Lupus Symptoms and Diagnosis

Signs and symptoms of lupus

Lupus symptoms can range from mild to severe and may come and go over time. You might have one or two symptoms at first and more as time goes on. Not everyone has the same symptoms. Watch for:

• Fatigue: Overwhelming tiredness where sleep and rest don’t help.
• Joint pain: Pain, stiffness and swelling, often in the fingers, hands, wrists and knees.
• Skin rash: A butterfly-shaped rash across the cheeks and nose, known as a malar rash, that may get worse with sun exposure. This is the most distinctive sign of lupus, but it doesn’t always occur. Other types of skin rashes and lesions may also develop.
• Swelling: Generally around the eyes.
• Fever: A low-grade fever, typically above 100.4°F, when symptoms flare.

Other symptoms may include:

• Chest pain or shortness of breath when you take a deep breath
• Dry eyes
• Hair loss
• Mouth or nose sores that are usually painless
• Blue or white fingers when you’re cold or stressed (Raynaud’s disease)
• Headaches, confusion or memory loss
• Blood clots
• Light sensitivity

Lupus may affect your:

• Kidneys: Lupus nephritis is a serious complication that affects the kidneys. It causes blood in the urine, high blood pressure and swelling (edema) in the legs and feet or around the eyes.
• Heart: Lupus can increase the risk of inflammation of the heart (myocarditis) or nearby tissues (pericarditis), which may cause chest pain or discomfort. It can also damage heart valves.
• Lungs: Lupus can cause inflammation of the lungs (pleuritis), leading to chest pain that gets worse with deep breathing.
• Neurological: Lupus may cause headaches, confusion, memory loss and sensory changes.

These symptoms may overlap with other medical conditions, so it can be hard to diagnose lupus. If you have any of these symptoms, contact a health care provider with experience treating lupus.

Diagnosing lupus

Diagnosing lupus can be difficult because signs and symptoms vary from person to person and may change over time. Sometimes it can take months or years to get the right diagnosis.

At first, you may see an internist, especially if symptoms are varied and affect multiple organs and systems. You may be referred to a rheumatologist, a doctor who specializes diagnosing and treating diseases that affect the joints, muscles and bones, including autoimmune conditions like lupus.

Diagnosing lupus usually starts with a thorough medical history and physical exam to check for rashes, joint tenderness and signs of organ issues. Your provider will ask about symptoms, family medical history and any environmental exposures or medications.

Blood and urine tests

The main blood test used to diagnose lupus is the antinuclear antibody (ANA) test, which detects antibodies that target the nucleus of cells. A positive ANA test suggests an autoimmune response but does not confirm lupus. 

Other blood tests may include:

• Complete blood count (CBC): To measure white blood cell counts and platelet counts and to check for anemia, which is common in lupus.
• Comprehensive metabolic panel (CMP): To check kidney and liver function and electrolyte levels.
• Blood clotting tests: To see if you have clotting problems.
• Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP): To measure inflammation levels in the body, which can be high in lupus.
• Urinalysis: To see if there are high levels of protein or red blood cells in your urine, which can be a sign that lupus is affecting your kidneys.

Imaging and biopsy

imaging studies such as ultrasound, CT scan or MRI may check to see how lupus is affecting certain organs. A chest X-ray can look for fluid or inflammation in your lungs. An electrocardiogram (EKG) can check for problems with your heart rhythm.

Removing a small sample of tissue to evaluate under a microscope (biopsy) may also confirm lupus and measure organ damage. Biopsies may be used in areas like the skin or kidneys.

Lupus may be hard to diagnose, since it may be mistaken for:   

• Rheumatoid arthritis: Both lupus and rheumatoid arthritis (RA) can cause joint pain, stiffness and swelling. But lupus may cause symptoms that affect organs while RA mainly affects the joints.
• Fibromyalgia: Fibromyalgia causes widespread pain, fatigue and tender points in muscles and joints. These symptoms may overlap with lupus in the early stages when lupus symptoms may not be clear.
• Lyme disease: Lyme disease shares lupus symptoms such as fatigue, joint pain and fever. Lyme disease often has a bullseye rash at the site of the tick bite that you don’t see in lupus.
• Multiple sclerosis (MS): MS is a neurological condition that can cause numbness, tingling, muscle weakness and trouble with thinking. Some neurological symptoms of lupus may be similar to MS, so it can be hard to tell what’s causing symptoms.

Your health care provider can evaluate your medical history, perform a physical examination and review test results to see if you have lupus or another condition. 

Learn about living with and treating lupus.