Systemic lupus erythematosus (SLE) and its manifestations

What is systemic lupus erythematosus (SLE)?

Lupus, whose full name is Systemic Lupus Erythematosus (SLE), formerly known as Disseminated Lupus Erythematosus (DLE), is a long-term (chronic) autoimmune disease whose manifestations can vary greatly from person to person. It most often begins with skin lesions and can progress to affect many organs (hence the term systemic lupus), most commonly the skin, joints, kidneys, heart, lungs, central nervous system, and blood cells. The disease often progresses in periods of flare-ups, during which certain symptoms appear or worsen, alternating with periods of remission. Lupus more often affects women of childbearing age, that is, between 15 and 45 years old. It can also affect men (about 10 times less often than women) and children.

*Autoimmune disease: a disease linked to an abnormal functioning of our innate immune system; this then attacks the constituents of our body, such as certain organs and certain cells, resulting in diseases known as autoimmune diseases.

The manifestations of systemic lupus erythematosus (SLE)

(For simplicity in the following text, we will use the term "Lupus" for SLE). The manifestations of lupus can vary greatly from person to person and can change over the course of the disease. The disease can begin with any one of these manifestations; it often progresses in periods of flare-ups (episodes), during which certain symptoms appear or worsen, alternating with periods of remission.

Fatigue and general symptoms

Fatigue is one of the most frequently reported symptoms in people with lupus. It can be significant and impact daily activities. During a flare-up, other general symptoms may appear, including a mild fever, decreased appetite, or sometimes weight loss.

Joint and muscle manifestations

Joint pain is among the most common symptoms of lupus. It can affect the fingers, wrists, knees, feet, or ankles. Pain is often bilateral, affecting either the upper or lower limbs. During flare-ups, the affected joints are painful, warm, red on light-colored skin, and swollen (this is known as arthritis). Muscle pain, often accompanied by weakness, may also be present.

Skin manifestations

Lupus can cause various skin conditions, some of which are present from the onset of the disease; these are aggravated or exacerbated by sun exposure. One of the most characteristic skin manifestations is facial redness that can extend to the cheekbones and bridge of the nose, often described as a "butterfly rash" (or a "wolf mask" or vespertilio, which gives the disease its name, lupus). Other skin lesions may appear on different parts of the body during flare-ups. Mouth ulcers or sores on the nose, as well as hair loss, may also occur.

Kidney manifestations

In some people, lupus can affect the kidneys as the disease progresses. This condition, called lupus nephritis, can sometimes develop without causing any obvious symptoms at first. It must be systematically detected through urine tests; these may show an excess of protein in the urine (proteinuria) or the presence of microscopic blood (microhematuria). This kidney involvement may be discovered when high blood pressure develops. The earlier it is detected, the better the prognosis, especially with newer lupus treatments. Regular monitoring of kidney function, particularly through blood and urine tests, is therefore an essential part of medical follow-up.

Cardiac and pulmonary manifestations

Lupus can cause inflammation of the membranes surrounding the heart (the pericardium, leading to pericarditis) or the lungs (the pleura, causing pleurisy); similarly, the valves separating the heart chambers can be affected, as well as the heart muscle itself. Symptoms such as chest pain, cough, or persistent shortness of breath require prompt cardiac and respiratory evaluation to determine the cause and ensure appropriate treatment.

Neurological and psychological manifestations

More rarely, the nervous system may be affected. The manifestations are varied and may include headaches, difficulty concentrating or remembering, mood disorders or, in some rare situations, more severe neurological, psychological or psychiatric manifestations.

Blood and vascular manifestations

Lupus can be associated with various blood abnormalities, including a decrease in red blood cell count and hemoglobin levels (anemia), white blood cell count (increasing the risk of infection), or platelet count (which can promote bleeding). In some people with lupus, the body can produce autoantibodies against phospholipids; phospholipids are lipid molecules that are the main components of the body's cell membranes. Antiphospholipid autoantibodies can promote blood clot formation and lead to thrombosis in blood vessels.

Note: Lupus is indeed frequently associated with "antiphospholipid syndrome", another autoimmune disease that predisposes to the formation of clots in blood vessels.

The manifestations vary from person to person.

Not everyone with lupus experiences all of these symptoms. Their nature, intensity, and progression vary from person to person. Indeed, each case is unique and requires individualized medical monitoring. This medical follow-up must be regular and allows for monitoring the progression of the disease, detecting any potential organ damage, and adapting the treatment plan.

This information sheet is for general information purposes only. It does not replace a consultation or personalized medical advice for diagnosis and follow-up.

Sources: PNDS Systemic Lupus of Adults and Children (2024) — Reference Centres / RAISE / FAI²R Network; Health Insurance.

Content reviewed and validated by Professor Saïd Norou DIOP, specialist in Internal Medicine, medical advisor for TAHIRAH CARE.