Systemic Lupus Erythematosus usually occurs between the ages of 20 and 40, but has been described at all ages. The subject most frequently affected is a woman of childbearing age.
General symptoms
General symptoms include:
- temperature,
- asthenia (weakness),
- weight loss,
- anorexia,
- general malaise.
Fever can be of different types: more often it is very high, or it can be moderate, or even a low-grade fever. However, the clinical picture reflects the involvement of one or more of the following systems: muscular and skeletal system, kidney, skin, blood, nervous system. Usually the systems affected first tend to remain the most affected during the course of the disease.
Joint and muscle disorders
Joint involvement is one of the most common manifestations of Systemic Lupus Erythematosus (92%). They are painful, mostly symmetrically. In order of frequency, the most affected are those of the hands, followed by wrists and knees. Less often affected are elbows, ankles and shoulders.
Muscles are just as painful (myalgia); pain regresses promptly after administration of cortisone. Finally, a significant incidence of femoral head rupture should be noted, especially in patients receiving therapy with the same cortisone.
Cutaneous signs
The most characteristic dermatological lesion (52%) of Systemic Lupus Erythematosus is an erythema called "butterfly", as it affects the cheekbones and the upper portion of the cheeks by bridging the back of the nose.
Other common skin lesions are: patchy alopecia (loss of hair and hair) (70%), and a reddening that appears above all after exposure to the sun in exposed areas: face, neck, hands. Sometimes there are ulcers of the skin and mucous membranes and small infarcts especially in correspondence of the nails. Important is the phenomenon of Raynaud, which affects about 20% of patients.
It is characterized by an important constriction of the finger vessels (especially of the hands) after exposure to cold ( pallor phase ) followed by stagnation of blood which determines a bluish color ( cyanosis phase ) and subsequent resolution with return to normal. However, when this phenomenon is repeated frequently, irreversible damage can occur.
The lesions of the mucous membranes, called aphta, are common and manifest as small superficial ulcers in the oral cavity (especially on the palate) and on the nasal mucosa.
There is also a form of exclusive cutaneous localization of lesions caused by lupus, and is called discoid lupus . Exceptionally, it can evolve into the systemic form. This disease is characterized by roundish lesions that are typically located on the head, neck and upper limbs.
Damage to Bodies
Kidney involvement is evident in about 50% of patients and is often one of the most serious manifestations of the disease.
Sometimes there are only isolated anomalies, others very serious, up to the nephrotic syndrome and, subsequently, to kidney failure .
Damage to the central nervous system is more common and more serious than that of the peripheral nervous system. The most frequent manifestations are psychoses and convulsions, present in about 15% of patients. In the peripheral nervous system are possible involvement of different nerves with disturbances of sensitivity and movement.
Common cardiac and pulmonary manifestations in those suffering from Systemic Lupus Erythematosus are pericarditis and pleuritis (between 20 and 40% of patients). Important, although not very common, are myocarditis and heart attacks . Pulmonary involvement, called lupus pneumonia, is rare .
Other symptoms
Other manifestations are represented by: increase in volume, without pain, of lymph nodes (60%), usually generalized, increase in the volume of the spleen (10%) and of the liver (in about a quarter of patients), gastrointestinal (rare) manifestations, possible conjunctivae and increase in volume of the salivary glands.
Finally, in systemic lupus erythematosus, accelerated atherosclerosis has been demonstrated, which in affected patients would occur much earlier than those of similar age.
