Symptoms:

SLE symptoms may develop slowly over months or years, or they may appear suddenly. Symptoms tend to be worse during winter months, perhaps because prolonged exposure to sunlight in the summer causes a gradual build-up of factors that trigger symptoms months later.

Arthritic Pain

The most common symptom is joint pain, which occurs in about 90% of patients with SLE. Characteristics of this symptom vary widely:

• It is often accompanied by swelling and redness.
• It can last from hours to months.
• It may be mild or severe.
• It can occur in one joint, move from one to another, or flare erratically.
• Pain often occurs in the morning and improves during the day, only to return later when the patient tires.
• The joints most affected are fingers, wrists, elbows, knees, and ankles. (Joints in the spine and neck are not affected.)

Children may experience these symptoms as growing pains, and, in all patients, they may be the only symptoms for many years.

Fever

Fever occurs in 90% of patients with SLE and is usually caused by the inflammatory process of the disease, not by infection. It is low-grade except during an acute lupus crisis.

Skin Rashes

Three-quarters of patients with SLE have skin inflammation and skin lesions (ulcers, rashes, or other injured areas). About half of these lesions are photosensitive; that is, they are aggravated by ultraviolet (UV) radiation from sunlight, even from light coming through a window. (UV radiation may even trigger systemic flares in patients with SLE.)

A number of different skin conditions have been described in patients with SLE.

Discoid Lupus Erythematosus. About 20% of patients have discoid lesions. In such cases, the condition is often known as discoid lupus erythematosus (DLE). Patients with this condition may have the following skin abnormalities:

• Discoid means coin-shaped, so these lesions are round and raised. They are also scaly. Untreated, the margins gradually extend outward as the center dries out and shrivels, causing severe scarring. If discoid lesions appear on the scalp, they can plug hair follicles and cause irreversible hair loss. Discoid lesions can also appear on the upper body.

Lupus, discoid -- view of lesions on the chest: This close-up picture of the neck clearly shows the typical rounded appearance of discoid lupus. The whitish appearance is caused by scaling. The two dark spots are biopsy sites and are not part of the disease.

• A butterfly-shaped rash across the face may accompany this condition. This rash causes little scarring, although spidery, branching lines of swollen capillaries (the tiniest blood vessels) may appear.

Most patients with this condition have only a limited skin disorder. In only about 10% of cases does discoid lupus develop into full-blown SLE.

Subacute Cutaneous Lupus Erythematosus. Subacute cutaneous lupus erythematosus (SCLE) can cause skin lesions on parts of the body that are exposed to sunlight. These lesions do not cause scarring.

Vasculitis. Patients with SLE sometimes develop inflammation in the blood vessels (vasculitis) that may have the following effects on the skin:

• Red welts may form across large areas of the body.
• Sometimes deep red bumps may appear, particularly on the leg, where they may ulcerate.
• In some people, reddish-purple lesions appear on the pads of fingers and toes or near the nails of fingers and toes.
• Lesions caused by vasculitis may ulcerate or blister if they erupt on mucous membranes in the mouth, nose, or vagina and can be painful if they occur on the throat.
• Vasulitis can attack blood vessels in almost any other organ, including the brain, the heart, and the gastrointestinal tract.

Other SLE Symptoms

Other symptoms include:

• Fatigue
• Loss of appetite, nausea, and weight loss
• Chest pain
• Bruising
• Menstrual irregularities
• Thought and concentration disturbances
• Personality changes
• Sleep disorders, such as restless legs syndrome and sleep apnea
• Dryness of the eyes and mouth
• Brittle hair or hair loss

Hair loss or breakage may also occur in about half of patients with SLE during severe flares or after pregnancy or severe illness. In such cases, hair grows back.

Raynaud's Phenomenon

Raynaud's phenomenon is a condition in which cold or stress can cause spasms in impaired blood vessels, resulting in pain in fingers and toes. It occurs as part of the inflammatory response in blood vessels, which can narrow them and reduce circulation. In extreme cases, gangrene can result.

Conditions with Similar Symptoms

A number of conditions overlap with SLE:

• Scleroderma: Hardening of the skin caused by overproduction of collagen
• Rheumatoid arthritis: Inflammation of the lining of the joints
• Sjögren syndrome: Characterized by dry eyes and dry mouth
• Mixed connective tissue disorder: Similar to SLE, but milder
• Myositis: Inflammation and degeneration of muscle tissues
• Rosacea: Flushed face with pus-filled blisters
• Seborrheic dermatitis: Sores on lips and nose
• Lichen planus: Swollen rash that itches, typically on scalp, arms, legs, or in the mouth
• Dermatomyositis: Bluish-red skin eruptions on face and upper body
• Lyme disease: Bulls-eye rash, joint inflammation, and flu-like symptoms