There is no single and clear symptom of SLE. Every lupus patient has an individual pattern of symptoms. This makes it difficult to diagnose the disease. Patients almost always feel tired, ill and rejected, sometimes there is fever or slightly elevated (subfebrile) temperatures without cold symptoms.
However, these general complaints also apply to numerous other diseases. Nevertheless, knowledge of typical symptoms is helpful, which can give an indication of the disease, especially if they occur together. In addition to the general symptoms, these are mainly the following:
Skin:
Typical for SLE is the so-called butterfly erythema in the face, which is induced or intensified by exposure to sunlight (photosensitivity). Further cutaneous manifestations are bright red, disc-shaped raised skin changes (discoid lupus), a livedo reticularis (reticular, bluish-violet drawing of the skin due to disturbances of the blood circulation), a nail fold erythema, circular, mostly reversible hair loss (alopecia areata) or diffuse hair loss (effluvium) as well as aphthae on the oral mucosa.
Joints, muscular and skeletal system:
Morning joint pain in large and especially small joints or arthritis (inflammation of the joints), often affecting several joints. In contrast to rheumatoid arthritis, SLE polyarthritis does not lead to erosive destruction of the joints (joint destruction). Nevertheless, a non-erosive deformation of the joints can occur (Jaccoud arthritis). A co-infestation of the tendon sheaths (tendovaginitis) is possible. Nonspecific muscle pain (myalgia) often occurs during phases of an active disease; manifest muscle inflammation (myositis) is less common.
Vessels:
Especially during cold stimulation, a vascular spasm of the finger vessels develops, which turns the fingers white and partly bluish and reddish (Raynaud's syndrome). Secondary vasculitis (inflammation of vessels), mostly of small vessels with formation of acral necroses (death of the tissue at the fingertips), is rather rare and must be distinguished clinically and pharmacoangiographically from severe courses of Raynaud's syndrome. Due to pathomechanisms that have not yet been clarified, SLE leads to an accumulation of arteriosclerosis (calcification of blood vessels).
Kidney:
Kidney involvement (glomerulonephritis or lupus nephritis) is one of the most common organ manifestations of SLE (over 70% of cases during the course of the disease). Proteinuria (protein excretion) and microhaematuria (hidden bleeding in the urine) can be detected in the urine examination. Lupus nephritis (LN), an inflammation of the kidneys that occurs as a result of systemic lupus erythematosus (SLE), is decisive for determining the prognosis of SLE. Early diagnosis and therapy of LN is essential to avoid permanent kidney disease with dialysis.
Heart:
Libman sack endocarditis (non-infectious inflammation of the inner lining of the heart) is the classic cardiac manifestation of SLE. Pericarditis (inflammation of the pericardium) or myocarditis (inflammation of the heart muscle) is more common. The risk of coronary heart disease (calcification of the coronary vessels) is significantly increased.
Lungs:
The most common lung manifestation is pleuritis (pleurisy) at 40-60 %. This usually leads to breath-dependent chest pain. Pneumonitis (inflammatory change of the lung) or alveolitis (disease of the lung tissue and alveoli) is rather rare.
Central nervous system (CNS) / peripheral nervous system:
CNS involvement in SLE is clinically very variable and often difficult to diagnose. Typical clinical symptoms include neuropsychiatric symptoms, but also psychoses and generalized seizures. The peripheral nervous system (and more rarely the cranial nerves) are also involved in the underlying disease. Depression, apoplexy (stroke), transversal myelitis (spinal cord inflammation) are other possible neurological manifestations of SLE.
