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- The symptoms of lupus can span
to any part of the body.
There are different symptoms of patients.
Some patient can present with oral ulcers,
hair loss, rashes in the sun, swollen joints
or morning stiffness in their joints.
Other patients will have inspiratory chest pains,
fevers, swollen glands, low white blood cell counts,
protein in the urine.
Other patients will have fatigue
associated with any of these symptoms,
but it's very important that this fatigue in lupus
is not chronic.
It's a fatigue that accompanies the activity of lupus
and generally resolves once the activity resolves itself.
Any kind of symptom can be a sign of lupus
and one symptom alone shouldn't raise a suspicion for lupus.
There are some manifestations that are very common
like cognitive dysfunction.
Not all cognitive dysfunction is a sign
that somebody has active inflammation of the brain.
That is a common misconception.
Cognitive dysfunction is commonly seen in lupus,
even at the time of diagnosis.
About 80% of the patients will have it
even during their first visit with their rheumatologist
to a mild degree and it may not progress over time.
Lupus can affect the brain by causing seizures,
by causing inflammation of the lining of the brain,
by inflaming the brain itself.
It can affect the spinal cord
and cause something called myelitis and paralyze patients.
It can affect peripheral nerves and cause footdrop
or wristdrop.
It can affect the lungs by causing bleeding in the lungs
or affecting the lining of the lungs and inflaming it,
something called pleuritis.
It can affect the lining of the heart
or the heart itself.
It can affect the valves of the heart.
Gastrointestinal involvement is relatively rare,
but can happen.
It can also inflame the peritoneum,
the lining of the abdomen.
Very rarely, the blood vessels of the bowels,
something called vasculitis, mesentery vasculitis.
It can affect the joints, but mostly small joints,
not the large joints like the hips or shoulders.
It can affect the skin by causing either inflammatory rashes
or ulcerations.
It can affect the fingers.
The Raynaud's I mentioned when they change colors.
Sometimes that can lead to ulcers, although it's very rare.
It can cause clots.
Patients with lupus have a higher risk of thrombosis
when they make so called antiphospholipid antibodies.
Very rarely it can affect the eye too
and people can get inflammation of the sclera
or the uvea or the retina.
So there's really no part of the body that is always spared.
Something can always be affected.
Patients that go into these long remissions
where they don't have flares and flares are rare,
but on average, flares occur about once a year.
And by flare, we generally mean clinical evidence
of activity or laboratory evidence of activity.
Some flares will not require changes in management.
Like I said, if somebody has a low white blood cell count
or suddenly drops their compliment levels,
that will count as a mild disease activity,
but doesn't necessarily require that
we change their management.
Some flares though do require changes in management
like if somebody has inflammation of the lining of the lungs
or inflammation of the lining of the heart
or the joints.
To the severe flares that I mentioned before.
Inflammation of the brain, kidneys or bleeding in the lungs,
which require hospitalization
and a very aggressive treatment of high dose of IV steroids
and immediate immunosuppressants.
About 30% of patients with lupus
will develop fibromyalgia and that is the most common course
of chronic pain and fatigue.
Exactly why this high percentage of lupus patients
develop it is unknown.
But it does affect their quality of life
in a manner that is even more significant
than the lupus itself.
It's a common misconception that chronic fatigue alone
is a sign of lupus activity.
Chronic fatigue is usually a sign that somebody
has developed fibromyalgia and doesn't require changes
in immunosuppression or any of the lupus medications.
Developing this fatigue and pain does require
a rule out of other things that can mimic it
like thyroid dysfunction or inflammation of the muscles,
which can rarely cause widespread pain,
but the context of fatigue, unrefreshed sleep,
widespread pain, cognitive dysfunction
generally accompanies fibromyalgia
and requires a completely different approach
rather than immunosuppression.
In the outpatient settings, a lot of times
chronic pain is worked up with an ANA
and that's a very important misconception
because lupus does not cause chronic pain.
Lupus does not cause hip girdle, or shoulder girdle pain.
It does not cause chronic neck or low back pain.
So whenever somebody has that kind of pain,
checking an ANA without having other signs of lupus
doesn't really make any sense, but I do evaluate
a lot of patients who have chronic pain
and end up getting a positive ANA and then nobody knows
exactly what the cause is and they think it's lupus.
So yes, I do see fibromyalgia patients in that context,
but lupus symptoms does not follow fibromyalgia patients.
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