Ask an expert: What are the signs and symptoms of lupus?

Lupus can cause a wide variety of symptoms, from headaches and vision problems to puffiness around the eyes and joint swelling, depending on which of the body’s systems the condition affects. In this informative article, revered paediatric rheumatologist Dr Vinay Shivamurthy expertly explains which symptoms can be indicative of lupus and how the condition can affect the body in so many different ways. The leading specialist also discuss how lupus is diagnosed and treated.

What is lupus?

Lupus is also known as systemic lupus erythematosus, or SLE in short form. It's an autoimmune condition where the body has developed antibodies which work against the body’s own cells, instead of working as a defensive mechanism against external agents. Lupus is a chronic condition and the patient may experience multiple symptoms depending on the organ systems involved.

What are the symptoms of lupus?

Lupus can affect any of the body’s organ systems. Lupus has been described as the disease of thousand faces as the affected organ systems can vary from individual to individual, with symptoms ranging from mild to very severe.

Lupus can affect any organ system from head to toe but the most common way people notice lupus is when they are affected by what we call constitutional symptoms, such as fever, loss of appetite, weight loss, fatigue, tiredness or weakness.

In addition, there will be some specific symptoms which may include a skin rash. There is a classic type of skin rash which the majority of lupus patients develop known as the butterfly rash, which most often occurs on the face, over the nasal bridge and the cheeks, although it can affect other areas of the skin too. Patients with lupus may also develop mouth ulcers, gland swelling in the neck or in other places in the body. Patients may also present with headaches or vision problems and a select few may have chest or heart involvement.

If the patient has heart involvement, they may have fluid around the heart, dizziness or fainting episodes or tachycardia, meaning a very fast beating heart, which may cause them to present at hospital. Other symptoms can relate to the joints and muscles, such as swelling similar to juvenile arthritis and muscle weakness or aching.

Some patients may have preferential kidney involvement without any other organ system involvement, resulting in constitutional symptoms such as fever, fatigue or swelling around the eyes when they wake up in the morning. They may also have puffiness around the feet or headaches. When you check the urine, these patients will have protein and blood present in the urine.

In other patients with preferential neurological (nervous system) involvement, they may present with headaches, hallucinations or rarely, some psychiatric symptoms or spinal cord inflammation. In a small proportion, patients may only show as having abnormality in blood testing, where they have low platelets, haemoglobin and vital count and may bruise easily. When blood tests are performed, you come across certain antibodies that are positive for lupus and that is how we make a diagnosis.

Therefore, as you can see, the presentation of lupus can vary hugely from one patient to another and may present in multiple different ways.

What can trigger lupus?

This is a very interesting question because autoimmune conditions are characterised by the fact that there is a genetic predisposition to developing them. We are all made of certain genes that dictate who we are, how we are and what we are. Something in our genetic system can predisposes us to condition such as lupus, although one doesn't know specifically which gene is actually to blame. In fact, there may be a constellation of genes which can predispose us to lupus.

Specific to lupus, the known triggers in the environment are infection and UV radiation. There are also other potential triggers that we are unaware of that can, either alone or in combination, hit the immune system and cause it want to work as a defensive portal and start making antibodies. That is the role of the immune system but unfortunately, in conditions such as lupus, those antibodies start attacking the body’s own cells. The affected cells could be part of the skin, the kidneys, the heart, the gut muscles, bones or joints, and so on. When this happens, symptoms affecting those organ systems may come on and when a blood test is performed, you will see those antibodies are elevated and that is how we diagnose lupus.

Although we are not aware of any particular food triggers, we suggest that patients eat well and maintain a balanced diet to keep the immune system in a good place and help the body fight in the appropriate way rather than actually succumbing to the autoimmune process.

Is there a cure for lupus?

Unfortunately, there is no cure for this chronic autoimmune condition. The next best thing we have are some medications that will help control the inflammation and minimise or prevent any presence of the disease, helping the individual lead as normal a life as possible.

The best choice of medication for each patient will vary as this depends on which organ systems are involved. In most, if not almost all, patients diagnosed with lupus, we use a medication called Hydroxychloroquine, which is an anti-malarial drug, which is a weak anti-inflammatory with profound benefits. It works to minimise organ system of flare-ups such as a skin or kidney flare. Most patients with lupus will be recommended to use Hydroxychloroquine, but there are other medications that may be described depending on which organ systems are affected.

Steroids remain the common stay because they help to control the inflammation faster but we cannot use them on a long-term basis. If you have kidney disease, your rheumatologist may suggest a medication called MMF, or Mycophenolate Mofetil. Alternatively, one may suggest Azathioprine depending on the organs involved. On the other hand, if you have joints or muscles which are affected, Methotrexate may be suggested. In very rare situations, we may go for other immunomodulatory or immunosuppressive medications such as Rituximab or Cyclophosphamide. However, the best medication for you entirely depends on which organ systems are affected, be it the kidneys, heart or only the blood system.

If you would like to schedule a consultation with Dr Shivamurthy, you can do so by visiting his Top Doctors profile.