Signs and symptoms of lupus

Lupus. You’ve probably heard of it. If you’re a fan of House, you might have noticed the running joke that every episode a character will suggest that the patient has this disease. But what exactly is lupus? Leading rheumatologist Dr Joel David explains.

What is lupus?

Lupus is an autoimmune inflammatory disease. Younger women are more likely to get it. It can occur in families where there are other autoimmune diseases such as rheumatoid arthritis or thyroid disease. The immune system, which usually provides defence and fights against infection or cancer, becomes dysregulated and starts to recognise parts of the body as foreign, mounting an attack against oneself.

It is called ‘lupus’ – which means wolf. The name comes from the classic ‘butterfly’ red rash on the face which some people with lupus experience, as early physicians thought these marks on some patients resembled a wolf bite.

How do you get lupus?

It is not entirely clear. The person may be genetically predisposed by having a family history of other autoimmune diseases. Then, a virus is encountered which switches on the immune attack against the patient’s own body.  There are hormonal factors, e.g. oestrogen, which play a part, as does stress, UV exposure, and certain drugs.

What are the first signs of lupus?

Lupus is a very heterogenous disease – this means that it can look very different in different individuals. There are 11 criteria which constitute features of the disease; four must be present for a diagnosis to be made.

Very common symptoms include fatigue, temperatures, weight loss, and night sweats (called constitutional upset).

A rash, especially on sun exposure, is typical – often on the face, bridge of the nose and cheek bones (butterfly rash). Other typical rashes include red scarring lesions on the upper body, leg ulcers, and hives (urticaria).

Other potential symptoms include:

• Raynaud’s phenomenon – poor circulation and chilblains
• Hair loss (alopecia)
• Mouth ulcers
• Pleurisy and chest pains
• Heart inflammation – often pericarditis
• Arthritis – joint and muscle pains

Other systems that may be involved include:

• Kidneys – these may suffer inflammation, and can leak blood and protein into the urine. Poor functioning of the kidneys can lead to high blood pressure.
• Neurological – headaches; weak, inflamed nerves; in very rare cases, fits; encephalitis and psychological or psychiatric symptoms with depression and anxiety.

There is a subset of lupus which is associated with clotting – mainly in the legs, but also arms, and, very rarely, strokes. This sub-type is characterized by a specific antibody (lupus anticoagulant or anticardiolipin antibody). When this is positive, pills containing oestrogen (contraceptive or HRT) are not advised.

Lupus can be associated with problems in pregnancy, so pregnancy needs to be planned and discussed with your doctor. It is always advised that conception take place when the lupus is under good control.

There are typical blood abnormalities that can occur with lupus, including a low white blood cell count, anaemia and a low platelet count.

What are the symptoms of advanced lupus?

Usually, if lupus is well controlled, it can go into remission. Some of the late manifestations include long-term use of medication – especially steroids, high blood pressure, and a higher incidence of cardiovascular disease after 20 years. Most people, if well managed, will be fine; they may be left with dry eyes and a dry mouth, and mild skin scarring.

Can you die from lupus?

The vast majority of people can be treated with few consequences. Very rarely though, lupus can be catastrophic and cause death. This will usually be due to kidney failure with overwhelming infection. Strokes and brain haemorrhage are very rare and if the depression and emotional consequences of the disease are not well managed then suicide is a risk. 95% of people with lupus have very treatable disease.

For more information or to book an appointment, visit Dr David’s Top Doctors profile.