Clinical features

The clinical features of SLE may vary markedly from relatively mild symptoms through to life-threatening multi-organ disease (1).

Non specific features of SLE include:

• fever - unexplained fever is common and characteristic for SLE
• malaise
• fatigue - occurs in 80% to 100% of patients, but does not always correlate with disease activity (2)
• weight loss
• oral ulcers
• myalgia and myositis - in about one third of patients
• photosensitive skin rashes. The characteristic malar or butterfly rash occurs in 30% to 40% of patients, and may be more common in female patients (3)
• lymphadenopathy - occurs in about half of cases, often in association with hepatomegaly
• pleuritic chest pains
• headache
• paraesthesia
• symptoms of dry eyes and mouth
• Raynaud's phenomenon (2)

In women, disease may be exacerbated by menstruation and pregnancy.

The approximate frequency of systems involvement is given below: (4)

• haematological 95%
• joints 95%
• cutaneous 80%
• pulmonary 65%
• nervous system 60%
• renal involvement is present in approximately 50% to 70% of patients, and may be more common in male patients (3)
• gastrointestinal 20%
• ocular 15%

References:

1. Aringer M, Costenbader K, Daikh D, et al. 2019 European League Against Rheumatism/American College of Rheumatology classification criteria for systemic lupus erythematosus. Arthritis Rheumatol. 2019 Sep;71(9):1400-12.
2. Leuchten N, Milke B, Winkler-Rohlfing B, et al. Early symptoms of systemic lupus erythematosus (SLE) recalled by 339 SLE patients. Lupus. 2018 Aug;27(9):1431-6.
3. Boodhoo KD, Liu S, Zuo X. Impact of sex disparities on the clinical manifestations in patients with systemic lupus erythematosus: a systematic review and meta-analysis. Medicine (Baltimore). 2016 Jul;95(29):e4272.
4. D'Cruz DP. Systemic lupus erythematosus. BMJ. 2006;332(7546):890-4.