When do Symptoms normally begin?
Symptoms can begin during early adulthood; it typically develops between 20 and 30 years old. Many Lupus patients are women (90%) and the most common time for women to develop this disease is during or after childbirth. It therefore makes sense that there is some hormonal component to the disease process. It commonly affects women of child bearing age and once a women is menopausal the likelihood of her developing Lupus drops dramatically.
The early signs and symptoms
These symptoms are not used as part of the diagnosis criteria but are very common in the early stages of Lupus. They will alert both you and your doctor that something is wrong.
Fatigue this would have to be one of the most common signs. Indeed according to the John Hopkins Lupus Centre 90% of people with Lupus experience it.
Unexplained fevers having a fever usually materialises into flu or some other kind of viral infection. If you are getting fevers for a couple of days without a real explanation why, it may be time to investigate this with your Doctor.
Malaise a general feeling of being unwell. You most probably can’t quite put your finger on it but you know something isn’t quite right.
Cold hands and feet Raynaud’s syndrome is a common overlap condition of SLE. Your hands and/or feet may turn white or blue in the cold.
Signs and symptoms – clinical
Acute cutaneous lupus including the hallmark butterfly rash, the malar rash across the bridge of the nose and on the cheeks. This occurs in roughly 50% of people who have SLE. Other more generalised rashes can occur anywhere on the body. Rashes can be more scaly and sunlight can make them more prevalent. Pigment changes are not uncommon.
Chronic cutaneous lupus this includes the discoid rash. Discoid lupus (skin lupus) commonly affects the scalp creating circular rashes; often hair doesn’t grow back once these rashes heal.
Ulcers most likely on the roof of your mouth on the sides of the mouth or in the nose.
Non scarring alopecia thinning of your hair or fragile hair that is brittle and breaks easily.
Synovitis involving two or more joints arthritic type pain and aching joints. This is normally worse in the morning and can last for at least 30 minutes on waking. The aches and pains can be travelling, in other words they move around the body and are often mild initially but become quite noticeable over time.
Serositis typically this presents as pleurisy and chest pain for one day or longer.
Renal disorders about 40% of people with Lupus will have kidney inflammation or Glomerulonephritis at some stage. A urine sample can determine if the protein level is higher than normal and if red or white blood cells are present.
Neurological problems seizures, psychosis or acute confused states can often be a sign something is wrong. Many people with Lupus report a feeling of brain fog or brain fuzziness.
Hemolytic anemia this is a form or anemia caused by the abnormal breakdown of red blood cells.
Leukopenia or Lymphopenia a low white blood cell count.
Thrombocytopenia a lower than normal platelet level, platelets are responsible for blood clotting. Clumping may also be present.
Immunological tests- blood screen
ANA this test can be positive for many collagen or connective tissue diseases and it is rarely negative for a person with SLE. It is a very important starting point for diagnosis.
Anti-dsDNA a positive reading for antibodies which are in relation to double stranded DNA are found in 40%-80% of SLE patients. Commonly these antibodies also rise during a Lupus flare up.
Anti Sm this antibody is specific to Lupus and it is more common in black people than Caucasians.
Antiphospholipid antibodies including lupus anticoagulant, false positive RPR and medium to high anti cardiolipin.
Anti B2 glycoprotein I approximately 30%-45% of people with Lupus will test positive for these antibodies.
Low complement C3, C4 CH50 proteins that normally decrease in SLE.
Direct coombs test coombs antibodies attach to red blood cells damaging them and causing haemolytic anemia.
As yet there isn’t one blood test that will clearly give a doctor a definitive positive result for lupus, it is normally a diagnosis made by a collaboration of test results and symptoms of which are outlined above. It is not uncommon for patients to have vague symptoms, which often wax and wane over the course of time.
As a general rule the first tests that your doctor orders may include a full blood count, inflammatory markers such as CRP and ESR and an ANA (anti nuclear antibody) test. If these produce some positive results then this doesn’t mean you have lupus but it may be an indication that further testing is needed.
An early diagnosis is much better for your long-term prognosis.