Autoimmune Diseases Lupus

Symptoms and Complications of Lupus

Overview

Systemic 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

Antiphospholipid Syndrome (APS)

Antiphospholipid Syndrome is also known as Hughes Syndrome. ISN.

Atherosclerosis

Biomarkers associating endothelial Dysregulation in pediatric-onset systemic lupus erythematous (pSLE). Endothelial dysregulation associating proteins seems to be potent biomarkers for pSLE activity as well as organ involvement in pSLE patients. PubMed, Pediatr Rheumatol Online J, 2019 Oct 24;17(1):69.

Incidence and predictors of aorta calcification in patients with systemic lupus erythematosus. Systemic lupus erythematosus patients had a much earlier onset and higher incidences of aorta calcium than coronary artery calcification. PubMed, Lupus, 2019 Feb 10:961203319826689.

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

Blood–brain barrier (BBB) leakage in systemic lupus erythematosus (SLE) is associated with gray matter loss and cognitive impairment. Our findings provide evidence for a link between extensive BBB leakage and changes in both brain structure and cognitive function in patients with SLE. PubMed, Ann Rheum Dis, 10/01/2020.

The blood-brain barrier, TNF-like weak inducer of apoptosis (TWEAK) and neuropsychiatric involvement in human systemic lupus erythematosus and primary Sjögren's syndrome. We hypothesize that increased TWEAK and S100B result from immunological stress caused by brain-reactive antibodies produced by brain residing immune cells. PubMed, Lupus, 2018 Nov;27(13):2101-2111. (Also see Sjögren's Syndrome)

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.

Cachexia

Cachexia in Systemic Lupus Erythematosus (SLE): Risk Factors and Relation to Disease Activity and Damage. Cachexia is an underrecognized syndrome in patients with SLE and SLE patients with intermittent cachexia have the highest risk of future organ damage. PubMed, Arthritis Care Res (Hoboken), 08/02/2020.

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.

Cancer

Cervical Cancer Screening in Women with Systemic Lupus Erythematosus (SLE). Patients with SLE are at higher risk of abnormal cervical screening test results than controls, supporting the need for regular screening. PubMed, Arthritis Care Res (Hoboken), 08/16/2020. (Also see Cancer)

Cytomegalovirus

Association between lymphocyte subsets and cytomegalovirus (CMV) infection status among patients with systemic lupus erythematosus (SLE): A pilot study. Our findings support a potential inverse relationship between lymphopenia, specifically CD4+ T-cell lymphopenia, and CMV disease among hospitalized SLE patients. PubMed, Medicine (Baltimore), 2019 Sep;98(39):e16997.

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

Kynurenine pathway is altered in patients with systemic lupus erythematosus (SLE) and associated with severe fatigue. Metabolites in the kynurenine pathway are altered in patients with SLE compared with controls. PubMed, Lupus Sci Med, 2018 May 23;5(1):e000254.

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.

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.

Case report: Synchronous Volvulus of the Transverse Colon and Cecum Associated with Scleroderma and Lupus. To our knowledge, this is the first reported case of synchronous double volvulus of the transverse colon and cecum. PubMed, Radiol Case Rep. (Also see Bowel Dysfunction)

Effect of early eradication therapy on systemic lupus erythematosus (SLE) risk in patients with Helicobacter pylori (HP) infection: a nationwide population-based cohort study. Early HP eradication could significantly reduce SLE risk, especially in the first three-year follow-up. PubMed, Lupus, 2020 May 7:961203320923393.

Case Report: Treatment of colon cancer in a patient with systemic lupus erythematosus. This report provides an effective way to diagnose colon cancer in patients with systemic lupus erythematous and illustrates a successful therapy strategy for this complex medical condition. PubMed, BMC Cancer. (Also see Cancer)

Hearing

Effect of systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) on sudden sensorineural hearing loss (SSNHL). Comorbid SLE or RA may negatively affect the prognosis of SSNHL. PubMed, Laryngoscope, 12/04/2019. (Also see Symptoms and Complications of Rheumatoid Arthritis and Autoimmune Ear Diseases)

Heart Disease

Systemic lupus erythematosus; stroke and myocardial infarction (MI) risk: a systematic review and meta-analysis. Overall, patients with SLE were identified to have a twofold to threefold higher risk of stroke and MI. PubMed, Clin Lab, RMD Open, 2020 Sep;6(2):e001247.

Prevalence of antiphospholipid antibodies in patients with overt myocardial dysfunction in systemic lupus erythematosus. A case-control study. This study did not find any significant association of anti-phospholipid antibodies with overt myocardial dysfunction in patients of SLE. PubMed, Lupus, 2020 Aug 4;961203320947784. (Also see Antiphospholipid Syndrome)

Differences in HDL-Cholesterol Efflux Capacity (CEC) Between Patients with Systemic Lupus Erythematosus (SLE) and Rheumatoid Arthritis (RA). RA patients have a more pro-atherogenic lipid pattern compared to those with SLE. However, CEC seems to be more damaged in SLE than in RA patients. PubMed, Arthritis Care Res (Hoboken), 08/08/2020. (Also see Symptoms and Complications of Rheumatoid Arthritis)

Left Ventricular (LV) Systolic Function in Patients With Systemic Lupus Erythematosus (SLE) and Its Association With Cardiovascular Events. In patients with SLE, LV systolic function as measured by LV global longitudinal strain is significantly impaired and associated with cardiovascular events. PubMed, J Am Soc Echocardiogr, 2020 Jul 1;S0894-7317(20)30230-3.

A Population-based Study of Risk Factors for Heart Failure in Pediatric and Adult-onset Systemic Lupus Erythematosus (SLE. Hypertension remains an important traditional cardiovascular risk factor across all ages and should be managed aggressively even in younger patients with SLE. Seminars in Arthritis and Rheumatism, 05/03/2020.

Maternal hypertensive disorders (HDP) in systemic lupus erythematosus (SLE) pregnancy and future cardiovascular outcomes. In women with and without SLE, HDP were associated with a three-fold higher rate of hypertension. PubMed, Arthritis Care Res (Hoboken), 01/31/2020.

Systemic lupus erythematosus (SLE) is a risk factor for atrial fibrillation (AF): a nationwide, population-based study. Development of AF in patients with SLE was associated with increased mortality. PubMed, Clin Exp Rheumatol, 2019 Nov-Dec;37(6):1019-1025.

Heart failure (HF) risk in systemic lupus erythematosus (SLE) compared to diabetes mellitus (DM) and general medicaid patients. Further investigation into the biologic mechanism of HF among SLE compared to non-SLE and DM patients may shed light on the findings of this study. PubMed, Semin Arthritis Rheum, 06/11/2019. (Also see Symptoms and Complications of Diabetes)

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)

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.

The influence of obesity on hydroxychloroquine (HCQ) blood levels in lupus nephritis patients. It was advised to consider the use of 2016-AAO dose of HCQ as per the ideal body weight for this group of patients. PubMed, Lupus, 2021 Jan 5;961203320985214. (Also see DMARDs)

Comparison of Clinical Features and Outcomes Between Patients With Early and Delayed Lupus Nephritis Clinical outcomes of early and delayed lupus nephritis are not significantly different. PubMed, BMC Nephrol, 2020 Jul 7;21(1):258.

Interleukin-34 as a marker for subclinical proliferative lupus nephritis (LN). Serum IL-34 may be used as a surrogate marker for early renal affection in silent LN, especially the proliferative type. Sage Journals, Lupus, 04/01/2020. (Also see Interleukins)

Transplant outcomes in kidney recipients with lupus nephritis (LN), and systematic review. Kidney transplantation is an acceptable option in patients with concurrent LN and end-stage renal disease. PubMed, Lupus, 2020 Mar;29(3):248-255. (Also see Kidney Transplant)

Dysregulated Fc gamma receptor IIa-induced cytokine production in dendritic cells (DCs) of lupus nephritis patients. We identified that DCs of lupus nephritis patients show increased Fcγ R-induced IL-1β production, which is another important cytokine that promotes kidney inflammation. PubMed, Clin Exp Immunol, 09/11/2019.

Relationship between interstitial CD34 positive cells and active phase of lupus nephritis. A strong interstitial expression of CD34 was observed in lower activity indices and it could play a protective role in lupus nephritis and could reduce renal activity. PubMed, Eur J Rheumatol, 2018 Oct 10:1-4.

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

Case Report: Case of autoimmune hepatitis with overlap systemic lupus erythematosus. We present here a challenging case of a middle-aged woman with AIH in remission who later developed new-onset fatigue, pleural effusion and splenomegaly. PubMed, BMJ Case Rep.

Lymphoma

The risks of cancer development in systemic lupus erythematosus (SLE) patients: a systematic review and meta–analysis. This comprehensive meta–analysis provides epidemiological evidence supporting the associations between SLE and cancer risk. BMC Journals, Arthritis Research & Therapy, 12/06/2018. (Also see Cancer)

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.

Miscarriages

Risk factors associated with adverse pregnancy outcomes (APOs) in patients with new–onset systemic lupus erythematosus (SLE) during pregnancy. New onset SLE during pregnancy increased the risk for multiple APOs. PubMed, Lupus, 2021 Jan 6;961203320980531. (Also see Pregnancy and Autoimmunity)

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.

Musculoskeletal

Construction of a Frailty Index (FI) as a Novel Health Measure in Systemic Lupus Erythematosus (SLE). The SLICC-FI may be a useful tool for identifying patients with SLE who are most vulnerable to adverse outcomes. PubMed, J Rheumatol, 2020 Jan;47(1):72-81.

The Impact of Systemic Lupus Erythematosus (SLE) on the Risk of Newly Diagnosed Hip Fracture. A General Population-Based Study. Patients with newly diagnosed SLE have a 62% increased risk of hip fractures compared to non-SLE individuals. PubMed, Arthritis Care Res (Hoboken), 11/23/2019.

Usefulness of composite indices in the assessment of joint involvement in systemic lupus erythematosus (SLE) patients: correlation with ultrasonographic score. We suggest the ability of composite indices in detecting SLE joint inflammation and their possible real–life use. PubMed, Lupus, 2019 Feb 11:961203319828527.

Neuropsychiatric

Association of clinical characteristics, disease activity and health-related quality of life in systemic lupus erythematosus (SLE) patients with major depressive disorder (MDD). Predictors of MDD in SLE patients include higher scores in pain and global assessment, poor or fair self-reported health, and specific organ involvement. PubMed, Rheumatology (Oxford), 2021 Feb 6;keab123. (Also see Depression)

Mortality in patients with systemic lupus erythematosus (SLE) and neuropsychiatric (NP) involvement: A retrospective analysis from a tertiary referral center in the Netherlands. Mortality was increased in both major NPSLE and minor/non-NPSLE patients in comparison with the general population. PubMed, Lupus, 2020 Oct 20;961203320963815.

Different patterns of cerebral perfusion in systemic lupus erythematosus (SLE) patients with and without neuropsychiatric (NP) manifestations. Cerebral blood flow measured by noninvasive three-dimensional arterial spin labeling could be a useful biomarker for the diagnosis and disease monitoring of NPSLE and non-NPSLE patients. PubMed, Hum Brain Mapp, 10/24/2019.

Association of Depression With Risk of Incident Systemic Lupus Erythematosus (SLE) in Women Assessed Across 2 Decades. This study contributes to increasing evidence that depression may be associated with increased risk of SLE. PubMed, JAMA Psychiatry, 2018 Dec 1;75(12):1225-1233. (Also see Depression)

Depression and anxiety in systemic lupus erythematosus: The crosstalk between immunological, clinical, and psychosocial factors. Despite also suffering from the pain and disability that accompanies chronic autoimmune disease, the rheumatoid arthritis patients had less anxiety and better relationship scores. PubMed, Medicine (Baltimore). 2018 Jul;97(28):e11376. (Also see Depression)

Pancreatitis

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

Persistent Lupus Myelitis

Suspected Transverse Myelitis (TM) with Normal MRI and CSF Findings in a Patient with Lupus (SLE): What to Do? A Case Series and Systematic Review. Outcome in SLE patients presenting with clinically suspected TM with normal sMRI and cerebrospinal fluid is less favorable, despite treatment with immunosuppressive therapy. PubMed, Neuropsychiatr Dis Treat, 2020 Dec 22;16:3173-3186.

Pulmonary Involvement

Complement alternative pathway activation associated with pulmonary hypertension in lupus nephritis patients. Activation of the complement alternative pathway may be involved in the pathogenesis of pulmonary hypertension in lupus nephritis. PubMed, Lupus, 2019 Jul 11:961203319860192. (Also see Pulmonary Hypertension)

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)

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.

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.

Retinal

Retinal Complications in Patients with Systemic Lupus Erythematosus Treated with Antimalarial Drugs. Just over 5% of patients developed antimalarial retinal complications, over an average of 12.8 years, but no cases were detected in the first 5 years of therapy. PubMed, J Rheumatol, 2020 Apr;47(4):553-556. (Also see DMARDs)

Skin

The dermatoscopic spectrum of cutaneous lupus erythematosus (CLE): a retrospective analysis by clinical subtype with clinicopathological correlation. Depending on CLE subtype, distinct dermatoscopic patterns are recognized. PubMed, Dermatol Ther, 11/09/2020.

Pathogenesis of skin injury in systemic lupus erythematosus (SLE). Skin deposited IgG is a crucial pathological factor to trigger skin lesions in SLE and blockade of IgG signaling may be effective target against skin injury of SLE. PubMed, Curr Rheumatol Rep, 2018 Feb 21;20(2):5.

Sleep Disorders

Anemia Linked to Restless Legs Syndrome in Lupus. Anemia could increase the prevalence of restless legs syndrome (RLS) in patients with lupus. PubMed, Int J Rheum Dis.

Thrombocytopenia

Profiling of non-criteria antiphospholipid antibodies in patients with systemic lupus erythematosus (SLE): differentiation of thrombotic SLE patients and risk of recurrence of thrombosis. Profiling of antiphospholipid antibodies by line immunoassay can differentiate SLE patients with thrombosis from SLE patients without thrombosis. PubMed, Lupus, 2020 Mar 4:961203320909952. (Also see Antibodies in Lupus)

Thrombotic thrombocytopenic purpura (TTP) as the first presentation in systemic lupus erythematosus (SLE). Coexistence of TTP with systemic lupus erythematosus (SLE) is extremely rare, and the emergence of the full manifestation of SLE starting with TTP is even rarer. PubMed, Reumatologia, 2018;56(4):268-270.

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

Active tuberculosis (TB) in patients with systemic lupus erythematosus (SLE) from Southern China: a retrospective study. TB infection is a common comorbidity in patients with SLE and co–infection with TB and other pathogens is not rare. PubMed, Clin Rheumatol, 2019 Feb;38(2):535-543

Vascular Involvement

Complement deposition, C4d, on platelets is associated with vascular events in systemic lupus erythematosus (SLE). PC4d+ is associated with vascular events in SLE, independently of traditional and SLE-associated risk factors. PubMed, Rheumatology (Oxford), 04/07/2020.

Septic shock among patients with systemic lupus erythematosus (SLE): short and long–term outcome. Analysis of a French nationwide database. Septic shock is a frequent and severe complication among SLE patients even if it is not associated with more healthcare use than another episode of same severity. PubMed, J Infect, 04/08/2019.

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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