Lupus signs, symptoms and concurrent conditions
Lupus affects everyone differently, but certain signs and symptoms are common. A sign is medical evidence that your doctor finds during a physical examination, such as a specific rash; a symptom is a subjective indication of a disease, such as joint stiffness or headaches. In addition, other conditions, such as fibromyalgia, are common in people with lupus, but are not directly related to disease activity. These common conditions are known to physicians as “comorbidities”. Various signs, symptoms and comorbidities of lupus are explained in more detail below.
The average human body temperature is around 98.5°F, but many people walk just above or below this mark. A temperature of 101°F is generally considered a fever. Many people with lupus experience recurring low temperatures that do not reach 101°F. Such low temperatures can be a sign of an impending illness or an approaching lupus attack. Fever can also be an indication of inflammation or infection, so it is important to be aware of your body’s patterns and inform your doctor of anything unusual.
Stiffness of the joints
Many lupus patients suffer from joint stiffness, especially in the morning. People often find that a hot shower alleviates this problem. If this habit does not provide comfort and the joint stiffness prevents you from daily activities, you should definitely talk to your doctor. He/she will examine you for signs of joint swelling and can talk to you about medications that can relieve some of this pain and inflammation, such as over-the-counter pain treatments and NSAIDs. Tenderness of a joint in a condition called arthralgia, and it is important that your doctor differentiates this from the arthritis (real swelling) that can accompany lupus.
If you have a fever that lasts for a few days, or a fever that comes and goes over the course of a few days, you should take your temperature twice a day and keep a log. Certain trends may alert your doctor to certain processes in your body. You should also seek medical attention if your fever is 101°F or higher. If you are taking steroid medications, such as prednisone, you should watch out for any signs of infection, as steroids can suppress your immune system while masking the symptoms of infection. Immunosuppressive drugs such as Fosamax, methotrexate, cyclophosphamide and mycophenolate also suppress the immune system. So if you feel ill while taking any of these medications, you should tell your doctor immediately.
Increased lupus activity can sometimes lead to weight loss, and certain medications can cause loss of appetite. Regardless of the cause of your weight loss, you should talk to your doctor to make sure that the loss does not indicate a more serious condition. If you experience loss of appetite due to your medications, your doctor may suggest alternative medications or solutions to relieve the stomach pain problems.
Other drugs, such as corticosteroids, can cause weight gain. It is therefore very important that you talk to your doctor about maintaining a balanced diet while taking these medications. You may need to reduce your calorie consumption; your doctor may refer you to a dietician if necessary. Light to moderate exercise can also help you maintain a healthy weight and cardiovascular system while improving your mood.
Please remember that it is very easy to gain weight, especially when taking steroids, but it is much more difficult to lose it again. It is very important that you try to achieve a healthy weight, because women with lupus between the ages of 35 and 44 are fifty times more likely to have a heart attack than the average woman. In addition, maintaining a healthy weight helps to take the strain off your joints and make your organs work productively and efficiently.
Tiredness and discomfort
Ninety percent of people with lupus will suffer from general fatigue and discomfort at some point during the course of the disease. Some people find that a short nap of 1 ½ hour is effective in reducing fatigue. However, exceeding this time frame can lead to sleep problems at night.
Up to 10% of people with lupus may suffer from a condition called Sjögren’s syndrome, a chronic autoimmune disease in which the glands that produce tears and saliva do not function properly. Sjogren’s syndrome can also affect people who do not have lupus. People with Sjogren’s syndrome often suffer from dryness of the eyes, mouth and vagina. They may also experience a gritty or sandy feeling in their eyes, especially in the morning. This dryness occurs because the immune system has begun to attack the moisture-producing glands of the eyes and mouth (the lacrimal gland or parotid gland), which leads to a decrease in tears and saliva.
It is important that you speak to your doctor if you feel dryness in your eyes and mouth, as medication for these conditions must be taken regularly to prevent discomfort and permanent scarring (especially of the tear glands). The Schirmer test is usually performed to check for sjogren and consists of placing a small piece of litmus paper under the eyelid. Eye symptoms can be relieved by the frequent use of artificial tears, and an eye drop medication called Restasis is often used to prevent worsening of Sjogren’s disease. Evoxac (or pilocarpine) can be used to increase the production of both tears and saliva, and certain lozenges (numoisyn) can also be helpful for dry mouth.
Depression and anxiety are present in almost one third of people with lupus. Clinical depression is different from the temporary pain of sadness that can afflict us all from time to time. In fact, clinical depression is a long-lasting, unpleasant and disabling condition. The characteristic features of depression are feelings of helplessness, hopelessness, general sadness and loss of interest in daily activities. Depression is also often associated with crying fits, loss of appetite, restless sleep, loss of self-esteem, inability to concentrate, reduced interest in the outside world, memory problems and indecision. In addition, people who are depressed may suffer from certain physiological signs such as headaches, palpitations, loss of sex drive, indigestion and cramps. Patients are considered clinically depressed if they have symptoms that last for several weeks and are sufficient to disrupt their daily lives. Patients suffering from depression often also experience a general slowdown and clouding of mental functions such as memory, concentration and problem-solving ability. This phenomenon is sometimes called “fog”. The cause of depression is not known; sometimes a genetic component predisposes a person to the disease. Depression is almost never caused by an active lupus in the brain.
While clinical depression can be caused by the emotional strain of coping with a chronic disease and the sacrifices and adjustments that go along with the disease, it can also be triggered by steroid drugs (e.g. prednisone) and other physiological factors. It is important that you talk to your doctor if you feel that you are suffering from clinical depression, as many people who are physically ill respond well to antidepressant medication. In addition, your doctor may treat your depression in different ways depending on the cause.
Many people with lupus suffer from gastrointestinal problems, especially heartburn caused by gastroesophageal reflux disease (GERD). Peptic ulcers can also occur, often due to certain drugs used in the treatment of lupus, including NSAIDs and steroids. Occasional heartburn or acid indigestion can be treated with an over-the-counter antacid such as Rolaids, Maalox, Mylanta or Tums. Your doctor may also include an antacid or other form of GI medication (a proton pump inhibitor, histamine 2 blocker or motility enhancer) in your treatment regimen. Antacids are effective when used to treat occasional symptoms, but you should try to avoid heartburn and acid indigestion altogether by eating smaller meals, staying upright after meals, and drinking less caffeine. If heartburn and acid reflux persist (e.g., for more than two weeks), you should talk to your doctor, as your heartburn symptoms may be due to a greater risk of acid reflux.