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Symptoms and Complications of Lupus

Author: Shelley Ensz. Scleroderma is highly variable. See Types of Scleroderma. Read Disclaimer
Overview
Antiphospholipid
Atherosclerosis
Brain, Cognitive
Calcinosis
Cytomegalovirus
Dermatofibromas
Fatigue
Fibromyalgia and Lupus
Flares
Gastrointestinal
Heart Disease
Jaccoud's Arthritis
Kidney
Liver
Lymphoma
Microstomia
Miscarriages
Neuropsychiatric
Pancreatitis
Persistent Lupus Myelitis
Pulmonary
Skin
Sleep Disorders
Thrombocytopenia
Thyroid
Tuberculosis
Vascular

Overview

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

A retrospective study of joint infections in patients with systemic lupus erythematosus (SLE). When an SLE patient presents with pre–existing arthritis and suddenly develops asymmetric oligo– or large–joint swelling and pain with elevated C-reactive protein levels and low disease activity, joint infections should be considered. PubMed, Clin Rheumatol, 07/08/2017.

Antiphospholipid Syndrome (APS)

Antiphospholipid Syndrome is also known as Hughes Syndrome. ISN.

Overview
APS and Heart Disease
Scleroderma and APS
Diagnosis
Symptoms
Complications
Treatments
Causes and Research
Support Resources
Personal Stories

Atherosclerosis

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

Cerebrovascular Events (CerVEs) in Systemic Lupus Erythematosus (SLE). CerVEs, the fourth most frequent neuropsychiatric event in SLE, are usually attributable to lupus. PubMed, Arthritis Care Res (Hoboken), 01/05/2018.

Enlarged perivascular spaces (EPVS) are associated with the disease activity in systemic lupus erythematosus. The centrum semiovale (CS)–EPVS in the SLE patients are associated with the systemic disease activity, suggesting that CS–EPVS may be indicative of the reactive changes of the white matter due to the inflammatory activity. ResearchGate, December 2017.

Impact of cognitive impairment, depression, disease activity, and disease damage on quality of life (HRQoL) in women with systemic lupus erythematosus (SLE). Our results highlight the relevance of executive dysfunction to poor physical and mental health components of HRQoL in SLE together with depression, while disease activity and disease damage are associated with lower HRQoL physical components. PubMed, Scand J Rheumatol, 2017 Jul;46(4):273-280.

Clinical utility of circulating anti-N-methyl-d-aspartate receptor subunits NR2A/B antibody for the diagnosis of neuropsychiatric (NP) syndromes in systemic lupus erythematosus (SLE) and Sjögren's syndrome (SS). Circulating anti-NR2A/B antibody testing has a diagnostic value for NP syndromes in SLE and SS collectively. PubMed, Autoimmun Rev, 2017 Feb;16(2):114-122. (Also see Sjogren's Syndrome)

Calcinosis

(Case Report) Diffuse Dystrophic Calcinosis Cutis of the Scalp in a Patient With Scalp Discoid Lupus Erythematosus and Systemic Lupus Erythematosus. PubMed, JAMA Dermatol.

Cytomegalovirus

Disseminated cytomegalovirus (CMV) infection complicating active treatment of systemic lupus erythematosus: an emerging problem. Given the rise in prevalence of CMV, there is a need for appropriate screening for this opportunistic pathogen and studies to determine the risks and benefits of prophylactic or preemptive treatment for this virus. PubMed, Lupus, 10/04/2016.

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.

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

Analysis of Erythrocyte C4d to Complement Receptor 1 Ratio: Use in Distinguishing between Infection and Flare-Up in Febrile Patients with Systemic Lupus Erythematosus. The C4d/CR1 ratio is a simple and quickly determinable biomarker that enables the differentiation between infection and flare-up in febrile SLE patients at initial evaluation. PubMed, Biomed Res Int, 2015;2015:939783.

Gastrointestinal

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

Metabolic syndrome (MetS) in patients with systemic lupus erythematosus: Association with disease activity, disease damage and age. The frequency of MetS was not significantly different from that of the control group, but almost half of the patients were found with this syndrome. PubMed, Int J Rheum Dis, 04/03/2018.

Novel gene variants associated with cardiovascular disease (CVD) in systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA). The IL19 risk allele was associated with stroke/MI in SLE and RA, but not in the general population, indicating that shared immune pathways may be involved in the CVD pathogenesis in inflammatory rheumatic diseases. PubMed, Ann Rheum Dis, 03/07/2018. (Also see Symptoms and Complications of Rheumatoid Arthritis)

Cardiac complications in rheumatoid arthritis (RA), systemic lupus erythematosus (SLE) and systemic sclerosis (SSc). Since an increased risk of cardiovascular complications applies to many rheumatic diseases, the European League Against Rheumatism (EULAR) has developed a number of recommendations related to the prevention and therapy of cardiovascular events. PubMed, Przegl Lek, 2017;74(4):179-82. (Also see Symptoms and Complications of Rheumatoid Arthritis and Complications with Systemic Scleroderma (SSc) Heart Involvement)

Risk of Myocardial Infarction and Stroke in Newly Diagnosed Systemic Lupus Erythematosus: A General Population-Based Study. Patients with SLE have an increased risk of cardiovascular events, particularly during the first year after diagnosis. PubMed, Arthritis Care Res (Hoboken), 01/27/2017.

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.

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.

Effect of low and high HDL-C levels on the prognosis of lupus nephritis (LN) patients: a prospective cohort study. Our results demonstrate that high HDL-C levels were associated with increased risk of end–stage renal disease in LN patients with advanced renal dysfunction. PubMed, Lipids Health Dis, 2017 Dec 6;16(1):232.

Recent advances in the understanding of renal inflammation and fibrosis in lupus nephritis. This review discusses recent advances in the understanding of pathogenic mechanisms leading to inflammation and fibrosis of the kidney in lupus nephritis in the context of established standard–of–care and emerging therapies. PubMed, 1000Res, 2017 Jun 13;6:874.

Antibody–Array–Based Proteomic Screening of Serum Markers in Systemic Lupus Erythematosus: A Discovery Study. In summary, serum proteins have the capacity to identify patients with active nephritis, flares, and renal pathology activity or chronicity changes, although larger longitudinal cohort studies are warranted. PubMed, J Proteome Res, 2016 Jul 1;15(7):2102-14.

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.

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.

Lymphoma

Lupus–related single nucleotide polymorphisms and risk of diffuse large B-cell lymphoma (DLBCL). These data suggest several plausible genetic links between DLBCL and SLE. PubMed, Lupus Sci Med. 2017 Nov 12;4(1):e000187.

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
Prevention of Microstomia
Treatments for Microstomia
Microstomia Personal Stories

Miscarriages

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.

Neuropsychiatric

The diagnosis and clinical management of the neuropsychiatric manifestations of lupus (NPSLE). In the attempt to depict a journey throughout NPSLE from diagnosis to a reasoned therapeutic approach, classification, epidemiology, attribution, risk factors, diagnostic challenges, neuroimaging techniques and pathogenesis will be considered in this narrative review. PubMed, J Autoimmun, 2016 Nov;74:41-72.

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.

Pancreatitis

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

Persistent Lupus Myelitis

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

Case Report: Systemic lupus erythematosus (SLE) presenting as severe alveolar hypoventilation and the shrinking lung syndrome (SLS). The interesting features of this case report consist of the presentation of the SLS as an alveolar hypoventilation with a fatal outcome and the presentation of systemic lupus as SLS. PubMed, Rev Mal Respir. (Also see Lung 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.

Skin

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

Anemia Linked to Restless Legs Syndrome in Lupus. Anemia could increase the prevalence of restless legs syndrome (RLS) in patients with lupus. Modern Medicine Network.

Thrombocytopenia

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.

Thyroid

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.

Tuberculosis

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

Endothelial dysfunction in early systemic lupus erythematosus patients and controls without previous cardiovascular events. A high rate of endothelial dysfunction and vascular stiffness occurs in early lupus patients without cardiovascular risk factors and disease. PubMed, Arthritis Care Res (Hoboken), 12/15/2017.

Case Report: Mesenteric Vasculitis in a Case of Systemic Lupus Erythematosus. We present a case of mesentric vasculitis with systemic lupus erythematosus who relapsed after high dose steroids but achieved subsequent remission after starting pulse cyclophosphamide therapy. PubMed, J Assoc Physicians India. (Also see Vasculitis)

Case Report: Successful treatment of cerebral large vessel vasculitis in systemic lupus erythematosus with intravenous pulse cyclophosphamide. Here, we present a rare case of cerebral large vessel vasculitis treated successfully with a clear visual presentation. PubMed, Lupus. (Also see Vasculitis and Immunosuppressants)

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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