Systemic lupus erythematosus (SLE, also known as lupus) is an autoimmune disease. This means the immune system makes proteins called autoantibodies that can mistakenly attack healthy tissues, causing inflammation and a wide variety of symptoms.

Lupus symptoms can imitate other illnesses, making the process of diagnosis more complicated. Symptoms of lupus are different in each person and can change over time. Symptoms may decrease or disappear when disease activity is low, only to worsen or reappear with subsequent disease flares. New symptoms can suddenly arise.

Types of Lupus Symptoms

Lupus symptoms vary depending on which parts of the body are affected or where the disease has been active. Most lupus symptoms fall into several general categories: skin and hair symptoms, pain, generalized symptoms, neurological symptoms, and symptoms involving the blood or urine.

Skin and Hair Symptoms

Rashes are common in all types of lupus. The malar or butterfly rash is considered a typical sign of lupus. A malar rash shows up as patches across the cheeks and nose, which are purple on darker skin or reddish pink on lighter skin.

In discoid lupus, round or oval patches form on the head and upper body. In subacute cutaneous lupus, scaly, discolored patches and ring-shaped lesions develop. Lupus rashes are usually sensitive to sunlight or tanning beds and can cause paler or darker spots and thinning of the skin.

Lupus may cause hair loss, especially around the forehead. This can be caused by rashes, sores, or scarring on the scalp. Hair loss can also be a side effect of certain medications that treat lupus, including steroids and immunosuppressives (drugs that suppress the immune system).

Problems with small blood vessels in the hands may cause the fingers to turn red, blue, dusky, or pale when exposed to cold. This condition is called Raynaud’s disease.

Oral ulcers are very common in people with lupus and tend to be recurrent. Some people also develop ulcers in areas such as the nose, eyes, or genital region.

Pain

Joint pain and stiffness are extremely common symptoms of lupus, especially upon waking in the morning. People with lupus may also experience headaches, muscle pain, and abdominal pain caused by inflammation of the pancreas.

Chest pain can be caused by inflammation of the lungs or heart, including:

• Pleuritis (also known as pleurisy) — Inflammation of the pleura, tissues that line the lungs and chest cavity
• Pneumonitis —Inflammation within the lung tissue
• Endocarditis — Inflammation of the heart walls and valves
• Myocarditis — Inflammation of the heart muscle
• Pericarditis — Inflammation of the sac around the heart

Chest pain in lupus can sometimes come with coughing or shortness of breath, depending on the cause. Abdominal pain may be accompanied by symptoms such as nausea, vomiting, loss of appetite, or diarrhea.

General Symptoms

Fatigue and malaise (a feeling of being unwell) are the most common symptoms, experienced by 90 percent of those with lupus.

Other generalized symptoms include insomnia (often due to pain, anxiety, or medication), high blood pressure, swelling in the extremities, weight changes, loss of appetite, and swollen lymph nodes. An article in BMC Psychiatry states that as many as one-third of people with lupus have depression and anxiety, which are common in those with chronic (long-term) conditions.

People with lupus may develop dryness in the eyes, mouth, and vagina. These symptoms may be linked to a separate but related autoimmune condition called Sjögren’s syndrome. Up to 10 percent of people with lupus also have Sjögren’s syndrome, according to Johns Hopkins Lupus Center.

Neurological Symptoms

Lupus can cause cognitive dysfunction (also called brain fog or “cog fog”), including problems with thinking or memory. Other neurological symptoms include vision changes, ringing in the ears, tremors, tingling and numbness in the hands and feet, and balance problems.

In severe cases, lupus can cause seizures, strokes, and psychotic episodes (delusions, paranoid ideation, or hallucinations).

Blood and Bleeding Symptoms

Lupus can cause a drop in blood cell counts because the body’s antibodies attack blood cells faster than they can be replaced. This can lead to anemia (low red blood cell count), which often causes fatigue, and abnormal bleeding.

People with antiphospholipid antibodies in their blood are at higher risk of developing thromboses (dangerous clots inside the blood vessels) anywhere in the body, a condition often referred to as antiphospholipid syndrome. These antibodies can also lead to recurrent miscarriages by causing blood clots in the placenta and are sometimes discovered during fertility evaluations.

Urinary Symptoms

From 20 percent to 40 percent of adults with lupus and 50 percent to 82 percent of children with the condition will develop lupus nephritis, which affects the kidneys. Urine that’s pink or brown or looks foamy or frothy may indicate kidney damage caused by lupus. Frequent urination may be a symptom of kidney problems or other conditions related to lupus, such as interstitial cystitis (also called painful bladder syndrome).

‘Silent’ Complications

Some of the most severe complications of lupus don’t cause noticeable symptoms until they become advanced.

About 50 percent of people with lupus have high blood pressure, which can damage organs and raise the risk of life-threatening cardiovascular events such as heart attack and stroke. In fact, cardiovascular disease (disease of the heart and blood vessels) is the No. 1 cause of death in people with lupus.

Lupus nephritis can cause kidney failure, which may not become obvious until the kidneys are significantly damaged. Doctors order regular urine and blood tests to assess kidney function and detect these “silent” complications of lupus.

Studies have shown that osteoporosis (a disease that causes weakened bones) is more likely to occur in people with lupus due to disease-related inflammation and the use of corticosteroids (such as prednisone) for treatment. Osteoporosis can lead to fractures, bone pain, and shorter height.

What Are the Early Signs of Lupus?

Lupus begins differently for each person, and early symptoms can include any of those discussed here and many others. Some people experience multiple symptoms at once.

For about half of those with lupus, joint pain is among the first symptoms to be reported. About 20 percent of people with lupus initially go to their doctor because of a rash. Rarely, people with central nervous system lupus may have a seizure or a psychotic episode as the first symptom.

Do Men and Women Experience Different Symptoms?

Females of childbearing age are far more likely than any other group to develop lupus, according to a study in the journal Rheumatology. The authors wrote that males who develop lupus are less likely to experience skin rash and joint pain than women but may be more likely to develop serious complications such as kidney disease and thrombosis.

Those complications may occur because of delayed diagnosis or hormonal differences. However, studies are unclear about whether symptoms vary based on sex, partly because fewer men have lupus, making it harder to study the differences.

According to the Centers for Disease Control and Prevention, about 9 in 10 people with lupus are women. For some, lupus flares are worse before menstrual periods and during pregnancy, when levels of estrogen — a hormone involved in sexual and reproductive health — are higher.

Talk With Others Who Understand

MyLupusTeam is the social network for people with lupus and their loved ones. On MyLupusTeam, more than 231,000 members come together to ask questions, give advice, and share their stories with others who understand life with lupus.

Do you have questions about lupus symptoms? Do you have advice for others? Share your feelings in the comments below, or start a conversation by posting on MyLupusTeam.