Systemic lupus erythematosus history and symptoms: Difference between revisions

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__NOTOC__
{{Systemic lupus erythematosus}}
{{Systemic lupus erythematosus}}


{{CMG}}; {{AE}} {{RT}}
{{CMG}}; {{AE}} {{MIR}}


==Overview==
==Overview==
A positive history of familial [[lupus]], [[skin rashes]] (especially [[Photosensitivity|photosensitive]] [[skin rashes]]), [[arthritis]], and [[fatigue]] may be suggestive of [[systemic lupus erythematosus]]. The most common symptoms of [[SLE]] include constitutional symptoms like [[fatigue]], [[fever]], [[myalgia]], and [[Weight|weight changes]]. Other organ-specific symptoms mostly occur with disease progression. [[SLE]] may show a variety of symptoms in different organs depending on its complications.


==Signs and symptoms==
==History==
Obtaining the history is one of the most important aspects in making a diagnosis of [[systemic lupus erythematosus]]. It provides insight into disease course and severity, precipitating risk factors, and associated [[comorbid]] conditions. Complete history will help determine the correct complication diagnosis, and helps in determining the prognosis as well. Specific histories about the symptoms (duration, onset, progression), associated symptoms, and [[drug]] usage have to be obtained. Specific areas of focus when obtaining the history are outlined below:
* Onset, duration and progression of symptoms
* History of [[Weight change|weight changes]] (gain or loss)
* [[Anorexia]]
* [[Arthritis]], [[Arthralgia|arthralgias]], or [[muscle pain]]
* Morning [[stiffness]]
* [[Skin rashes]] and their association to flare ups, especially after exposure to sunlight
* [[Medications]] and their association to flare ups
* [[Infections]] especially [[mononucleosis]]
* Sores in the mouth, nose, or other [[Mucous membrane|mucous membranes]]
* Symptoms of other organ failure
** [[Renal failure]]: Recent peripheral [[edema]] and [[weight gain]]
** [[Cardiac]] involvement: [[Tachycardia]], [[dyspnea]], [[Chest pain|chest pains]]
* History of having a pet
* [[Hair loss]]
* Job history
* [[Comorbid|Co-morbid]] conditions include:
** Other [[Rheumatologic disease|rheumatologic]] and [[autoimmune diseases]]
** [[Hypertension]]
** [[Diabetes]], [[immunodeficiency]]
* [[Seizure|Seizures]], or other [[nervous system]] symptoms
* [[Family history]] of [[Rheumatologic disease|rheumatologic diseases]]


SLE is one of several diseases known as [[the great imitator]]<ref>[http://healthcare.utah.edu/healthtools/articles/lupus.html Lupus: The Great Imitator]</ref> because its symptoms vary so widely it often mimics or is mistaken for other illnesses, and because the symptoms come and go unpredictably. Diagnosis can be elusive, with patients sometimes suffering unexplained symptoms and untreated SLE for years. Common initial and chronic complaints are [[fever]], [[malaise]], [[arthralgia|joint pains]], [[myalgia]]s and [[Fatigue (medical)|fatigue]]. Because they are so often seen with other diseases, these signs and symptoms are not part of the diagnostic criteria for SLE. When occurring in conjunction with other signs and symptoms (below), however, they are considered suggestive.
== Common Symptoms ==
The early manifestations of [[systemic lupus erythematosus]] include common constitutional symptoms that may be seen in many other diseases as well:<ref name="pmid11085805">{{cite journal |vauthors=Tench CM, McCurdie I, White PD, D'Cruz DP |title=The prevalence and associations of fatigue in systemic lupus erythematosus |journal=Rheumatology (Oxford) |volume=39 |issue=11 |pages=1249–54 |year=2000 |pmid=11085805 |doi= |url=}}</ref><ref name="pmid7779127">{{cite journal |vauthors=McKinley PS, Ouellette SC, Winkel GH |title=The contributions of disease activity, sleep patterns, and depression to fatigue in systemic lupus erythematosus. A proposed model |journal=Arthritis Rheum. |volume=38 |issue=6 |pages=826–34 |year=1995 |pmid=7779127 |doi= |url=}}</ref><ref name="pmid9598886">{{cite journal |vauthors=Wang B, Gladman DD, Urowitz MB |title=Fatigue in lupus is not correlated with disease activity |journal=J. Rheumatol. |volume=25 |issue=5 |pages=892–5 |year=1998 |pmid=9598886 |doi= |url=}}</ref>
*[[Fatigue]]
*[[Fever]]
*[[Myalgia]]
*Joint [[tenderness]]
*[[Muscle weakness]]
*[[Weight]] change
**[[Weight gain]] due to increase in [[water retention]] and increase in appetite
**[[Weight loss]] due to medication side effect and gastrointestinal problems


===Most Common Symptoms===
== Less Common Symptoms ==
 
# [[Joint pain]] or [[joint swelling]]
# [[Skin rash]]
# [[Malaise]] or [[fatigue]]
 
===Complete List of Signs and Symptoms===


=== Organ system based signs and symptoms ===
* Symptoms in the below table are listed based on their frequency in each organ system and the disease that is responsible for each symptom:<ref name="pmid14530779">{{cite journal |vauthors=Cervera R, Khamashta MA, Font J, Sebastiani GD, Gil A, Lavilla P, Mejía JC, Aydintug AO, Chwalinska-Sadowska H, de Ramón E, Fernández-Nebro A, Galeazzi M, Valen M, Mathieu A, Houssiau F, Caro N, Alba P, Ramos-Casals M, Ingelmo M, Hughes GR |title=Morbidity and mortality in systemic lupus erythematosus during a 10-year period: a comparison of early and late manifestations in a cohort of 1,000 patients |journal=Medicine (Baltimore) |volume=82 |issue=5 |pages=299–308 |year=2003 |pmid=14530779 |doi=10.1097/01.md.0000091181.93122.55 |url=}}</ref><ref name="pmid2319520">{{cite journal |vauthors=Finol HJ, Montagnani S, Márquez A, Montes de Oca I, Müller B |title=Ultrastructural pathology of skeletal muscle in systemic lupus erythematosus |journal=J. Rheumatol. |volume=17 |issue=2 |pages=210–9 |year=1990 |pmid=2319520 |doi= |url=}}</ref><ref name="pmid20572299">{{cite journal |vauthors=Tian XP, Zhang X |title=Gastrointestinal involvement in systemic lupus erythematosus: insight into pathogenesis, diagnosis and treatment |journal=World J. Gastroenterol. |volume=16 |issue=24 |pages=2971–7 |year=2010 |pmid=20572299 |pmc=2890936 |doi= |url=}}</ref><ref name="pmid27329649">{{cite journal |vauthors=Alves SC, Fasano S, Isenberg DA |title=Autoimmune gastrointestinal complications in patients with systemic lupus erythematosus: case series and literature review |journal=Lupus |volume=25 |issue=14 |pages=1509–1519 |year=2016 |pmid=27329649 |doi=10.1177/0961203316655210 |url=}}</ref><ref name="pmid27055518">{{cite journal |vauthors=Fawzy M, Edrees A, Okasha H, El Ashmaui A, Ragab G |title=Gastrointestinal manifestations in systemic lupus erythematosus |journal=Lupus |volume=25 |issue=13 |pages=1456–1462 |year=2016 |pmid=27055518 |doi=10.1177/0961203316642308 |url=}}</ref><ref name="pmid28523968">{{cite journal |vauthors=Li Z, Xu D, Wang Z, Wang Y, Zhang S, Li M, Zeng X |title=Gastrointestinal system involvement in systemic lupus erythematosus |journal=Lupus |volume= |issue= |pages=961203317707825 |year=2017 |pmid=28523968 |doi=10.1177/0961203317707825 |url=}}</ref><ref name="pmid26550810">{{cite journal |vauthors=Salvati F |title=[The involvement of pulmonary interstitial tissue in multisystemic lupus erythematosus: interdisciplinarity and role of the pneumologists] |language=Italian |journal=Clin Ter |volume=166 |issue=5 |pages=205–7 |year=2015 |pmid=26550810 |doi= |url=}}</ref><ref name="pmid21194884">{{cite journal |vauthors=Torre O, Harari S |title=Pleural and pulmonary involvement in systemic lupus erythematosus |journal=Presse Med |volume=40 |issue=1 Pt 2 |pages=e19–29 |year=2011 |pmid=21194884 |doi=10.1016/j.lpm.2010.11.004 |url=}}</ref><ref name="pmid25639532">{{cite journal |vauthors=Alamoudi OS, Attar SM |title=Pulmonary manifestations in systemic lupus erythematosus: association with disease activity |journal=Respirology |volume=20 |issue=3 |pages=474–80 |year=2015 |pmid=25639532 |pmc=4418345 |doi=10.1111/resp.12473 |url=}}</ref><ref name="pmid25458514">{{cite journal |vauthors=Finucci Curi P, Pierrestegui M, Ortiz A, Ceccato F, Paira S |title=[Pulmonary hemorrhage in patients with systemic lupus erythematosus. Clinical manifestations and prognosis] |language=Spanish; Castilian |journal=Med Clin (Barc) |volume=145 |issue=9 |pages=375–9 |year=2015 |pmid=25458514 |doi=10.1016/j.medcli.2014.07.034 |url=}}</ref><ref name="pmid24790989">{{cite journal |vauthors=Mak A, Kow NY |title=Imbalance between endothelial damage and repair: a gateway to cardiovascular disease in systemic lupus erythematosus |journal=Biomed Res Int |volume=2014 |issue= |pages=178721 |year=2014 |pmid=24790989 |pmc=3984775 |doi=10.1155/2014/178721 |url=}}</ref><ref name="pmid24722263">{{cite journal |vauthors=Sacre K, Escoubet B, Pasquet B, Chauveheid MP, Zennaro MC, Tubach F, Papo T |title=Increased arterial stiffness in systemic lupus erythematosus (SLE) patients at low risk for cardiovascular disease: a cross-sectional controlled study |journal=PLoS ONE |volume=9 |issue=4 |pages=e94511 |year=2014 |pmid=24722263 |pmc=3983200 |doi=10.1371/journal.pone.0094511 |url=}}</ref><ref name="pmid23052654">{{cite journal |vauthors=Canpolat N, Kasapcopur O, Caliskan S, Gokalp S, Bor M, Tasdemir M, Sever L, Arisoy N |title=Ambulatory blood pressure and subclinical cardiovascular disease in patients with juvenile-onset systemic lupus erythematosus |journal=Pediatr. Nephrol. |volume=28 |issue=2 |pages=305–13 |year=2013 |pmid=23052654 |doi=10.1007/s00467-012-2317-3 |url=}}</ref><ref name="pmid19366083">{{cite journal |vauthors=Cojocaru IM, Cojocaru M, Tănăsescu R, Burcin C, Atanasiu AN, Silosi I |title=Detection of autoantibodies to ribosome P in lupus patients with neurological involvement |journal=Rom J Intern Med |volume=46 |issue=3 |pages=239–42 |year=2008 |pmid=19366083 |doi= |url=}}</ref><ref name="pmid22594009">{{cite journal |vauthors=Madrane S, Ribi C |title=[Central neuropsychiatric involvement in systemic lupus erythematosus] |language=French |journal=Rev Med Suisse |volume=8 |issue=337 |pages=848–53 |year=2012 |pmid=22594009 |doi= |url=}}</ref><ref name="pmid7555923">{{cite journal |vauthors=Sivri A, Hasçelik Z, Celiker R, Başgöze O |title=Early detection of neurological involvement in systemic lupus erythematosus patients |journal=Electromyogr Clin Neurophysiol |volume=35 |issue=4 |pages=195–9 |year=1995 |pmid=7555923 |doi= |url=}}</ref><ref name="pmid19217587">{{cite journal |vauthors=Juncal Gallego L, Almuíña Simón C, Muíños Esparza LF, Díaz Soto R, Ramil Fraga C, Quiroga Ordóñez E |title=[Systemic lupus erythematosus with fulminant neurological involvement] |language=Spanish; Castilian |journal=An Pediatr (Barc) |volume=70 |issue=2 |pages=202–4 |year=2009 |pmid=19217587 |doi=10.1016/j.anpedi.2008.09.009 |url=}}</ref><ref name="pmid22192934">{{cite journal |vauthors=Karras A |title=[Renal involvement in systemic lupus erythematosus] |language=French |journal=Presse Med |volume=41 |issue=3 Pt 1 |pages=260–6 |year=2012 |pmid=22192934 |doi=10.1016/j.lpm.2011.11.006 |url=}}</ref><ref name="pmid25548784">{{cite journal |vauthors=Kiremitci S, Ensari A |title=Classifying lupus nephritis: an ongoing story |journal=ScientificWorldJournal |volume=2014 |issue= |pages=580620 |year=2014 |pmid=25548784 |pmc=4274910 |doi=10.1155/2014/580620 |url=}}</ref><ref name="pmid15580980">{{cite journal |vauthors=Zoma A |title=Musculoskeletal involvement in systemic lupus erythematosus |journal=Lupus |volume=13 |issue=11 |pages=851–3 |year=2004 |pmid=15580980 |doi=10.1191/0961203303lu2021oa |url=}}</ref><ref name="pmid22956550">{{cite journal |vauthors=Gabba A, Piga M, Vacca A, Porru G, Garau P, Cauli A, Mathieu A |title=Joint and tendon involvement in systemic lupus erythematosus: an ultrasound study of hands and wrists in 108 patients |journal=Rheumatology (Oxford) |volume=51 |issue=12 |pages=2278–85 |year=2012 |pmid=22956550 |doi=10.1093/rheumatology/kes226 |url=}}</ref><ref name="pmid19591780">{{cite journal |vauthors=Grossman JM |title=Lupus arthritis |journal=Best Pract Res Clin Rheumatol |volume=23 |issue=4 |pages=495–506 |year=2009 |pmid=19591780 |doi=10.1016/j.berh.2009.04.003 |url=}}</ref><ref name="pmid24862229">{{cite journal |vauthors=Zhu KK, Xu WD, Pan HF, Zhang M, Ni J, Ge FY, Ye DQ |title=The risk factors of avascular necrosis in patients with systemic lupus erythematosus: a meta-analysis |journal=Inflammation |volume=37 |issue=5 |pages=1852–64 |year=2014 |pmid=24862229 |doi=10.1007/s10753-014-9917-y |url=}}</ref><ref name="pmid23731640">{{cite journal |vauthors=Voulgari PV, Kosta P, Argyropoulou MI, Drosos AA |title=Avascular necrosis in a patient with systemic lupus erythematosus |journal=Joint Bone Spine |volume=80 |issue=6 |pages=665 |year=2013 |pmid=23731640 |doi=10.1016/j.jbspin.2013.03.018 |url=}}</ref><ref name="pmid25077888">{{cite journal |vauthors=Parodi A, Cozzani E |title=Cutaneous manifestations of lupus erythematosus |journal=G Ital Dermatol Venereol |volume=149 |issue=5 |pages=549–54 |year=2014 |pmid=25077888 |doi= |url=}}</ref><ref name="pmid26985173">{{cite journal |vauthors=Szczęch J, Rutka M, Samotij D, Zalewska A, Reich A |title=Clinical characteristics of cutaneous lupus erythematosus |journal=Postepy Dermatol Alergol |volume=33 |issue=1 |pages=13–7 |year=2016 |pmid=26985173 |pmc=4793050 |doi=10.5114/pdia.2014.44031 |url=}}</ref><ref name="pmid19824738">{{cite journal |vauthors=Walling HW, Sontheimer RD |title=Cutaneous lupus erythematosus: issues in diagnosis and treatment |journal=Am J Clin Dermatol |volume=10 |issue=6 |pages=365–81 |year=2009 |pmid=19824738 |doi=10.2165/11310780-000000000-00000 |url=}}</ref>
{| class="wikitable"
! style="background: #4479BA; color: #FFFFFF; " |Organ system
! style="background: #4479BA; color: #FFFFFF; " |Disease
! style="background: #4479BA; color: #FFFFFF; " |Symptom
|-
| rowspan="7" |<small>[[Gastrointestinal]]</small>
| style="background: #DCDCDC; " |[[Dysphagia]] 
|
* Retrosternal [[chest pain]]
* [[Heartburn]]
* [[Regurgitation]]
* [[Odynophagia]]
|-
| style="background: #DCDCDC; " |[[Peptic ulcer disease]]
|
* [[Epigastric pain]]
* Food-provoked [[Discomfort|epigastric discomfort]] and fullness
* Early satiety
* [[Nausea]]
|-
| style="background: #DCDCDC; " |[[Intestinal pseudo obstruction|Intestinal pseudo-obstruction]]
|
* [[Abdominal pain]]
* [[Bloating]]
* [[Distension]]
|-
| style="background: #DCDCDC; " |[[Protein losing enteropathy|Protein-losing enteropathy]]
|
* Profound [[edema]]
* Severe [[diarrhea]]
|-
| style="background: #DCDCDC; " |[[Acute pancreatitis]]
|
* Severe persistent [[epigastric pain]] often radiating to the back
|-
| style="background: #DCDCDC; " |[[Vasculitis|Mesenteric vasculitis]]
|
* [[Abdominal pain]]
* [[Abdominal pain]]
* Discoid skin lesions
* Food aversion
* Erythematous macules
* [[Fatigue]]
* [[Hemolytic anemia]]
* [[Interstitial lung disease]]
* [[Keratoconjunctivitis sicca]]
* [[Leukopenia]]
* Mucosal lesions
* [[Pericarditis]]
* Photo distributed rash
* [[Pleural effusion]]
* [[Pleuritic chest pain]]
* [[Pneumonitis]]
* [[Polyarthritis]] / [[polyarthralgia]]
* [[Raynaud phenomenon]]
* [[Renal disease]]
* [[Renal vasculitis]]
* [[Seizure]]s
* [[Stroke]]
* [[Thrombocytopenia]]
* [[Weight loss]]
* [[Weight loss]]
 
* [[Nausea]]
===Warning Signs of a Flare===
* [[Vomiting]]
 
* [[Diarrhea]]
* Increased [[fatigue]]
** Due to chronic [[mesenteric ischemia]]
* [[Pain]]
|-
* [[Rash]]
| style="background: #DCDCDC; " |[[Peritonitis]]
|
* Abdominal [[bloating]] or [[Abdominal distension|distension]]
* [[Nausea and vomiting]]
* [[Constipation]] or the inability to pass gas
* [[Anorexia]]
* [[Abdominal pain]]
|-
| rowspan="7" |<small>[[Pulmonary]]</small>
| style="background: #DCDCDC; " |[[Pleural disease]]
|
* [[Cough]]
* [[Dyspnea]]
* [[Fever]]
|-
| style="background: #DCDCDC; " |[[Pneumonitis]]
|
* [[Fever]]
* [[Fever]]
* [[Abdominal discomfort]]
* [[Cough]] (sometimes with hemoptysis)
* [[Dyspnea]]
|-
| style="background: #DCDCDC; " |[[Pulmonary hemorrhage]]
|
* [[Dyspnea]]
* [[Cough]]
* [[Hemoptysis]]
|-
| style="background: #DCDCDC; " |[[Interstitial lung disease]]
|
* May be [[asymptomatic]]
* Chronic nonproductive [[cough]]
* [[Dyspnea]]
* Decreased [[Exercise tolerance test|exercise tolerance]]
|-
| style="background: #DCDCDC; " |[[Pulmonary emboli]] 
|
* [[Dyspnea]]
* Sharp [[chest pain]] that may become worse with deep breathing or [[Cough|coughing]]
|-
| style="background: #DCDCDC; " |[[Pulmonary hypertension]]
|
* [[Dyspnea]]
* [[Palpitation|Palpitations]]
* [[Fatigue]]
* Impaired [[Exercise tolerance test|exercise tolerance]]
* [[Weakness]]
* [[Syncope]]
* [[Edema]]
* Increased abdominal girth
|-
| style="background: #DCDCDC; " |Shrinking lung syndrome
|
* [[Dyspnea]]
* [[Pleuritic chest pain]] (episodic)
|-
| rowspan="4" |<small>[[Cardiac]]</small>
| style="background: #DCDCDC; " |[[Valvular disease]]
|
* [[Tachycardia]]
* [[Syncope]]
* [[Dyspnea]]
* [[Peripheral edema]]
|-
| style="background: #DCDCDC; " |[[Pericarditis]]
|
* Sharp, stabbing [[chest pain]] with a sudden start
* Positional pain that decreases when sitting up and leaning forward
|-
| style="background: #DCDCDC; " |[[Myocarditis]] 
|
* [[Tachycardia]]
* [[Fever]] and chills
|-
| style="background: #DCDCDC; " |[[Coronary heart disease]]
|
* [[Chest pain]]
* [[Dyspnea]]
* [[Nausea and vomiting]]
|-
| rowspan="4" |<small>[[Neurological disorders|Neurological]]</small>
| style="background: #DCDCDC; " |CNS small vessle [[vasculitis]]
|
* [[Cognitive impairment]]
* [[Headache]]
* [[Headache]]
* [[Dizziness]]
|-
 
| style="background: #DCDCDC; " |[[Stroke]]
===Common Symptoms Explained===
|
 
* [[Speech disturbances|Speech disturbance]]
;Dermatological manifestations: As many as 30% of patients present with some dermatological symptoms (and 65% suffer such symptoms at some point), with 30% to 50% suffering from the classic [[malar rash]] (or ''butterfly rash'') associated with the disease. Patients may present with discoid lupus (thick, red scaly patches on the skin). [[Alopecia]], mouth, nasal, and vaginal [[mouth ulcer|ulcers]], and lesions on the skin are also possible manifestations.
* [[Weakness]] on one-half of the body
 
|-
;Musculoskeletal manifestations: Patients most often seek medical attention for [[joint pain]], with small joints of the hand and wrist usually affected, although any joint is at risk. The Lupus Foundation of America "estimates that 95 percent of lupus cases involve achy joints <ref name="DiGeronimo">DiGeronimo, Theresa. New Hope for People with Lupus. Prima Publishing. 2002.</ref> Unlike [[rheumatoid arthritis]], SLE arthropathy is not usually destructive of [[bone]], however, deformities caused by the disease may become irreversible in as many as 20% of patients.This small percentage may experience "damage to tendons or joint coverings in the hand" which leads to "deformity of the finger joint" <ref name="DiGeronimo">DiGeronimo, Theresa. New Hope for People with Lupus. Prima Publishing. 2002.</ref>
| style="background: #DCDCDC; " |[[Seizure|Seizures]]
 
|
;Hematological manifestations: [[Anemia]] and iron deficiency may develop in as many as half of patients. Low [[platelet]] and [[white blood cell]] counts may be due to the disease or a side-effect of pharmacological treatment.  Patients may have an association with [[Antiphospholipid syndrome|antiphospholipid antibody syndrome]] (a thrombotic disorder) where autoantibodies to phospholipids are present in the patient's serum.  Abnormalities associated with antiphospholipid antibody syndrome include a paradoxical prolonged PTT (which usually occurs in hemorrhagic disorders) and a positive test for antiphospholipid antibodies; the combination of such findings have earned the term "[[lupus anticoagulant]] positive". Another autoantibody finding in lupus is the [[anticardiolipin antibody]] which can cause a false positive test for [[syphilis]]. 
* [[Tonic-clonic seizure]]
 
|-
;Cardiac manifestations: Patients may present with inflammation of various parts of the [[heart]], such as [[pericarditis]], [[myocarditis]], and [[endocarditis]]. The endocarditis of SLE is characteristically non-infective ([[Libman-Sacks endocarditis]]) and involves either the [[mitral valve]] or the [[tricuspid valve]]. [[Atherosclerosis]] also tends to occur more often and advance more rapidly in SLE patients than in the general population.<ref>{{cite journal | author=Yu Asanuma, M.D., Ph.D., Annette Oeser, B.S., Ayumi K. Shintani, Ph.D., M.P.H., Elizabeth Turner, M.D., Nancy Olsen, M.D., Sergio Fazio, M.D., Ph.D., MacRae F. Linton, M.D., Paolo Raggi, M.D., and C. Michael Stein, M.D. | title=Premature coronary-artery atherosclerosis in systemic lupus erythematosus
| style="background: #DCDCDC; " |[[Psychosis]]
| journal=New England Journal of Medicine | volume=349 | issue=Dec. 18 | year=2003| pages=2407-2414 | url = http://content.nejm.org/cgi/content/full/349/25/2407 | id = PMID 14681506 [http://content.nejm.org/cgi/content/abstract/349/25/2407 Abstract] (full text requires registration) }}</ref><ref>{{cite journal | author=Bevra Hannahs Hahn, M.D. | title=Systemic lupus erythematosus and accelerated atherosclerosis | journal=New England Journal of Medicine | volume=349 | issue=Dec. 18 | year=2003 | pages=2379-2380 | url = http://content.nejm.org/cgi/content/full/349/25/2379 | id =PMID 14681501 [http://content.nejm.org/cgi/content/extract/349/25/2379 Extract] (full text requires registration) }}</ref><ref> {{cite journal | author=Mary J. Roman, M.D., Beth-Ann Shanker, A.B., Adrienne Davis, A.B., Michael D. Lockshin, M.D., Lisa Sammaritano, M.D., Ronit Simantov, M.D., Mary K. Crow, M.D., Joseph E. Schwartz, Ph.D., Stephen A. Paget, M.D., Richard B. Devereux, M.D., and Jane E. Salmon, M.D. | title=Prevalence and correlates of accelerated atherosclerosis in systemic lupus erythematosus  | journal=New England Journal of Medicine | volume=349 | issue=Dec. 18 | year=2003 | pages=2399-2406 | url = http://content.nejm.org/cgi/content/full/349/25/2399
|
| id = PMID 14681505 [http://content.nejm.org/cgi/content/abstract/349/25/2399 Abstract] (full text requires registration) }}</ref>
* [[Hallucination|Hallucinations]]
 
** [[Visual hallucinations|Visual]]
;Pulmonary manifestations: Lung and pleura inflammation can cause [[Pleurisy|pleuritis]], [[pleural effusion]], lupus pneumonitis, chronic diffuse interstitial lung disease, [[pulmonary hypertension]], [[Pulmonary embolism|pulmonary emboli]], [[pulmonary hemorrhage]].
** [[Auditory hallucinations|Auditory]]
 
|-
;Hepatic involvement: See [[autoimmune hepatitis]]
|<small>[[Genitourinary system|Genitourinary]]</small>
 
| style="background: #DCDCDC; " |[[Nephrotic syndrome]]
;Renal involvement: Painless [[hematuria]] or [[proteinuria]] may often be the only presenting renal symptom. Acute or chronic renal impairment may develop with [[lupus nephritis]], leading to acute or end stage [[renal failure]]. Because of early recognition and management of SLE, end stage renal failure occurs in less than 5% of patients.
|
 
* [[Hypertension]]
:Histologically, a hallmark of SLE is membranous [[glomerulonephritis]] with "wire loop" abnormalities.<ref>{{cite web |url=http://erl.pathology.iupui.edu/C603/GENE607.HTM |title=General Pathology Images for Immunopathology |accessdate=2007-07-24 |format= |work=}}</ref> This finding is due to immune complex deposition along the [[glomerular basement membrane]] leading to a typical granular appearance in [[immunofluorescence]] testing. 
* [[Peripheral edema]]
 
* Foamy [[urine]]
;Neurological manifestations: About 10% of patients may present with [[seizure]]s or [[psychosis]]. A third may test positive for abnormalities in the [[cerebrospinal fluid]].
* [[Weight gain]]
 
|-
;T-cell abnormalities: Abnormalities in [[T cell]] signaling are associated with SLE, including deficiency in [[CD45]] [[phosphatase]] and increased expression of CD40 ligand.
| rowspan="3" |<small>[[Musculoskeletal]]</small>
 
| style="background: #DCDCDC; " |[[Arthritis]]
;Other rarer manifestations:  [[gastroenteritis|lupus gastroenteritis]], [[pancreatitis|lupus pancreatitis]], [[cystitis|lupus cystitis]], [[autoimmune]] [[Otitis interna|inner ear disease]], [[parasympathetic|parasympathetic dysfunction]], [[vasculitis|retinal vasculitis]], and [[vasculitis|systemic vasculitis]].
|
 
* Mostly symmetrical
Other abnormalities include:
* [[Arthralgias]]
*Increased expression of [[FcεRI]]γ, which replaces the sometimes deficient TCR ζ chain
* Decreased [[range of motion]] of both small and large joints
*Increased and sustained calcium levels in [[T cell]]s
* Morning [[stiffness]] that will last less than 1 hour
*Moderate increase of [[inositol triphosphate]]
|-
*Reduction in [[Protein kinase C|PKC]] phosphorylation
| style="background: #DCDCDC; " |[[Avascular necrosis]]
*Increased desire of animal protein intake.
|
*Reduction in Ras-[[Mitogen-activated protein kinase|MAP kinase]] signaling
* [[Asymptomatic]]
*Deficiencies in [[protein kinase]] A I activity
* Mild to moderate pain in [[groin]] and lower abdomen in case of femoral head [[AVN]]
 
* Secondary pain amplification
|-
| style="background: #DCDCDC; " |[[Osteoporosis]] 
|
* Loss of height
* Sudden [[back pain]]
|-
| rowspan="4" |<small>[[Skin]] disorder</small>
| style="background: #DCDCDC; " |[[Cutaneous lupus erythematosus]]
|
* [[Malar rash]]
* Generalized [[maculopapular rash]]
* [[Discoid lupus|Discoid]] [[rash]]
* [[Bullous]] [[lesions]]
* [[Raynaud's phenomenon]]
* [[Pyoderma gangrenosum]]
** Ulcerative cutaneous condition
* [[Erythema multiforme]]  
* Nail fold infarcts
|-
| style="background: #DCDCDC; " |[[Photosensitivity]]
|
* Common theme for skin [[lesions]] associated with [[SLE]]
|-
| style="background: #DCDCDC; " |[[Oral ulcer|Oral]] and nasal ulcers
|
* Usually painless
|-
| style="background: #DCDCDC; " |[[Alopecia|Nonscarring alopecia]]
|
* May occur at some point during the course of their disease
|}


==References==
==References==
{{reflist|2}}
{{Reflist|2}}
 


[[Category:Arthritis]]
[[Category:Dermatology]]
[[Category:Diseases involving the fasciae]]
[[Category:Rheumatology]]
[[Category:Nephrology]]
[[Category:Autoimmune diseases]]
[[Category:Disease]]


{{WH}}
{{WH}}
{{WS}}
{{WS}}

Latest revision as of 19:04, 14 August 2020

Systemic lupus erythematosus Microchapters

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mahshid Mir, M.D. [2]

Overview

A positive history of familial lupus, skin rashes (especially photosensitive skin rashes), arthritis, and fatigue may be suggestive of systemic lupus erythematosus. The most common symptoms of SLE include constitutional symptoms like fatigue, fever, myalgia, and weight changes. Other organ-specific symptoms mostly occur with disease progression. SLE may show a variety of symptoms in different organs depending on its complications.

History

Obtaining the history is one of the most important aspects in making a diagnosis of systemic lupus erythematosus. It provides insight into disease course and severity, precipitating risk factors, and associated comorbid conditions. Complete history will help determine the correct complication diagnosis, and helps in determining the prognosis as well. Specific histories about the symptoms (duration, onset, progression), associated symptoms, and drug usage have to be obtained. Specific areas of focus when obtaining the history are outlined below:

Common Symptoms

The early manifestations of systemic lupus erythematosus include common constitutional symptoms that may be seen in many other diseases as well:[1][2][3]

Less Common Symptoms

Organ system based signs and symptoms

Organ system Disease Symptom
Gastrointestinal Dysphagia 
Peptic ulcer disease
Intestinal pseudo-obstruction
Protein-losing enteropathy
Acute pancreatitis
Mesenteric vasculitis
Peritonitis
Pulmonary Pleural disease
Pneumonitis
Pulmonary hemorrhage
Interstitial lung disease
Pulmonary emboli 
Pulmonary hypertension
Shrinking lung syndrome
Cardiac Valvular disease
Pericarditis
  • Sharp, stabbing chest pain with a sudden start
  • Positional pain that decreases when sitting up and leaning forward
Myocarditis 
Coronary heart disease
Neurological CNS small vessle vasculitis
Stroke
Seizures
Psychosis
Genitourinary Nephrotic syndrome
Musculoskeletal Arthritis
Avascular necrosis
  • Asymptomatic
  • Mild to moderate pain in groin and lower abdomen in case of femoral head AVN
  • Secondary pain amplification
Osteoporosis 
Skin disorder Cutaneous lupus erythematosus
Photosensitivity
Oral and nasal ulcers
  • Usually painless
Nonscarring alopecia
  • May occur at some point during the course of their disease

References

  1. ↑ Tench CM, McCurdie I, White PD, D'Cruz DP (2000). "The prevalence and associations of fatigue in systemic lupus erythematosus". Rheumatology (Oxford). 39 (11): 1249–54. PMID 11085805.
  2. ↑ McKinley PS, Ouellette SC, Winkel GH (1995). "The contributions of disease activity, sleep patterns, and depression to fatigue in systemic lupus erythematosus. A proposed model". Arthritis Rheum. 38 (6): 826–34. PMID 7779127.
  3. ↑ Wang B, Gladman DD, Urowitz MB (1998). "Fatigue in lupus is not correlated with disease activity". J. Rheumatol. 25 (5): 892–5. PMID 9598886.
  4. ↑ Cervera R, Khamashta MA, Font J, Sebastiani GD, Gil A, Lavilla P, Mejía JC, Aydintug AO, Chwalinska-Sadowska H, de Ramón E, Fernández-Nebro A, Galeazzi M, Valen M, Mathieu A, Houssiau F, Caro N, Alba P, Ramos-Casals M, Ingelmo M, Hughes GR (2003). "Morbidity and mortality in systemic lupus erythematosus during a 10-year period: a comparison of early and late manifestations in a cohort of 1,000 patients". Medicine (Baltimore). 82 (5): 299–308. doi:10.1097/01.md.0000091181.93122.55. PMID 14530779.
  5. ↑ Finol HJ, Montagnani S, Márquez A, Montes de Oca I, Müller B (1990). "Ultrastructural pathology of skeletal muscle in systemic lupus erythematosus". J. Rheumatol. 17 (2): 210–9. PMID 2319520.
  6. ↑ Tian XP, Zhang X (2010). "Gastrointestinal involvement in systemic lupus erythematosus: insight into pathogenesis, diagnosis and treatment". World J. Gastroenterol. 16 (24): 2971–7. PMC 2890936. PMID 20572299.
  7. ↑ Alves SC, Fasano S, Isenberg DA (2016). "Autoimmune gastrointestinal complications in patients with systemic lupus erythematosus: case series and literature review". Lupus. 25 (14): 1509–1519. doi:10.1177/0961203316655210. PMID 27329649.
  8. ↑ Fawzy M, Edrees A, Okasha H, El Ashmaui A, Ragab G (2016). "Gastrointestinal manifestations in systemic lupus erythematosus". Lupus. 25 (13): 1456–1462. doi:10.1177/0961203316642308. PMID 27055518.
  9. ↑ Li Z, Xu D, Wang Z, Wang Y, Zhang S, Li M, Zeng X (2017). "Gastrointestinal system involvement in systemic lupus erythematosus". Lupus: 961203317707825. doi:10.1177/0961203317707825. PMID 28523968.
  10. ↑ Salvati F (2015). "[The involvement of pulmonary interstitial tissue in multisystemic lupus erythematosus: interdisciplinarity and role of the pneumologists]". Clin Ter (in Italian). 166 (5): 205–7. PMID 26550810.
  11. ↑ Torre O, Harari S (2011). "Pleural and pulmonary involvement in systemic lupus erythematosus". Presse Med. 40 (1 Pt 2): e19–29. doi:10.1016/j.lpm.2010.11.004. PMID 21194884.
  12. ↑ Alamoudi OS, Attar SM (2015). "Pulmonary manifestations in systemic lupus erythematosus: association with disease activity". Respirology. 20 (3): 474–80. doi:10.1111/resp.12473. PMC 4418345. PMID 25639532.
  13. ↑ Finucci Curi P, Pierrestegui M, Ortiz A, Ceccato F, Paira S (2015). "[Pulmonary hemorrhage in patients with systemic lupus erythematosus. Clinical manifestations and prognosis]". Med Clin (Barc) (in Spanish; Castilian). 145 (9): 375–9. doi:10.1016/j.medcli.2014.07.034. PMID 25458514.
  14. ↑ Mak A, Kow NY (2014). "Imbalance between endothelial damage and repair: a gateway to cardiovascular disease in systemic lupus erythematosus". Biomed Res Int. 2014: 178721. doi:10.1155/2014/178721. PMC 3984775. PMID 24790989.
  15. ↑ Sacre K, Escoubet B, Pasquet B, Chauveheid MP, Zennaro MC, Tubach F, Papo T (2014). "Increased arterial stiffness in systemic lupus erythematosus (SLE) patients at low risk for cardiovascular disease: a cross-sectional controlled study". PLoS ONE. 9 (4): e94511. doi:10.1371/journal.pone.0094511. PMC 3983200. PMID 24722263.
  16. ↑ Canpolat N, Kasapcopur O, Caliskan S, Gokalp S, Bor M, Tasdemir M, Sever L, Arisoy N (2013). "Ambulatory blood pressure and subclinical cardiovascular disease in patients with juvenile-onset systemic lupus erythematosus". Pediatr. Nephrol. 28 (2): 305–13. doi:10.1007/s00467-012-2317-3. PMID 23052654.
  17. ↑ Cojocaru IM, Cojocaru M, Tănăsescu R, Burcin C, Atanasiu AN, Silosi I (2008). "Detection of autoantibodies to ribosome P in lupus patients with neurological involvement". Rom J Intern Med. 46 (3): 239–42. PMID 19366083.
  18. ↑ Madrane S, Ribi C (2012). "[Central neuropsychiatric involvement in systemic lupus erythematosus]". Rev Med Suisse (in French). 8 (337): 848–53. PMID 22594009.
  19. ↑ Sivri A, Hasçelik Z, Celiker R, Başgöze O (1995). "Early detection of neurological involvement in systemic lupus erythematosus patients". Electromyogr Clin Neurophysiol. 35 (4): 195–9. PMID 7555923.
  20. ↑ Juncal Gallego L, Almuíña Simón C, Muíños Esparza LF, Díaz Soto R, Ramil Fraga C, Quiroga Ordóñez E (2009). "[Systemic lupus erythematosus with fulminant neurological involvement]". An Pediatr (Barc) (in Spanish; Castilian). 70 (2): 202–4. doi:10.1016/j.anpedi.2008.09.009. PMID 19217587.
  21. ↑ Karras A (2012). "[Renal involvement in systemic lupus erythematosus]". Presse Med (in French). 41 (3 Pt 1): 260–6. doi:10.1016/j.lpm.2011.11.006. PMID 22192934.
  22. ↑ Kiremitci S, Ensari A (2014). "Classifying lupus nephritis: an ongoing story". ScientificWorldJournal. 2014: 580620. doi:10.1155/2014/580620. PMC 4274910. PMID 25548784.
  23. ↑ Zoma A (2004). "Musculoskeletal involvement in systemic lupus erythematosus". Lupus. 13 (11): 851–3. doi:10.1191/0961203303lu2021oa. PMID 15580980.
  24. ↑ Gabba A, Piga M, Vacca A, Porru G, Garau P, Cauli A, Mathieu A (2012). "Joint and tendon involvement in systemic lupus erythematosus: an ultrasound study of hands and wrists in 108 patients". Rheumatology (Oxford). 51 (12): 2278–85. doi:10.1093/rheumatology/kes226. PMID 22956550.
  25. ↑ Grossman JM (2009). "Lupus arthritis". Best Pract Res Clin Rheumatol. 23 (4): 495–506. doi:10.1016/j.berh.2009.04.003. PMID 19591780.
  26. ↑ Zhu KK, Xu WD, Pan HF, Zhang M, Ni J, Ge FY, Ye DQ (2014). "The risk factors of avascular necrosis in patients with systemic lupus erythematosus: a meta-analysis". Inflammation. 37 (5): 1852–64. doi:10.1007/s10753-014-9917-y. PMID 24862229.
  27. ↑ Voulgari PV, Kosta P, Argyropoulou MI, Drosos AA (2013). "Avascular necrosis in a patient with systemic lupus erythematosus". Joint Bone Spine. 80 (6): 665. doi:10.1016/j.jbspin.2013.03.018. PMID 23731640.
  28. ↑ Parodi A, Cozzani E (2014). "Cutaneous manifestations of lupus erythematosus". G Ital Dermatol Venereol. 149 (5): 549–54. PMID 25077888.
  29. ↑ Szczęch J, Rutka M, Samotij D, Zalewska A, Reich A (2016). "Clinical characteristics of cutaneous lupus erythematosus". Postepy Dermatol Alergol. 33 (1): 13–7. doi:10.5114/pdia.2014.44031. PMC 4793050. PMID 26985173.
  30. ↑ Walling HW, Sontheimer RD (2009). "Cutaneous lupus erythematosus: issues in diagnosis and treatment". Am J Clin Dermatol. 10 (6): 365–81. doi:10.2165/11310780-000000000-00000. PMID 19824738.

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