Symptoms and Complications of Lupus

Author: Shelley Ensz. Scleroderma is highly variable. See Types of Scleroderma. Read Disclaimer
Brain, Cognitive
Fibromyalgia and Lupus
Heart Disease
Jaccoud's Arthritis
Persistent Lupus Myelitis
Sleep Disorders


Photo of butterfly plaqueSystemic lupus erythematosus (SLE) can affect any part of the body, including blood vessels, and internal organs.

It can also cause cognitive impairments, neuropathies, psychosis, and depression.

It is perhaps most widely known for the distinctive butterfly (malar) facial rash that can occur during flares or after sun exposure. Oddly enough, however, the butterfly rash only occurs in about 50% of lupus patients. Therefore, the absence of malar rash does not preclude a lupus diagnosis.

General symptoms, that occur with many other diseases as well, include muscle and joint pain, Raynaud's, fatigue, low-grade fever, mouth and nose ulcers, and loss of appetite. (Also see Autoimmune Diseases and Overview of Lupus)

What are the symptoms of lupus? MedicineNet

Antiphospholipid Syndrome (APS)

Antiphospholipid Syndrome is also known as Hughes Syndrome. ISN.

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Cardiovascular Disease in Lupus. People with lupus have a significantly increased risk of premature coronary heart disease (CHD) or atherosclerosis, stroke and other cardiovascular-related conditions than those without lupus. LupusResearchUpdate.

Brain, Cognitive

Cardiopulmonary correlates of cognition in systemic lupus erythematosus (SLE). Patients with mild SLE disease activity have cognitive dysfunction associated with certain objective markers of exercise capacity and activity levels and additional studies are needed to better understand the relationship between cognition and physical activity in patients with SLE. PubMed, Lupus, 2014 Sep 23.

Hippocampal atrophy is associated with cerebrospinal fluid anti-NR2 antibodies in patients with systemic lupus erythematosus (SLE) and primary Sjögren's syndrome (pSS). Anti-NR2 antibodies cause neuronal death observed as reduced hippocampal grey matter in patients with SLE and pSS as previously demonstrated in mice with autoimmune disease. PubMed, Arthritis Rheumatol, 2014 Aug 22. (Also see Sjogren's Syndrome)

Systemic lupus erythematosus (SLE): prediction by MRI of the subsequent development of brain lesions. The presence of lacunar and/or localized cortical infarcts on initial MRI scans may predict the development of new brain lesions in patients with SLE. PubMed, Acad Radiol, 2014 May;21(5):617-23.

Cognitive dysfunction in antiphospholipid antibody (aPL)-negative systemic lupus erythematosus (SLE) versus aPL-positive non-SLE patients. Both aPL-negative SLE and aPL-positive non-SLE patients, without other overt neuropsychiatric disease, demonstrated high levels of cognitive impairment. PubMed, Clin Exp Rheumatol, 09/10/2013. (Also see Antiphospholipid Syndrome)

An explanation of how migraine headaches can trigger relapse in systemic lupus erythematosus. Migraine headaches in systemic lupus erythematosus patients are statistically associated with disease activity, i.e. the patients with bad lupus are the ones who get migraine. Med Hypotheses, 2013 May;80(5):553-5.

For Lupus Patients, Cognitive Function Varies by Location. Because of the correlation between cognitive impairment and disease duration and severity, the researchers suggest that longer disease duration may be responsible for the differences in the rates of mild cognitive dysfunction. Pharmacy Times. 02/14/2013.


(Case Report) Diffuse Dystrophic Calcinosis Cutis of the Scalp in a Patient With Scalp Discoid Lupus Erythematosus and Systemic Lupus Erythematosus. PubMed, JAMA Dermatol, 2013;149(2):246-248.

Dermatofibromas in Lupus

Case Report: Multiple dermatofibromas in a patient with systemic lupus erythematosus (SLE) and Sjögren's syndrome (SS). As these tumors appeared during the remission stage of SLE, they might have been under immunosuppressive conditions caused by immunosuppressing agents rather than collagen disease itself. SpringerLink. (Also see Sjogren's)

Fatigue in Lupus

Lifestyle habits and fatigue among people with systemic lupus erythematosus (SLE) and matched population controls. Fatigue is common, but not a general feature of SLE and is associated with depression, anxiety, low health-related quality of life and less physical exercise. PubMed, Lupus, 02/18/2015.

Patient-reported fatigue and its impact on patients with systemic lupus erythematosus. Understanding how patients with SLE describe the symptom of fatigue and how it impacts their lives is the key to better understanding how to measure fatigue in clinical studies evaluating new treatments for SLE. PubMed, Lupus, 11/06/2013.

Fibromyalgia and Lupus

What's the difference between lupus and fibromyalgia? Fibromyalgia can occur concurrently with lupus, but most of the time lupus and fibromyalgia are separate diagnoses. Lupus Foundation of America.

Flares of Lupus

Delta neutrophil index (DNI) as a marker for differential diagnosis between flare and infection in febrile systemic lupus erythematosus (SLE) patients. Fever is a common symptom of systemic lupus erythematosus (SLE), and because of this it is difficult to discriminate between SLE flare and infection. DNI may be a marker to differentiate infections from SLE flares in febrile SLE patients. PubMed, Lupus, 2013 Aug 9.


The Gastrointestinal System. People with lupus may be affected by problems in any area of the GI system, including the surrounding organs such as the liver, the pancreas, the bile ducts, and the gallbladder. Lupus Foundation of America.

Heart Disease

Impact of heart rate variability (HRV), a marker for cardiac health, on lupus disease activity. Impaired HRV, particularly the low frequency to high frequency ratio, is associated with lupus disease activity and several cytokines related to interferons type II and tumor necrosis factor pathways. PubMed, Arthritis Res Ther, 2016 Sep 2;18(1):197.

Evaluation of early cardiac dysfunction in patients with systemic lupus erythematosus (SLE) with or without anticardiolipin antibodies. Identifying early cardiac involvement in SLE may lead to a reduction in mortality and morbidity rates. PubMed, Lupus. 02/18/2015.

Evaluation of Left Atrial Function by Real-time 3-D Echocardiography in Patients with Systemic Lupus Erythematosus (SLE). Real-time 3-D echocardiography may have better diagnostic value than traditional echo indexes in detecting subclinical cardiac dysfunction in patients with SLE. PubMed, J Rheumatol, 12/15/2014.

Vascular manifestations of systemic lupus erythematosis. Awareness of the aetiology, pathophysiology, the clinical and histopathogical setting, and SLE-associated vascular complications is of great clinical significance. Neth J Med, 2013 Jan;71(1):10-6.

Jaccoud's Arthritis

Jaccoud's Arthritis or Jaccoud's arthropathy. A progressive deforming arthropathy of the hands and feet in young adults following recurrent rheumatic fever or systemic lupus erythematosus. Who named it?

Kidney Involvement

Lupus Kidney Disease. The two medical terms for the kidney disease that occurs in systemic lupus erythematosus are lupus nephritis or lupus glomerulonephritis. It is estimated that about one-third of people with lupus will develop nephritis that requires medical evaluation and treatment. Lupus Foundation of America.

Intrarenal macrophage infiltration induced by T cells is associated with podocyte injury in lupus nephritis patients. The present study provides possible links between intrarenal T cells, osteopontin, macrophages with reduced podocyte–nephrin and podocytopathy in systemic lupus erythematosus. PubMed, Lupus, 05/04/2016. (Also see B Cells and T Cells)

Anti–Sm is associated with the early poor outcome of lupus nephritis. Our data suggest that anti–Sm identified at kidney biopsy might have a predictive value for the early poor outcome of biopsy–proven lupus nephritis during the follow–up period. PubMed, Int J Rheum Dis, 04/29/2016. (Also see Antibodies in Lupus)

Urinary dedifferentiated podocytes as a non-invasive biomarker of lupus nephritis (LN). Urinary dedifferentiated podocytes were shown in active LN, and their protein levels correlated with proteinuria and histological features in LN. PubMed, Nephrol Dial Transplant, 02/29/2016.

Risk of end–stage renal disease (ESRD) in systemic lupus erythematosus (SLE) patients: a nationwide population–based study. ESRD is more common in SLE than non–SLE patients in this insurance database. Wiley Online Library, 02/10/2016.

Pathological spectrums and renal prognosis of severe lupus patients with rapidly progressive glomerulonephritis. Creatinine concentrations in the serum (SCr) and the proportion of crescents were the most important risk factors for end-stage renal disease (ESRD). PubMed, Rheumatol Int, 2014 Oct 4.

The association of cytokines with disease activity and damage scores in systemic lupus erythematosus (SLE) patients. Increased levels of a number of immunomodulatory cytokines relative to IL-12p70 in this Caucasian SLE patient population are seen in patients with renal involvement and are associated with increased accrual of damage at the 5-year follow-up. PubMed, Rheumatology (Oxford), 2014 Apr 4.

Cell adhesion molecules as potential biomarkers of nephritis, damage and accelerated atherosclerosis in patients with Systemic Lupus Erythematosus (SLE). E-selectin may act as a marker of cardiovascular risk in SLE, whilst vascular cell adhesion molecule-1 may have a role as a non-invasive biomarker for lupus nephritis activity. PubMed, Lupus, 2014 Mar 19.

Liver Involvement

Liver Complications Associated with Systemic Lupus Erythematosus Although liver dysfunction is not considered the main organ pathology or prognostic factor in patients with Systemic Lupus Erythematosus (SLE), it is not uncommon during the course of SLE. Rheumatology: Current Research, 2015.


Incidence of lymphoma associated with underlying lupus (SLE): Lessons learned from observational studies. Although the association of non-Hodgkin's lymphoma in SLE is well established, risk factors attributing to this association are still not understood. PubMed, Curr Opin Rheumatol, 2014 Mar;26(2):111-7. (Also see Non Hodgkin's Lymphoma)

Lymphoma risk in systemic lupus: effects of disease activity versus treatment. There was a suggestion of higher lymphoma risk with exposure to cyclophosphamide and high cumulative steroids although disease activity itself was not clearly associated with lymphoma risk. PubMed, Ann Rheum Dis, 2014 Jan 1;73(1):138-42. (Also see Lymphoma)

Microstomia (Small Mouth)

Microstomia (small mouth) is most often caused by systemic scleroderma. However, it has occasionally been associated with systemic lupus (SLE) or rheumatoid arthritis (RA), or Sjogren's. ISN.

Microstomia (Small Mouth) and Scleroderma
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Risk factors of systemic lupus erythematosus (SLE) flares during pregnancy. The SLE flares during pregnancy make the difference between an uncomplicated pregnancy and pregnancy with maternal and fetal complications. Knowledge of risk factors leads the best treatment strategies to reduce flares and fetal complications in SLE patients. PubMed, Immunol Res, 2014 Nov 13.


Predictors of clinical outcomes in patients with neuropsychiatric systemic lupus erythematosus (NPSLE). Patients with longer disease durations of SLE and those with more than one NPSLE symptom types had poorer outcomes. ScienceDirect, 01/07/2016.

Diagnosis and management of neuropsychiatric SLE (NPSLE). Although the prognosis is variable, studies suggest a more favourable outcome for primary NPSLE manifestations compared with neuropsychiatric events attributable to non-SLE causes. PubMed, Nat Rev Rheumatol, 2014 Feb 11.

Mortality in neuropsychiatric systemic lupus erythematosus (NPSLE). A decreased mortality risk was seen with the prescription of antiplatelet therapy and the time period in which NPSLE was diagnosed did not significantly influence survival. PubMed, Lupus, 2013 Nov 15.


Systemic lupus erythematosus can cause pancreatitis, and those who have psychosis and pleurisy are at increased risk for pancreatitis.

Persistent Lupus Myelitis

Transverse myelitis. Transverse myelitis is inflammation of the spinal cord, which can cause pain or other sensory problems, weakness or paralysis of muscles, or bladder and bowel dysfunction. Mayo Clinic.

Myelitis in systemic lupus erythematosus: clinical characteristics and effect in accrual damage. A single–center experience. Myelitis is associated with a significant increase in accrual damage compared with severe non–neuropsychiatric manifestations. PubMed, Lupus, 08/01/2016.

Pulmonary Involvement

Impact of pulmonary disease on patient–reported outcomes (PRO) and patient–performed functional testing in systemic lupus erythematosus (SLE). The six–minute walk test (6MWT) may be a promising tool in the assessment of pulmonary disease, which is common in SLE and adversely impacts 6MWT distance and dyspnea without apparent influence on other PROs. PubMed, Lupus, 02/03/2016.

Decreased diffusion capacity on lung function testing in asymptomatic patients with systemic lupus erythematosus (SLE) does not predict future lung disease. A finding of low diffusion capacity in asymptomatic patients with SLE, with or without antiphospholipid syndrome, does not necessarily require further evaluation and imaging and may improve spontaneously over time. PubMed, Lupus, 01/16/2015.

Pulmonary Issues and Lupus. Inflammation caused by lupus may affect the lungs in many ways, and can involve the membrane lining of the lungs, the lungs themselves, the blood vessels within the lungs, and the diaphragm. Lupus Foundation of America.


Pathogenesis and targeted treatment of skin injury in systemic lupus erythematosus (SLE). Ultraviolet light (UV), immune cells, cytokines and deposition of immunoglobulins all seem to have a role in the development of skin inflammation and damage in SLE. PubMed, Nat Rev Rheumatol, 08/04/2015.

Sleep Disorders

High prevalence of restless legs syndrome in systemic lupus erythematosus. The prevalence of RLS is high is SLE. The severity of disease is high and occur in 58% more than 4 nights per week. Movement Disorders, 2013.


Prognostic significance of platelet count in SLE patients. It was concluded that platelet count has a negative correlation with disease activity in SLE patients, and it should be considered as a prognostic factor, identifying patients with aggressive disease course. PubMed, Platelets, 2016 Sep 2:1-5.

Haematological manifestations of lupus. Our purpose was to compile information on the haematological manifestations of systemic lupus erythematosus (SLE), namely leucopenia, lymphopenia, thrombocytopenia, autoimmune haemolytic anaemia (AIHA), thrombotic thrombocytopenic purpura (TTP) and myelofibrosis. NCBI, Lupus Sci Med. 2015; 2(1): e000078.


The Thyroid-Lupus Relationship. Lupus patients should be tested for signs of abnormal thyroid activity, including thyroid antibody levels, which may show up earlier than other features of thyroid disease. Lupus Foundation of America.


Increased Incidence of Tuberculosis Among Systemic Lupus Erythematous Patients - Should Tuberculosis Screening at Diagnosis be the Next Step? We found an increased incidence of active TB infection with a majority of extrapulmonary TB in a large cohort of Romanian SLE patients. In a country with a high TB burden, TB screening and treatment of latent TB would be useful before initiation of immunosuppressive treatment. ACR Meeting Abstracts, 09/15/2015.

Vascular Involvement

Cerebral large vessel vasculitis in systemic lupus erythematosus. A female patient with the diagnosis of SLE presented with stroke-like symptoms, headache and vertigo, and palpable purpura on her legs. Further investigations revealed that she suffered from both vasculitis of the cerebral large vessels and coexisting cutaneous small-vessel vasculitis. PubMed, Lupus, 2014 Jun 26. (Also see Vasculitis)

Lupus mesenteric vasculitis (LMV): Clinical features and associated factors for the recurrence and prognosis of disease. The clinical characteristics of (LMV) and the potential factors and appropriate treatments associated with disease relapse and prognosis. PubMed, Semin Arthritis Rheum, 2014 Jun;43(6):759-66. (Also see Vasculitis)

Lupus Complications. Lupus may lead to blood problems, including anemia and increased risk of bleeding or blood clotting. It can also cause inflammation of the blood vessels (vasculitis). Mayo Clinic.

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