue and Malaise
As a primary symptom, 80% of lupus patients report severe fatigue. It is an abnormal, bone-deep level of exhaustion that cannot be cured with sleep. Most people attribute extreme tiredness to work, age, or stress. Because fatigue is a common complaint, patients usually do not acknowledge it as a medical warning. However, fatigue from lupus disrupts daily functioning and lasts for weeks or months.
Joint Pain and Swelling
Joint stiffness is a common symptom with lupus. The disease causes painful inflammation of the lining which leads to swelling. The stiffness also causes an annoying level of pain that lasts longer than 30 minutes. Swelling and stiffness pain can occur in both wrists, ankles, or knees. Most people dismiss this as an annoyance due to aging or a minor sports injury, but the bilateral pain suggests an autoimmune disease.
Skin Rashes and Photosensitivity
Malaria rash is a common sign of lupus rash and is also referred to as butterfly rash. It can occur from sun exposure resulting in a rash that extends to the cheeks and nose. Many lupus patients have a heightened sensitivity to ultraviolet rays. Prolonged or even short exposure can result in fatigue or pain in the joints.
Unexplained fevers
A low-grade fever that lingers for days or weeks can indicate an overactive immune system. These fevers typically hover around 100°F to 101°F and happen without any obvious signs of a viral or bacterial infection. People frequently dismiss a mild fever as a lingering cold or a minor bug. Recurrent temperature spikes without a clear cause warrant a thorough medical evaluation.
Less Common, but Significant Early Warning Signs
While fatigue and joint pain are the most frequent complaints, lupus can manifest in several other surprising ways.
Hair loss
Sudden shedding or hair thinning happens when lupus causes scalp inflammation. Hair might fall out in clumps in the shower or slowly thin out over time. Some people develop a condition sometimes called “lupus hair” where strands become brittle and break off easily near the scalp, leaving a ragged appearance.
Raynaud’s phenomenon
Lupus can can severely affect blood circulation, particularly in the extremities. A condition called Raynaud’s phenomenon leads to the fingers and toes turning white, blue or red, due to exposure to cold or high stess. Color changes are due to blood vessels spasming and restricting blood flow to the skin.
Mouth sores
Autoimmune inflammation can lead to the formation of ulcers in the mouth or the nose. Different from cankers, lupus ulcers are totally painless in most cases. This leads many to remain ignorant to these sores, until chronic ulcer evaluation or routine screenings are performed and the healthcare providers notice the sores.
Chest Pain (Pleurisy)
Active lupus sometimes goes to the tissue layer of the lungs causing pleuritis (inflammation of the pleura) which causes sharp shooting pain in the chest which is exacerbated when breathing deeply, coughing, laughing, or sneezing. Another symptom that is closely associated with pleurisy is shortness of breath which is not associated with any activity. This is a very serious symptom and requires immediate attention.
When to Seek Medical Attention
Having just one symptom that correlates to any of the autoimmune symptoms mentioned like fatigue, and low grade fever does not warrant making an assumption that you may have an autoimmune condition. However, if you notice a large manifestation of symptoms, you should schedule an appointment to see your doctor. If your doctor suspects that you may have an autoimmune condition, you will be referred to a rheumatologist or a specialist which focuses on diseases of the joint and the immune system.
It is beneficial to keep a diary to track the symptoms that you are having pain to show to your doctor. Each time you have an episode, write a note of when the episode started, what symptoms you experienced, and what you think may have caused it like a stressful event or sun exposure.
The Diagnostic Process
As each condition has a specific set of diagnostic criteria to be met, lupus is the same and requires more than one test to be completed, which is a test of several done by rheumatologists. The test phase begins by having a comprehensive physical and medical history assessed.
Your doctor will order autoimmune blood tests. The Antinuclear Antibody (ANA) test will most likely be done first. Most people with lupus test positive. Inflammation in the patient is measured by the doctor using the Erythrocyte Sedimentation Rate test (ESR) and the C-Reactive Protein (CRP) test. A full blood count and urinalysis will be used to test if the glucose is changing the patient’s blood cells and if the kidneys are affected by the disease.
Living with a Lupus Diagnosis
Your lupus diagnosis may have been a journey with many obstacles but a modern lupus diagnosis has many treatment options. This treatment includes both medications (antimalarial medications) or drugs (hydroxychloroquine) and the patient changing his or her lifestyle. For example, the medications mentioned above are used to reduce the immune system.
There are many lifestyle changes the patient must adopt to limit lupus flare-ups. For example, the patient should be cautious of the sun and apply sun block (SPF) to be sun safe. The patient should have a healthy balanced diet, and strive to increase relaxation and rest. Building a support system through friends, family, and even other people with chronic illness will be really helpful.
Managing Your Health
Ongoing medical management is vital for lupus. Learning the associated symptoms can help you find the right specialists before serious organ damage occurs. Be proactive if you experience fatigue, joint pain, or skin rashes. The sooner you address a lupus flare up with a doctor, the better you will be able to craft your future and maintain your quality of life.
