Lupus Symptoms: Joint Pain, Rash, Fatigue and What a Visit Can Check

What it involves

MedlinePlus describes lupus as a chronic autoimmune disease in which the immune system attacks healthy cells and tissues by mistake, causing inflammation that can damage the joints, skin, kidneys, heart, lungs and brain. Systemic lupus erythematosus, or SLE, is the most common type, and it can be mild or severe.

Who this is for

• Adults with joint pain and swelling, fatigue and a rash that have lasted more than a few weeks
• Women between their teens and mid-forties, the group the MedlinePlus encyclopedia says is most often affected
• Patients whose fingers or toes turn pale or purple in the cold, or who burn easily in the sun
• Anyone whose symptoms keep coming back in flares and who has never had them put together on one list

What to expect

• Questions about which symptoms you have had, when they flare and what seems to set them off, such as sunlight
• An exam of the skin, mouth, joints, heart, lungs and ankles for swelling
• Blood and urine tests, which can include a blood count, kidney function tests, a urinalysis and an ANA blood test when the history fits
• A referral to a rheumatologist if the findings point to lupus or another autoimmune disease

Why it is hard to spot

MedlinePlus says lupus has many symptoms, that they differ from person to person and that they come and go. A period of symptoms is called a flare, and flares range from mild to severe. Because joint pain, fever, fatigue and hair loss each have many ordinary explanations, people often bring them up at separate visits. Writing them on one list, with dates, lets a provider see the pattern. The fatigue guide and the swollen joints guide cover two of the most common starting points.

Symptoms MedlinePlus lists

The common ones are painful, swollen joints with morning stiffness, fever, a red rash most often on the face that is called a butterfly rash, chest pain when taking a deep breath, hair loss, sensitivity to the sun, mouth ulcers and swollen glands. The encyclopedia says the butterfly rash develops in about half of people with SLE and gets worse in sunlight. Pale or purple fingers or toes in the cold are known as Raynaud phenomenon, which the Raynaud guide explains on its own. Swelling in the legs or around the eyes can point to the kidneys. Lupus can inflame the lining around the lungs and cause sharp chest pain with deep breaths, which is called pleurisy, so tell your provider about any new pain with breathing. Autoimmune diseases can inflame the sac around the heart and cause sharp chest pain with breathing, which the pericarditis chest pain guide describes along with the other causes of that pain.

Who is more likely to get it

MedlinePlus says anyone can get lupus but women get it much more often than men, and the encyclopedia puts the ratio at nearly 10 to 1, with onset most often in young women between 15 and 44. It is more common in African Americans, Asian Americans and Hispanic Americans than in non-Hispanic white people, and African American and Hispanic women are more likely to have severe forms. The cause is not known. Researchers are studying genetics, viral infections, sunlight, some medicines and smoking.

How a provider looks for it

There is no single test. MedlinePlus says nearly everyone with SLE has a positive antinuclear antibody test, or ANA, but a positive ANA alone does not mean lupus. Other tests may include a complete blood count, kidney function and urine tests and a chest x-ray. Serenity By A Dr. Sareen lists blood work among its in-office services, and the complete blood count guide and urinalysis guide explain two of the first tests. Further antibody tests and a kidney biopsy, when needed, are arranged by referral.

Treatment and why a specialist is involved

MedlinePlus says there is no cure and that the goal of treatment is to control symptoms. Mild forms may be treated with anti-inflammatory medicines, low-dose corticosteroids, corticosteroid creams or hydroxychloroquine, and severe disease affecting the kidneys, heart, lungs or nervous system needs specialist care. It adds that most people with lupus will need medicines for a long time and that outcomes have improved in recent years. A primary care provider helps coordinate those visits and keeps blood pressure, kidney tests and preventive screening on schedule.

Sun, skin and everyday protection

The encyclopedia advises people with lupus to wear protective clothing, sunglasses and sunscreen in the sun, to avoid tobacco, to drink minimal alcohol, and to get preventive heart care and bone thinning tests. Some people have lupus that affects only the skin, called discoid or cutaneous lupus. The skin conditions guide describes how a provider sorts rashes, and the osteoporosis screening guide covers the bone side. Dry eyes and a dry mouth along with joint pain can also come from a related autoimmune condition, described in the Sjögren's disease guide.

Sources

• MedlinePlus: Lupus (health topic)
• MedlinePlus: Systemic lupus erythematosus (medical encyclopedia)