The symptoms of lupus can span any part of the body, there are different subsets of patients so some patients can present with current 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 and Lupas is not chronic, it’s a fatigue that accompanies the activity of lupus and the activity resolves itself, any kind of symptom can be a sign of lupus and one symptom alone shouldn’t raise a suspicion for all of us. There are some manifestations that are very common, not all cognitive dysfunction is a sign that somebody has active information of the brain, that is a common misconception, cognitive dysfunction is commonly seen and especially even at the time of diagnosis, about 80% of 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, also by causing inflammation of the lining of the brains, by inflaming the brain itself, it can affect the spinal cord and cause something called myelitis and paralyze patients, it can affect peripheral nerves thereby causing foot drop or wrist drop, it can affect the lungs because of bleeding in the lungs or affecting the lining of the lungs in inflaming, that something called pleuritis can affect the lining of the heart or the heart itself and it can affect the valves of the heart. Gastrointestinal involvement is relatively rare but can happen, very rarely the blood vessels of the bowels, something called a vasculitis mesenteric, vasculitis can affect joints but mostly small joints not large joints like the hips or shoulders, it can affect the skin by causing either inflammatory rashes or observations, it can affect the fingers, the raynaud’s, i mentioned when they change color sometimes that can lead to ulcers, 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 can affect that eye – and the people can get information of the sclera of the UVI of the retina so there’s really no part of the body that is always spared. There are patients that go into these long remissions where they don’t have flares and flares are rare but on average in our cohort, 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 complement 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, swollen joints, the severe flares that was mentioned before inflammation of the brain kidneys or bleeding in the lungs which require hospitalization and a very aggressive treatment with high dose of IV steroids and immediate immunosuppressive. About 30% of patients with lupus will develop fibromyalgia and that is the most common cause of chronic pain and fatigue, exactly why this high percentage of lupus patients developed 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 AMA 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 without having other signs of lupus, it doesn’t really make any sense but doctors evaluate a lot of patients who have chronic pain and end up getting a positive AMA 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 simply does not follow fibromyalgia patients.