Lupus (SLE): Early Signs, the Butterfly Rash, Diagnosis and Treatment

Lupus (systemic lupus erythematosus, or SLE) is an autoimmune disease: the immune system attacks the body’s own tissues. It can affect the joints, skin, kidneys, blood and other organs, and it often takes years to diagnose because symptoms come and go. Most people with lupus are women, and it usually starts between the teens and the forties.

Imagine years of being told your tiredness and aching joints are stress, until someone notices the rash that appears every time you are in the sun. A diagnosis opens the door to treatment that can keep lupus quiet for long stretches.

Common signs

• Joint pain and swelling, often in the hands and wrists
• Extreme tiredness
• A rash across the cheeks and nose (the “butterfly rash”), often worse after sun
• Sensitivity to sunlight
• Fever, mouth ulcers and hair loss
• Fingers turning white or blue in the cold (Raynaud’s)
• Chest pain on breathing, or swollen ankles (possible kidney involvement)

How it is diagnosed

There is no single test. Doctors combine your symptoms and examination with blood tests (such as antinuclear antibodies, ANA, and more specific antibodies) and urine tests to check the kidneys. A positive ANA alone does not mean lupus, because many healthy people test positive.

Treatment

• Hydroxychloroquine, the mainstay for most people
• Anti-inflammatory painkillers for joint pain
• Steroids for flares, at the lowest dose for the shortest time
• Immunosuppressants or biological medicines for more serious disease
• Sun protection, rest and pacing to help prevent flares

Lupus tends to come in flares. Regular check-ups, including blood pressure and urine tests, help catch kidney problems early.

But can women with lupus have children?

Many do, with planning. Pregnancy is safest when lupus has been quiet for some months and medicines have been reviewed, so talk to your specialist before trying to conceive.

Sources: NHS, “Lupus”; US National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), “Systemic lupus erythematosus”. This guide is for general information and does not replace advice from your own nurse, doctor or pharmacist.