12 Common Lupus Symptoms You Should Never Ignore

Lupus, also known as systemic lupus erythematosus (SLE), is a chronic autoimmune disease where the immune system mistakenly attacks healthy tissues and organs throughout the body. Understanding what lupus is and recognizing its symptoms early can be crucial for timely medical intervention and better disease management. This condition affects approximately 1.5 million Americans, with women being nine times more likely to develop lupus than men, particularly during their childbearing years.

What does lupus do to the body? Lupus causes widespread inflammation that can affect multiple organ systems including the skin, joints, kidneys, heart, lungs, brain, and blood cells. The disease is characterized by periods of flare-ups when symptoms worsen and periods of remission when symptoms improve or disappear completely. Because lupus symptoms can mimic those of other conditions and vary greatly from person to person, it’s often called “the great imitator,” making diagnosis challenging.

Recognizing the early signs of lupus is essential for seeking appropriate medical care. Below are the 12 most common symptoms of lupus that you should be aware of:

1. Butterfly Rash (Malar Rash)

The butterfly rash is one of the most distinctive and recognizable signs of lupus. This characteristic facial rash spreads across the cheeks and bridge of the nose in a pattern that resembles a butterfly’s wings. The lupus butterfly rash typically appears as a flat or raised red patch that may feel warm to the touch.

In early stage butterfly rash, the discoloration may be mild and easily mistaken for sunburn or rosacea. The rash often appears or worsens after sun exposure and can last for days or weeks during a lupus flare. While approximately 30-60% of people with lupus develop this butterfly rash on face, its absence doesn’t rule out the disease. The rash is usually painless but can be accompanied by a burning sensation and may leave no scarring once it fades.

2. Discoid Lupus Rash

Unlike the butterfly rash, discoid lupus lesions are raised, scaly, disk-shaped patches that can appear anywhere on the body but are most common on the face, scalp, and ears. Early stage discoid lupus rash begins as red, circular patches that gradually develop thick scales and can cause permanent scarring and skin discoloration if left untreated.

These lesions can be particularly concerning when they appear on the scalp, as they may lead to permanent hair loss in the affected areas. Discoid lesions are photosensitive, meaning they worsen with sun exposure. Some people have only discoid lupus affecting the skin, while others may have discoid lesions as part of systemic lupus erythematosus. The patches may be itchy or painful and require careful monitoring to prevent long-term skin damage.

3. Extreme Fatigue and Exhaustion

Overwhelming fatigue is one of the most common and debilitating symptoms of lupus, affecting approximately 90% of people with the condition. This isn’t ordinary tiredness that improves with rest—lupus fatigue is profound exhaustion that can make even simple daily tasks feel impossible.

People with lupus often describe feeling drained of all energy, as if their body is constantly fighting an illness. This fatigue doesn’t correlate with activity levels; you might feel exhausted even after a full night’s sleep or minimal physical exertion. The fatigue can fluctuate in intensity and is often worse during disease flares. It can significantly impact work performance, social activities, and overall quality of life. Many factors contribute to lupus fatigue, including the disease’s inflammatory process, anemia, poor sleep quality, medication side effects, and the emotional stress of living with a chronic illness.

4. Joint Pain and Swelling

Joint pain and swelling, known as arthralgia and arthritis, are among the early lupus symptoms that affect more than 90% of people with the disease at some point. Lupus arthritis typically affects the small joints of the hands, wrists, and knees, though any joint can be involved.

The joint pain is usually symmetric, meaning it affects the same joints on both sides of the body simultaneously. Unlike rheumatoid arthritis, lupus joint inflammation rarely causes permanent joint damage or deformity, though it can be quite painful and limiting during flares. The affected joints may feel stiff, especially in the morning, and can be swollen, warm, and tender to the touch. The pain can range from mild to severe and may migrate from one joint to another. Some people experience only occasional joint discomfort, while others have persistent arthritis that significantly affects their daily activities and mobility.

5. Photosensitivity (Sun Sensitivity)

Photosensitivity is a hallmark feature of lupus, affecting approximately 40-70% of people with the condition. This means that exposure to ultraviolet (UV) light from the sun or fluorescent bulbs can trigger or worsen lupus symptoms, including skin rashes, fatigue, joint pain, and internal organ inflammation.

Even brief sun exposure can cause problems for people with lupus. Within minutes to hours of being in the sun, sensitive individuals may develop skin rashes, feel suddenly exhausted, or experience a full-blown lupus flare that can last for days or weeks. The reaction isn’t always immediate—sometimes symptoms appear days after sun exposure. This photosensitivity occurs because UV light can cause changes in skin cells that trigger an immune response in people with lupus. Some lupus medications can also increase sun sensitivity, making sun protection absolutely essential for people with this condition.

6. Fever Without Infection

Unexplained low-grade fever is a common early sign of lupus that often goes unrecognized. People with lupus may experience temperatures ranging from 98.5°F to 101°F (36.9°C to 38.3°C) without having an infection or other obvious cause.

These fevers often accompany lupus flares and reflect the body’s inflammatory response. The fever may come and go, sometimes occurring daily or several times a week. It’s typically accompanied by other symptoms such as fatigue, joint pain, or malaise. Because fever can also indicate an infection—which people with lupus are more susceptible to due to their compromised immune system and immunosuppressive medications—any persistent or high fever should be evaluated by a healthcare provider to rule out infection.

7. Hair Loss (Alopecia)

Hair loss is a distressing symptom that affects many people with lupus. Lupus-related hair loss can occur in several patterns: gradual thinning of hair all over the scalp, patchy bald spots, or breakage of hair along the hairline creating short, broken hairs sometimes called “lupus hair.”

The hair loss occurs because lupus inflammation affects the hair follicles. During active disease or flares, hair may fall out in clumps or thin noticeably. Some people also develop discoid lesions on the scalp that can cause scarring and permanent hair loss in those areas. The good news is that non-scarring hair loss from lupus is usually temporary and hair often regrows when the disease is under better control. However, the emotional impact of hair loss can be significant and shouldn’t be underestimated.

8. Raynaud’s Phenomenon

Raynaud’s phenomenon affects approximately one-third of people with lupus. This condition causes the fingers and toes (and sometimes the nose and ears) to turn white or blue in response to cold temperatures or stress. The color changes occur because the small blood vessels spasm and restrict blood flow to these areas.

During a Raynaud’s episode, the affected areas first turn white as blood flow decreases, then blue as oxygen in the tissues is depleted, and finally red as blood flow returns. The episodes can last from minutes to hours and may be accompanied by numbness, tingling, or pain. As circulation returns, people often experience throbbing, tingling, or swelling in the affected areas. While Raynaud’s can occur independently of lupus, its presence along with other symptoms can help doctors diagnose lupus. Severe Raynaud’s can occasionally lead to sores or ulcers on the fingertips.

9. Mouth and Nose Sores

Painless mouth ulcers are a common manifestation of lupus, appearing on the roof of the mouth, gums, inside the cheeks, or on the lips. These sores typically appear during lupus flares and are usually painless, which distinguishes them from canker sores or cold sores that are typically quite painful.

The ulcers appear as red or white spots with a red halo and can vary in size. Some people with lupus also develop sores inside the nose or experience nasal ulcers that can cause nosebleeds or crusting. While these oral and nasal sores are generally painless, they can occasionally become painful, especially if they become infected. The presence of painless mouth sores is actually one of the criteria doctors use when diagnosing lupus.

10. Chest Pain and Breathing Problems

Lupus can cause inflammation of the tissues surrounding the lungs (pleuritis) and heart (pericarditis), leading to chest pain that worsens with deep breathing, coughing, or lying down. This sharp, stabbing chest pain is one of the more alarming symptoms of lupus and requires immediate medical attention to rule out other serious conditions.

Pleuritis affects approximately 40-60% of people with lupus at some point. The inflammation can cause fluid to accumulate around the lungs (pleural effusion), leading to shortness of breath. Similarly, pericarditis causes inflammation of the sac surrounding the heart and can cause chest pain and breathing difficulties. Some people with lupus also develop pulmonary hypertension (high blood pressure in the lungs) or interstitial lung disease, both of which can cause progressive shortness of breath and reduced exercise tolerance. Any chest pain or significant breathing difficulties require immediate medical evaluation.

11. Kidney Problems

Lupus nephritis, or kidney inflammation, is a serious complication that affects approximately 40% of people with lupus. The kidneys are responsible for filtering waste from the blood, and when lupus attacks these organs, their function can become impaired. The concerning aspect of lupus nephritis is that it often develops without obvious symptoms in its early stages.

As kidney involvement progresses, symptoms may include swelling in the legs, ankles, feet, and around the eyes (especially noticeable in the morning), weight gain from fluid retention, high blood pressure, foamy or dark urine, and increased need to urinate at night. Some people may notice blood in their urine. Because kidney damage can be silent, regular urine and blood tests are essential for all people with lupus to catch kidney problems early when they’re most treatable. Untreated lupus nephritis can lead to permanent kidney damage and even kidney failure.

12. Cognitive Dysfunction and Mood Changes

Neurological and psychological symptoms occur in up to 90% of people with lupus, though they’re often subtle and can be mistaken for stress, depression, or aging. “Lupus fog” is a term commonly used to describe the cognitive difficulties associated with the disease, including problems with memory, concentration, confusion, and difficulty processing information or expressing thoughts.

People experiencing lupus fog often report feeling mentally cloudy, struggling to find the right words, forgetting appointments or conversations, and having difficulty multitasking or completing complex tasks. Beyond cognitive symptoms, lupus can also cause mood changes including depression, anxiety, and in rare cases, psychosis. These neuropsychiatric symptoms can result from inflammation in the brain, reduced blood flow to brain tissues, or the emotional burden of living with a chronic disease. Headaches, including migraines, are also common in people with lupus. Any significant cognitive changes or mood disturbances should be reported to a healthcare provider.

What Causes Lupus?

The exact lupus causes remain unknown, but researchers believe the disease develops from a combination of genetic, environmental, and hormonal factors. Understanding how do you get lupus involves recognizing that multiple elements work together to trigger the condition.

Genetic Predisposition: Is lupus hereditary? While lupus isn’t directly inherited, genetics play a significant role. Having a family member with lupus or another autoimmune disease increases your risk. Certain genes affect how the immune system functions, making some people more susceptible to developing lupus. However, most people with these genetic markers never develop the disease, suggesting that genes alone aren’t enough to cause lupus.

Environmental Triggers: Various environmental factors can trigger lupus in genetically susceptible individuals. These include:

• Ultraviolet (UV) light exposure, which can trigger skin lesions and systemic symptoms
• Certain infections, particularly Epstein-Barr virus, which may trigger or exacerbate lupus
• Certain medications that can cause drug-induced lupus (which usually resolves after stopping the medication)
• Exposure to certain chemicals, including silica dust and pesticides
• Smoking, which increases lupus risk and can make the disease more severe

Hormonal Factors: Hormones, particularly estrogen, appear to play a role in lupus development. This explains why lupus symptoms in women are far more common than symptoms of lupus in men, with women accounting for about 90% of cases. The disease often develops during childbearing years when estrogen levels are highest. Many women notice that their symptoms worsen before menstrual periods or during pregnancy, further supporting the hormone connection. However, the exact mechanism by which hormones influence lupus remains under investigation.

Immune System Dysfunction: In people with lupus, the immune system fails to properly distinguish between foreign invaders and the body’s own tissues. This leads to the production of autoantibodies—antibodies that attack the body’s own cells and tissues. This autoimmune response causes widespread inflammation and tissue damage throughout the body, creating the diverse symptoms associated with lupus disease.

Frequently Asked Questions

What is lupus disease?

Lupus is a chronic autoimmune disease where the immune system attacks healthy tissues and organs throughout the body. The full name is systemic lupus erythematosus (SLE), though there are other forms like discoid lupus that primarily affect the skin. The disease causes inflammation that can affect the skin, joints, kidneys, heart, lungs, brain, blood cells, and other organs.

What are the early signs of lupus in females?

Early signs of lupus in females often include extreme fatigue, joint pain and stiffness, low-grade fever, skin rashes (including the butterfly rash across the cheeks and nose), hair loss, and mouth sores. Many women also experience photosensitivity, meaning their symptoms worsen with sun exposure. Because symptoms can be vague and develop gradually, lupus is often difficult to diagnose in its early stages.

Is mild lupus possible?

Yes, mild lupus exists and affects some people with minimal symptoms that don’t significantly impact daily life. People with mild lupus might experience occasional fatigue, joint pain, or skin rashes during flares but have long periods of remission where they feel relatively normal. However, even mild lupus requires medical monitoring because the disease can progress over time and affect internal organs.

Can men get lupus?

Yes, men can develop lupus, though it’s much less common. Symptoms of lupus in men are generally similar to those in women but may be more severe at diagnosis. Men with lupus often experience more kidney problems, seizures, and cardiovascular complications. Because lupus is less common in men, it’s sometimes diagnosed later than in women, which can lead to more severe disease at the time of diagnosis.

Is lupus hereditary?

Lupus has a genetic component but isn’t directly inherited like some diseases. Having a family member with lupus increases your risk, but most people with lupus have no family history of the disease. If one identical twin has lupus, the other twin has about a 25-50% chance of developing it, showing that genetics alone don’t determine whether someone will develop lupus—environmental factors also play a crucial role.

What does the butterfly rash look like?

The butterfly rash, also called a malar rash, is a red or purple rash that spreads across the cheeks and bridge of the nose in a butterfly wing pattern. It can be flat or raised, may feel warm or tender, and often appears or worsens after sun exposure. The rash typically spares the nasolabial folds (the creases running from the nose to the corners of the mouth), which helps distinguish it from other facial rashes.

How is lupus diagnosed?

Diagnosing lupus requires a combination of medical history, physical examination, and laboratory tests. Doctors look for specific antibodies in the blood, particularly antinuclear antibodies (ANA) and anti-double-stranded DNA antibodies. They also use criteria that include specific symptoms and test results. No single test can definitively diagnose lupus, and the process can take months or even years as doctors rule out other conditions and watch how symptoms develop over time.

Can lupus symptoms come and go?

Yes, lupus is characterized by periods of flares (when symptoms are active and may worsen) and remission (when symptoms improve or disappear). Flares can be triggered by sun exposure, infections, stress, or sometimes occur without an obvious cause. The unpredictable nature of lupus symptoms makes the disease particularly challenging to live with, as you never know when a flare might occur.

When should I see a doctor about lupus symptoms?

You should see a doctor if you experience unexplained symptoms such as persistent fatigue, joint pain and swelling, skin rashes (especially the butterfly rash), recurring fever, or any combination of symptoms mentioned in this article. Immediate medical attention is necessary if you experience chest pain, difficulty breathing, severe headache, confusion, seizures, or signs of kidney problems such as swelling and dark urine. Early diagnosis and treatment of lupus can help prevent serious complications and improve long-term outcomes.

References:

• Lupus Foundation of America
• Johns Hopkins Lupus Center
• Mayo Clinic – Lupus
• Centers for Disease Control and Prevention – Lupus
• National Institute of Arthritis and Musculoskeletal and Skin Diseases
• American College of Rheumatology