Symptoms That Might Be Undiagnosed Lupus – Page 37

1. Persistent Fatigue

One of the most common—and often overlooked—symptoms of undiagnosed lupus is persistent fatigue. This isn’t just feeling tired after a long day or too little sleep; it is a profound, unrelenting exhaustion that doesn’t improve with rest. In lupus, chronic fatigue can stem from the body’s ongoing immune system attack, low-grade inflammation, anemia, and even side effects of medications. Unlike the tiredness caused by a busy lifestyle or occasional sleepless nights, lupus-related fatigue may disrupt daily activities and linger for weeks or months.

What makes lupus fatigue unique is its intensity and persistence. According to the Lupus Foundation of America, up to 90% of people with lupus report significant fatigue, often severe enough to impact work, relationships, and quality of life. If you find yourself struggling to get through the day despite adequate rest, and especially if this fatigue is accompanied by other unexplained symptoms, it’s important to seek further evaluation from a healthcare provider. Persistent fatigue should never be dismissed, as it may be an early warning sign of lupus or another underlying autoimmune condition.

2. Joint Pain and Swelling

Joint pain and swelling are hallmark symptoms of lupus, often presenting as one of the earliest warning signs. Unlike osteoarthritis, which typically affects weight-bearing joints due to wear and tear, lupus-related joint pain—known as “arthralgia”—often involves smaller joints in the hands, wrists, knees, and ankles. The pain may migrate from joint to joint, fluctuate in intensity, and is frequently accompanied by noticeable swelling or morning stiffness lasting more than an hour.

While both lupus and rheumatoid arthritis can cause joint inflammation, lupus tends to produce less joint damage and deformity, though the discomfort can be just as severe. In lupus, joint issues often appear suddenly and may be associated with periods of increased disease activity, or “flares.” According to the Lupus Foundation of America, about 95% of people with lupus will experience joint pain at some point.

Early signs to monitor include symmetrical pain (affecting both sides of the body), warmth, redness, and swelling that persists for days or recurs over weeks. If these symptoms occur without a clear explanation or persist despite standard treatments, a more thorough evaluation for lupus or other autoimmune diseases is warranted.

3. Skin Rashes (Butterfly Rash)

One of the most recognizable signs of lupus is the butterfly rash, also known as a malar rash. This distinctive rash spreads across the cheeks and the bridge of the nose, forming a shape reminiscent of a butterfly’s wings. Unlike common facial rashes, the butterfly rash typically avoids the area under the nose and rarely appears on the forehead or chin. It may appear as flat or slightly raised, and often becomes more pronounced after sun exposure due to lupus patients’ heightened sensitivity to ultraviolet light.

The butterfly rash can develop suddenly or gradually, and while it may not always be itchy or painful, it is a strong clinical clue for lupus diagnosis. According to the Lupus Foundation of America, about half of people with lupus develop some form of skin involvement, with the butterfly rash being the most iconic.

It’s important to distinguish this rash from other causes of facial redness, such as rosacea or allergic reactions. Unlike acne or eczema, the lupus butterfly rash is usually not accompanied by pustules or scaling. If you notice a persistent or recurring facial rash—especially after sun exposure—consult a healthcare provider for proper evaluation.

4. Sensitivity to Sunlight (Photosensitivity)

Photosensitivity is a common and distinctive feature of lupus, affecting up to 70% of patients. In lupus, exposure to ultraviolet (UV) light triggers an abnormal immune response, causing skin cells to become inflamed and sometimes even leading to a flare of systemic symptoms. This heightened sensitivity means even brief periods in the sun can provoke rashes, redness, or a severe sunburn-like reaction, far more intense than what’s typical for most people.

Unlike ordinary sunburns, lupus-induced photosensitivity may cause persistent skin changes or trigger joint pain, fatigue, and other systemic symptoms. According to the Lupus Foundation of America, sun exposure can also exacerbate existing rashes, including the classic butterfly rash.

Practical sun protection is essential for anyone with unexplained or recurrent sun sensitivity. This includes applying broad-spectrum sunscreen with SPF 50 or higher, wearing wide-brimmed hats and long-sleeved clothing, and seeking shade during peak sunlight hours. If you experience unusual sun reactions that linger or occur alongside other symptoms, it’s wise to consult your healthcare provider—photosensitivity could be an early indicator of undiagnosed lupus.

5. Mouth or Nose Ulcers

Recurring ulcers in the mouth or nose are another subtle but telling symptom of lupus. These ulcers, sometimes called mucosal ulcers, occur when the immune system mistakenly attacks healthy tissue in the moist linings of the mouth or nasal passages. Unlike typical canker sores—which are usually small, round, and heal within a week—lupus-related ulcers can be painless, may persist for a longer period, and often develop in unusual locations such as the roof of the mouth or inside the nose.

Mouth ulcers from lupus may be flat or slightly raised and might not cause the sharp discomfort associated with canker sores. Nasal ulcers can lead to crusting or minor nosebleeds. According to the Lupus Foundation of America, these ulcers are a recognized diagnostic feature and may appear during disease flares or periods of increased immune activity.

Seek medical care if you notice recurrent, persistent, or unusual ulcers in your mouth or nose—especially if they don’t heal or are accompanied by other symptoms such as fever, joint pain, or skin rashes. Persistent mucosal ulcers may be an early clue toward an underlying diagnosis of lupus.

6. Unexplained Fever

Frequent or persistent low-grade fevers are a common yet often overlooked symptom of lupus. Unlike fevers caused by infections—which usually occur suddenly and are accompanied by other telltale signs like a sore throat or cough—lupus-related fevers often arise without a clear cause. They typically range from 99°F to 101°F (37.2°C to 38.3°C) and may come and go, sometimes lasting for days or even weeks.

These fevers are a result of the immune system’s chronic activation, leading to ongoing inflammation throughout the body. According to the Lupus Foundation of America, unexplained fever is frequently one of the earliest signs of active lupus, especially when it occurs with other symptoms such as fatigue, joint pain, or rashes.

A fever without obvious infection or other explanation is a red flag and warrants medical attention—especially if it recurs or is associated with additional symptoms. If you develop persistent, unexplained fevers, don’t ignore them. Early evaluation is crucial to rule out infection and to screen for autoimmune disorders like lupus, which may otherwise go undiagnosed for years.

7. Hair Loss (Alopecia)

Hair loss, or alopecia, is a frequent and distressing symptom of lupus. In lupus, inflammation targets the skin, including the scalp, disrupting normal hair growth cycles and leading to noticeable thinning or bald patches. Unlike typical pattern baldness—which progresses gradually and is often inherited—lupus-related hair loss may occur suddenly and affect both men and women.

The hair loss in lupus can be diffuse, meaning it affects the entire scalp, or localized, resulting in round patches of baldness. Sometimes, brittle or broken hairs around the hairline, known as “lupus hair,” are a telltale sign. According to the Lupus Foundation of America, hair loss may worsen during lupus flares and can also be triggered by medications or severe stress.

Unlike male or female pattern baldness, lupus-related alopecia is often reversible if the underlying disease is brought under control. However, scarring on the scalp or persistent bald patches warrant prompt medical attention. If you experience sudden or patchy hair loss, especially with other unexplained symptoms, consult your healthcare provider. Early recognition can lead to better management and prevent permanent hair loss.

8. Chest Pain or Shortness of Breath

Lupus can affect both the heart and lungs, sometimes causing chest pain or shortness of breath that may be mistaken for other common conditions. Inflammation of the lining around the lungs (pleuritis) or the heart (pericarditis) can lead to sharp, stabbing pains, especially with deep breaths or movement. These symptoms often mimic those of infections, anxiety, or even heart attacks, making it challenging to quickly identify lupus as the cause.

In some cases, lupus can also contribute to fluid buildup around the heart or lungs, leading to persistent shortness of breath, fatigue, and swelling in the lower limbs. According to the Centers for Disease Control and Prevention (CDC), cardiovascular and respiratory involvement are serious complications that require prompt recognition and treatment.

Chest pain or unexplained breathlessness should never be ignored—these are red flag symptoms that require urgent assessment, particularly if they are sudden, severe, or associated with fainting, rapid heartbeat, or swelling. Early medical evaluation is critical to rule out life-threatening issues and to determine if lupus or another underlying disease is at play.

9. Swelling in Legs or Around Eyes

Unexplained swelling in the legs, ankles, or around the eyes can be a sign of kidney involvement in lupus, known as lupus nephritis. When lupus attacks the kidneys, it impairs their ability to filter and remove excess fluid and waste, leading to fluid accumulation in the body’s tissues. This swelling, or edema, is often most noticeable in the lower legs and feet by the end of the day, and around the eyes first thing in the morning.

Lupus-related kidney swelling differs from the swelling seen in heart failure, which is often accompanied by shortness of breath, rapid weight gain, or swelling that worsens when lying down. In lupus, the swelling may appear suddenly, sometimes with frothy urine or changes in urination. According to the National Kidney Foundation, kidney disease is a serious and potentially silent complication of lupus, often requiring specialized treatment.

Warning signs to watch for include swelling that doesn’t improve with rest, puffiness around the eyes, or a sudden increase in body weight. If you notice these symptoms—especially with other signs of lupus—seek medical care promptly. Early intervention can help protect kidney function and prevent long-term complications.

10. Headaches or Migraines

Lupus can cause a variety of neurological symptoms, with headaches and migraines being among the most common. These headaches can range from mild tension headaches to severe, recurrent migraines that may impact quality of life. Unlike typical migraines, lupus-related headaches are often associated with other neurological symptoms such as confusion, memory problems, or visual disturbances. Some patients may experience what is known as “lupus headache,” a distinct type of severe, persistent pain that does not always respond to standard migraine treatments.

Neurological symptoms in lupus can stem from inflammation of blood vessels in the brain (vasculitis) or other autoimmune processes affecting the nervous system. According to the Lupus Foundation of America, up to 40% of people with lupus may experience frequent headaches, which can sometimes be the first sign of central nervous system involvement.

It’s important to seek further workup if you notice new, severe, or rapidly worsening headaches, especially if they are accompanied by vision changes, confusion, neck stiffness, or fever. Prompt evaluation can help distinguish lupus-related headaches from other causes and ensure timely treatment.

11. Memory Problems or Confusion

Cognitive difficulties, sometimes referred to as “lupus fog,” are a frequent and frustrating symptom for many people with lupus. These issues can include memory lapses, trouble concentrating, difficulty finding words, and episodes of confusion. Unlike age-related memory loss, which tends to develop gradually and mainly affects short-term memory, lupus-related cognitive dysfunction can occur suddenly and fluctuate with disease activity or flares.

Lupus fog is believed to result from inflammation affecting the brain or blood vessels, and may also be influenced by fatigue, stress, or medication side effects. According to the Lupus Foundation of America, up to 50% of people with lupus report some degree of cognitive impairment during their illness.

If you notice persistent or worsening memory problems, confusion, or difficulties with thinking that interfere with work, relationships, or daily functioning, it’s important to seek neurological evaluation. Prompt assessment is crucial to rule out other causes and to determine if these cognitive symptoms are related to lupus or another medical condition requiring treatment.

12. Raynaud’s Phenomenon (Color Changes in Fingers)

Raynaud’s phenomenon is a unique symptom often seen in people with lupus, marked by dramatic color changes in the fingers and sometimes toes. When exposed to cold temperatures or emotional stress, the small blood vessels in these areas constrict, briefly limiting blood flow. This can cause the fingers to turn white, then blue, and finally red as circulation returns. While Raynaud’s can occur on its own, it is more concerning when it appears alongside other lupus symptoms.

Unlike the typical numbness or tingling from brief cold exposure, Raynaud’s phenomenon tends to be more intense and can last several minutes to hours. The affected fingers may feel numb, tingly, or even painful during an episode. According to the Arthritis Foundation, Raynaud’s is present in up to one-third of people with lupus and can indicate underlying autoimmune activity affecting the blood vessels.

If you experience frequent or severe color changes in your fingers—especially with other symptoms such as joint pain or skin rashes—keep a symptom diary and discuss these episodes with your healthcare provider. Monitoring these changes is important for early detection and management of lupus and related vascular complications.

13. Chest Tightness or Pleuritic Pain

Chest tightness or sharp pain with breathing, known as pleuritic pain, is a frequent complication of lupus. This discomfort occurs when inflammation affects the pleura—the thin membrane lining the lungs and chest cavity. In lupus, the immune system’s attack on this lining can cause pain that worsens during deep breaths, coughing, or movement. Unlike typical muscle aches or heartburn, pleuritic pain is often sudden, stabbing, and specifically linked to respiratory movements.

While other causes of chest pain, such as heart attacks or anxiety, may lead to pressure or squeezing sensations, pleuritic pain is distinguished by its relationship to breathing. According to the Johns Hopkins Lupus Center, pleuritis is one of the most common lung problems in lupus and may sometimes be accompanied by a low-grade fever or shortness of breath.

Persistent or severe chest pain should never be ignored. If chest discomfort lasts more than a few minutes, is associated with difficulty breathing, or occurs alongside other worrying symptoms, seek urgent medical attention. Prompt evaluation is essential to rule out serious complications and to address underlying lupus inflammation effectively.

14. Unexplained Weight Loss

Unintentional weight loss can be a subtle but significant sign of lupus, especially when it occurs without changes in diet or exercise. In lupus, chronic inflammation ramps up the body’s metabolism and can decrease appetite, leading to steady weight loss over weeks or months. Some individuals might also develop gastrointestinal symptoms—such as nausea, mouth ulcers, or abdominal pain—that further reduce food intake.

While many diseases can cause weight loss, lupus-related loss is often gradual and paired with other systemic symptoms like fatigue, joint pain, or fever. This contrasts with more rapid weight changes due to thyroid disorders, diabetes, or cancers, which may present with their own distinctive signs. According to the Lupus Foundation of America, weight changes—both gain and loss—are common in lupus, sometimes related to medication or kidney involvement as well.

If you experience ongoing, unexplained weight loss—especially alongside other signs of illness—it’s important to consult your healthcare provider promptly. Early evaluation can help uncover underlying causes and enable appropriate treatment, whether lupus or another medical condition is the culprit.

15. Anemia (Low Red Blood Cells)

Anemia, or a deficiency in red blood cells, is a frequent complication of lupus. In lupus, the immune system can attack blood cells themselves or the bone marrow, reducing production. Chronic inflammation also plays a role, disrupting the body’s ability to use iron efficiently. This form of anemia is different from classic iron-deficiency anemia, which is usually caused by poor dietary intake or blood loss. In lupus, anemia can develop even when iron levels are normal.

Symptoms of anemia include persistent fatigue, weakness, pale skin, shortness of breath, and rapid heartbeat. According to the Lupus Foundation of America, up to half of people with lupus will develop some form of anemia during their illness, and it may be the first sign of underlying disease activity.

Anemia in lupus can also be associated with other abnormal blood counts, such as low white blood cells or platelets. If you notice unexplained tiredness, paleness, or trouble catching your breath, it’s wise to have your blood counts checked. Early detection of anemia can lead to more effective lupus management and help prevent serious complications.

16. Easy Bruising or Bleeding

Easy bruising or unexpected bleeding can be a sign of blood clotting abnormalities in lupus. Lupus may cause the immune system to attack platelets—cells that help your blood clot—or interfere with clotting factors, resulting in a tendency to bruise with minor bumps or to bleed more than usual from small cuts. This is distinct from bruising caused by blood-thinning medications, such as aspirin or warfarin, which have a predictable effect on clotting and are usually monitored by doctors.

In lupus, bruising may develop without any clear injury, and you might also notice frequent nosebleeds, gum bleeding, or prolonged bleeding from minor wounds. According to the Lupus Foundation of America, blood disorders—including low platelet counts (thrombocytopenia)—are a well-recognized feature of lupus and can sometimes be the first sign of the disease.

If you experience unexplained bruising or bleeding—especially if it is new or worsening—consider asking your healthcare provider about blood tests to check your platelet counts and clotting function. Early detection is key to managing potential blood-related complications of lupus and preventing serious health risks.

17. Swollen Lymph Nodes

Swollen or enlarged lymph nodes can be an early sign of heightened immune activity in lupus. Lymph nodes act as filters for the immune system, capturing and fighting off pathogens. In lupus, the immune system’s chronic activation can cause these nodes to become enlarged, often in the neck, armpits, or groin. Unlike the rapid swelling seen with infections—such as a sore throat or cold—lupus-related lymph node enlargement is usually painless and persists for longer periods, sometimes waxing and waning with disease activity.

Infections typically cause lymph nodes to swell quickly and then return to normal once the infection resolves. With lupus, however, the swelling may not be linked to any obvious illness and can last for weeks or even months. According to the Lupus Foundation of America, persistent or unexplained lymph node swelling warrants further investigation to rule out infections, lymphoma, or other autoimmune causes.

If you notice swollen lymph nodes that remain enlarged for several weeks, are growing, or are associated with other unexplained symptoms, it’s important to seek medical advice. Prolonged lymph node swelling requires evaluation to determine the underlying cause and ensure proper treatment.

18. Dry Eyes or Mouth (Sjögren’s Overlap)

Many people with lupus experience dry eyes or dry mouth, symptoms that may indicate an overlap with another autoimmune condition called Sjögren’s syndrome. In this overlap, the immune system attacks the glands responsible for producing saliva and tears, leading to persistent dryness. This is different from simple dehydration, which usually resolves with increased fluid intake and is often accompanied by thirst or signs of fluid loss.

Dry eyes in lupus-Sjögren’s overlap may cause a gritty or burning sensation, redness, increased sensitivity to light, or frequent eye infections. Dry mouth can result in difficulty swallowing, cracked lips, mouth sores, or an increased risk of dental cavities. According to the American College of Rheumatology, up to 30% of lupus patients may show features of Sjögren’s syndrome.

If you notice persistent dryness of the eyes or mouth that doesn’t improve with hydration or is associated with other autoimmune symptoms, discuss it with your healthcare provider. Early recognition of glandular involvement can reduce complications and improve quality of life for those with lupus and overlapping Sjögren’s syndrome.

19. Abdominal Pain or Digestive Upset

Abdominal pain and digestive upset are sometimes overlooked manifestations of lupus. Lupus can affect the gastrointestinal (GI) tract in several ways, including inflammation of the lining of the abdomen (peritonitis), involvement of the liver or pancreas, or reduced blood flow to the intestines. These autoimmune processes may cause symptoms such as persistent abdominal pain, bloating, nausea, vomiting, and intermittent diarrhea or constipation.

Unlike common GI issues—such as those triggered by diet, infections, or irritable bowel syndrome—lupus-related digestive symptoms often occur without clear triggers and may be accompanied by other systemic signs like fever, joint pain, or weight loss. According to the Johns Hopkins Lupus Center, up to half of people with lupus may experience some form of GI involvement during the course of their illness.

If you have recurring abdominal pain or ongoing digestive problems—especially if standard treatments don’t help or symptoms are joined by other unexplained health issues—consider the possibility of an autoimmune disorder. Early investigation is key to identifying lupus-related GI involvement and preventing serious complications.

20. Protein in Urine (Proteinuria)

Proteinuria, or the presence of excess protein in the urine, is a hallmark of lupus kidney involvement—most commonly seen in lupus nephritis. When lupus attacks the kidneys, it damages the filtering structures (glomeruli), allowing proteins that should be retained in the bloodstream to leak into the urine. This leakage can occur silently, without obvious symptoms, or may eventually cause swelling in the legs, foamy urine, or rising blood pressure.

Proteinuria is also found in other conditions such as diabetes, which can similarly damage the kidneys over time. However, lupus-related proteinuria is often accompanied by other autoimmune features, such as joint pain or rashes, and may fluctuate with disease activity. According to the National Kidney Foundation, regular screening for protein in the urine is crucial for people at risk of lupus or known autoimmune disease.

Routine urinalysis is an important tool for early detection, as kidney disease can progress silently until significant damage has occurred. If you have risk factors for lupus or develop swelling or foamy urine, speak with your healthcare provider about checking for proteinuria. Early intervention can protect kidney function and improve long-term health outcomes.

21. High Blood Pressure

High blood pressure, or hypertension, is a potential complication of lupus, particularly when the kidneys are involved. As lupus damages the filtering units of the kidneys, it can disrupt the body’s fluid and salt balance, leading to increased blood pressure. Unlike essential hypertension—which often develops gradually and is linked to genetics, weight, or lifestyle—lupus-related hypertension may appear suddenly and is more likely to occur in younger individuals or in conjunction with other lupus symptoms.

Lupus-induced high blood pressure is especially concerning because it can accelerate kidney damage and increase the risk of heart disease and stroke. According to the Lupus Foundation of America, blood pressure should be closely monitored in anyone with lupus, especially if there are signs of kidney involvement, such as swelling or protein in the urine.

Regular blood pressure checks—both at home and during medical visits—are important for early detection and management. If you notice consistently elevated readings, headaches, or changes in your health, consult your healthcare provider. Proper blood pressure control is essential to preserving both kidney and cardiovascular health in people with lupus.

22. Numbness or Tingling in Extremities

Numbness or tingling sensations in the hands, feet, arms, or legs can be a sign of nerve involvement in lupus. This occurs when inflammation or immune complexes affect the peripheral nerves, a condition known as peripheral neuropathy. The sensations may range from mild tingling or “pins and needles” to burning pain, muscle weakness, or even loss of coordination.

While diabetic neuropathy is a leading cause of nerve damage, it typically develops in people with longstanding high blood sugar and is most pronounced in the feet. In lupus, nerve symptoms may appear suddenly, affect both the hands and feet, and sometimes fluctuate with disease activity. According to the Lupus Foundation of America, up to 15% of people with lupus develop some form of nervous system involvement, which may also include headaches, memory changes, or seizures.

If you notice persistent or worsening numbness, tingling, or weakness—especially when accompanied by other unexplained symptoms—seek a neurological evaluation. Prompt attention is critical to identifying the cause, preventing further nerve damage, and guiding appropriate lupus treatment.

23. Seizures

Seizures are a serious neurological complication that can occur in people with lupus, even in those without a prior history of epilepsy. In lupus, seizures are thought to result from inflammation of the brain’s blood vessels (vasculitis), the formation of blood clots, or the presence of autoantibodies that disrupt normal brain function. These episodes may present as sudden convulsions, loss of consciousness, or brief periods of confusion and staring.

Unlike classic epilepsy, which is often a lifelong disorder with a genetic or idiopathic basis, seizures in lupus may be episodic and directly related to disease activity or medication side effects. According to the Lupus Foundation of America, about 10% of people with lupus may experience seizures during their illness.

The sudden onset of seizures or any new neurological symptoms should always be treated as a medical emergency. Immediate evaluation and intervention are critical to prevent lasting brain injury, identify the underlying cause, and initiate appropriate treatment. New seizures in adults—especially when accompanied by other lupus symptoms—require urgent medical attention and thorough investigation.

24. Anxiety or Depression

Lupus can have a significant impact on mental health, often leading to symptoms of anxiety or depression. These emotional changes may be driven by the stress of living with a chronic, unpredictable illness, but lupus itself can also directly affect the brain and nervous system, altering mood and cognitive function. This makes lupus-related mood changes different from primary mood disorders, which are not linked to autoimmune or inflammatory activity.

Lupus-related anxiety or depression may be accompanied by fatigue, memory problems, or physical symptoms such as pain and sleep disturbances. According to the Lupus Foundation of America, up to 60% of people with lupus may experience significant depression or anxiety at some point during their illness.

It’s important to recognize when emotional symptoms are persistent, interfering with daily activities, or causing distress. Seeking support from mental health professionals, support groups, or your healthcare provider is crucial. Addressing mental health is a vital part of lupus care and can improve both quality of life and overall disease management.

25. Recurrent Miscarriages

Lupus can increase the risk of pregnancy complications, including recurrent miscarriages. This is often due to the presence of antiphospholipid antibodies, which are found in some people with lupus and can cause abnormal blood clotting in the placenta. These clots interfere with the blood supply to the developing fetus, raising the risk of miscarriage, stillbirth, and other complications such as preeclampsia or preterm labor.

While miscarriages can occur for many reasons—such as chromosomal abnormalities or hormonal imbalances—lupus-related losses are more likely when associated with a history of autoimmune disease or unexplained blood clots. According to the Lupus Foundation of America, women with lupus should receive care from a high-risk obstetrician familiar with autoimmune conditions to optimize outcomes.

If you experience repeated miscarriages or have a known diagnosis of lupus, it’s crucial to seek specialized prenatal and rheumatologic care. Early intervention and close monitoring can improve pregnancy outcomes and help manage risks for both mother and baby in lupus pregnancies.

26. Chest Palpitations or Irregular Heartbeat

Lupus can directly affect the heart, sometimes leading to chest palpitations or an irregular heartbeat. Inflammation of the heart’s lining (pericarditis), muscle (myocarditis), or electrical conduction system can disrupt normal heart rhythms, resulting in sensations of fluttering, pounding, or skipped beats. These symptoms may be persistent or episodic and can be accompanied by chest discomfort, dizziness, or shortness of breath.

While anxiety and stress are common causes of palpitations—often associated with rapid, forceful, or irregular heartbeats—they usually resolve with relaxation and are not typically linked to other systemic symptoms. Lupus-related palpitations, on the other hand, may be more likely to occur at rest, during flares, or in combination with other signs of inflammation. According to the Lupus Foundation of America, cardiovascular involvement in lupus is a leading cause of morbidity.

If you experience new or worsening palpitations, irregular heartbeat, or associated symptoms such as fainting or chest pain, seek prompt cardiac evaluation. Early assessment by a healthcare provider is crucial for identifying underlying heart issues and preventing potentially serious complications in lupus.

27. Swollen Hands or Feet (Peripheral Edema)

Swelling in the hands or feet, known as peripheral edema, is a common but often overlooked symptom of lupus. The underlying causes can include inflammation from active lupus, kidney involvement that impairs fluid balance, or side effects from medications. Swelling may appear as puffiness, tightness, or a feeling of heaviness, and is often most noticeable at the end of the day or after prolonged standing.

Peripheral edema from lupus can be distinguished from swelling due to venous insufficiency, which is more commonly associated with varicose veins and worsens with age or prolonged immobility. Unlike the gradual, gravity-dependent swelling of venous insufficiency, lupus-related edema may develop suddenly and can affect both the hands and feet. According to the Lupus Foundation of America, persistent swelling may also indicate underlying kidney or heart involvement, requiring further investigation.

If you notice new, unexplained, or worsening swelling—especially if it’s associated with other symptoms like foamy urine, chest pain, or shortness of breath—seek further medical evaluation. Timely testing and diagnosis are essential to address the underlying cause and prevent complications associated with lupus.

28. Persistent Cough

A persistent cough can be a sign of lung involvement in lupus, even in the absence of infection. Inflammation of the lung tissue (lupus pneumonitis) or the lining around the lungs (pleuritis) may provoke a dry, nagging cough that lingers for weeks or months. Unlike the productive coughs often caused by viral or bacterial infections, a lupus-related cough is typically dry and may be accompanied by chest discomfort, shortness of breath, or low-grade fever.

Some people with lupus may also develop interstitial lung disease, in which the lung tissue becomes stiff or scarred, further contributing to chronic cough and breathlessness. According to the Johns Hopkins Lupus Center, up to 50% of people with lupus may experience some form of lung involvement during the course of their illness.

If you notice a cough that persists beyond three weeks, is not relieved by usual treatments, or is associated with symptoms such as chest pain or difficulty breathing, consider prompt medical evaluation. Early recognition of lung involvement in lupus is crucial for preventing complications and ensuring effective treatment.

29. Chest Discomfort After Deep Breaths

Pain or discomfort in the chest after taking a deep breath is a classic symptom of pleuritis, a condition where the lining around the lungs becomes inflamed due to lupus. This pleuritic pain is often described as sharp or stabbing and is triggered or worsened by deep inhalation, coughing, or movement. Unlike musculoskeletal chest pain—which is commonly related to muscle strain or costochondritis and tends to be localized and reproducible with direct pressure—pleuritic pain is closely linked to breathing and often comes on suddenly.

People with lupus may experience pleuritis during disease flares, sometimes in conjunction with a mild fever, fatigue, or other respiratory symptoms. According to the Johns Hopkins Lupus Center, pleuritis is one of the most common lung complications in lupus and can signal active inflammation that requires prompt attention.

If you develop chest pain that is sharp, worsens with breathing, or persists for more than a few days, seek a thorough medical review. Early assessment can help distinguish pleuritic pain from more benign causes and ensure proper management of lupus-related lung inflammation.

30. Unusual Hair Breakage or Brittleness

Lupus can cause distinct changes in hair texture, leading to unusual breakage or brittleness. Inflammation of the scalp and blood vessels can weaken hair shafts, making them more prone to snapping or splitting, even with gentle handling. This “lupus hair” often appears as short, broken hairs around the hairline and temples, and is different from hair damage due to excessive styling, heat, or chemical treatments.

Cosmetic hair damage typically results from overuse of dyes, straighteners, or hot tools, affecting only certain sections of hair and improving with changes in hair care routines. In contrast, lupus-related hair brittleness is often widespread, persistent, and may occur alongside scalp tenderness, redness, or small patches of hair loss. According to the Lupus Foundation of America, hair texture changes can be an early sign of disease activity, even before noticeable thinning or bald spots develop.

If you observe sudden or persistent hair breakage—especially if it is accompanied by scalp inflammation or other unexplained symptoms—it’s important to consider an autoimmune cause. Consult your healthcare provider for evaluation, as early recognition and treatment of lupus can help prevent further hair and scalp damage.

31. Eye Pain or Vision Changes

Lupus can cause a range of eye problems, most notably ocular inflammation such as episcleritis, scleritis, or retinopathy. These conditions can result in eye pain, redness, sensitivity to light, or sudden vision changes. Unlike common eye strain—which usually presents as mild discomfort or blurred vision after prolonged reading or screen use—lupus-related eye issues may develop rapidly and be accompanied by persistent pain, floaters, or even partial vision loss.

Ocular inflammation in lupus occurs when the immune system targets the tiny blood vessels in or around the eyes, sometimes leading to swelling of the retina or optic nerve. According to the Lupus Foundation of America, untreated eye inflammation can result in permanent vision impairment, making prompt recognition critical.

If you experience new or severe eye pain, sudden vision changes, double vision, or persistent redness, seek urgent evaluation by an ophthalmologist or your healthcare provider. Swift intervention is vital to protect vision and address underlying lupus activity that may be affecting the eyes.

32. Recurrent Infections

People with lupus often experience recurrent infections due to immune system dysregulation. While lupus is characterized by an overactive immune response that attacks the body’s own tissues, this same dysfunction can impair the body’s ability to fight off actual pathogens. As a result, people with lupus may be more susceptible to frequent or severe infections, especially when taking immunosuppressive medications.

This pattern differs from classic immune deficiency disorders, which are typically present from childhood and involve a primary inability to fight infections. In lupus, infection risk is acquired and often accompanied by other autoimmune symptoms, such as joint pain or rashes. According to the Lupus Foundation of America, infections are a leading cause of hospitalization and complications in people with lupus.

Signs to watch for include frequent respiratory or urinary tract infections, slow healing wounds, or recurring fevers. If you notice a pattern of repeated infections or infections that are unusually severe, speak with your healthcare provider. Early recognition and management are essential to protect overall health and adjust lupus treatment strategies if needed.

33. Muscle Pain or Weakness

Muscle pain or weakness can be a sign of lupus myositis, a condition where inflammation targets the muscles. Unlike the soreness experienced after physical activity—which usually fades within a few days and is linked to overuse—lupus-related muscle pain is often persistent, symmetrical, and may be accompanied by swelling or tenderness. Muscle weakness may affect daily activities, making it difficult to climb stairs, lift objects, or even rise from a chair.

Lupus myositis commonly affects the muscles of the hips, thighs, shoulders, and upper arms. According to the Lupus Foundation of America, up to 50% of people with lupus may experience muscle pain or weakness at some point. These symptoms can develop gradually or appear suddenly during a lupus flare.

If you notice muscle pain or weakness that is persistent, unexplained, or worsening—especially if it is not related to recent exercise—consider discussing autoimmune testing with your healthcare provider. Early diagnosis and treatment can help prevent long-term muscle damage and improve quality of life for those with lupus myositis.

34. Persistent Low White Blood Cell Count

A persistently low white blood cell count, or leukopenia, is a common blood abnormality in lupus. This occurs when the immune system attacks white blood cells or the bone marrow, reducing the body’s ability to fight infections. Unlike temporary drops in white blood cells due to viral illnesses or medication side effects—such as those from chemotherapy or certain antibiotics—lupus-related cytopenia is often chronic and may go unnoticed unless routine blood tests are performed.

Leukopenia in lupus can develop alongside other blood cell abnormalities such as anemia or low platelets, and may not always cause noticeable symptoms until infections become more frequent or severe. According to the Lupus Foundation of America, blood disorders are a key diagnostic feature of lupus and often require specific treatment adjustments.

Regular blood tests are crucial for monitoring white blood cell counts in people with lupus or unexplained symptoms. If blood work reveals a persistent low white blood cell count—especially in the context of fatigue, infections, or other autoimmune symptoms—further evaluation for lupus or related conditions is essential for timely diagnosis and management.

35. Irregular Menstrual Cycles

Lupus can disrupt the normal balance of hormones in the body, sometimes leading to irregular menstrual cycles. Chronic inflammation and stress from the disease may interfere with signals from the brain to the ovaries, resulting in missed periods, unusually light or heavy bleeding, or unpredictable cycle lengths. This is different from polycystic ovary syndrome (PCOS), which is usually characterized by elevated androgen levels, ovarian cysts, and symptoms like acne or excess hair growth.

Women with lupus may also be more susceptible to menstrual irregularities due to medication side effects or coexisting thyroid disorders, both of which can further affect hormone regulation. According to the Lupus Foundation of America, changes in menstrual patterns are not uncommon and may coincide with periods of increased disease activity or stress.

If you notice significant changes in your menstrual cycle—such as frequent missed periods, unusually heavy or prolonged bleeding, or sudden cycle irregularity—consult your healthcare provider. Early evaluation is important to identify the underlying cause and to manage both your reproductive and autoimmune health effectively.

36. Abnormal Blood Clotting

Lupus can significantly increase the risk of abnormal blood clotting, primarily due to the presence of antiphospholipid antibodies—often referred to as “lupus anticoagulant.” Paradoxically, despite the name, lupus anticoagulant actually promotes clot formation in veins and arteries, putting individuals at higher risk for deep vein thrombosis (DVT), pulmonary embolism, or strokes. This acquired clotting risk is different from inherited clotting disorders like Factor V Leiden, which are genetic and usually present from a young age.

The risk of clots in lupus is unpredictable and can be triggered by periods of increased disease activity, immobility, or certain medications. According to the Lupus Foundation of America, antiphospholipid syndrome (APS) affects up to 40% of lupus patients and can also contribute to pregnancy complications.

Red flags for abnormal clotting include unexplained leg swelling or pain, sudden shortness of breath, chest pain, vision changes, or neurologic symptoms like weakness or numbness. Immediate medical attention is critical if you suspect a blood clot, as prompt treatment can be lifesaving and prevent permanent complications from lupus-associated clotting disorders.

37. Unexplained Night Sweats

Unexplained night sweats can be a subtle sign of lupus, often reflecting underlying immune system activation or low-grade inflammation. Unlike the night sweats associated with menopause—which are triggered by hormonal changes and frequently accompanied by hot flashes during the day—lupus-related night sweats may occur at any age and often without other menopausal symptoms. These episodes can be intense enough to disrupt sleep, causing the need to change clothes or bedding.

Night sweats in lupus may also be linked to periodic fevers, infections, or medication side effects. According to the Lupus Foundation of America, low-grade fever and immune activation often go hand-in-hand with sweats, especially during disease flares or periods of increased inflammation.

If you experience persistent, drenching night sweats—particularly when accompanied by fatigue, weight loss, or other systemic symptoms—it’s important to consult your healthcare provider. Ongoing night sweats may warrant blood tests and medical evaluation to rule out lupus, infections, or other underlying conditions that require attention.

38. High Cholesterol or Lipid Changes

Lupus can trigger metabolic changes that alter cholesterol and lipid levels in the blood, even in people who eat a healthy diet. Chronic inflammation from lupus disrupts normal fat metabolism, often leading to increases in total cholesterol, LDL (“bad” cholesterol), and triglycerides, while decreasing HDL (“good” cholesterol). This is distinct from cholesterol elevation primarily caused by dietary choices or lack of exercise, which tends to respond more directly to lifestyle interventions.

Treatment with corticosteroids—a common lupus medication—can further worsen lipid profiles and increase cardiovascular risk. According to the Lupus Foundation of America, people with lupus are at significantly higher risk for heart disease, making lipid monitoring a key part of long-term care.

Regular lipid panels are recommended for anyone with lupus or unexplained cholesterol changes, as early detection allows for risk reduction strategies such as medication adjustments or preventive therapies. If you notice high cholesterol despite good dietary and exercise habits, ask your healthcare provider about screening for underlying autoimmune or inflammatory conditions like lupus.

39. Red or Purple Spots on Skin (Purpura)

Red or purple spots on the skin, known as purpura, can be an important indicator of lupus-related blood vessel or clotting problems. Purpura occurs when small blood vessels under the skin bleed, resulting in flat, pinpoint spots (petechiae) or larger patches that do not blanch when pressed. Unlike typical bruising, which is usually caused by trauma and may change color as it heals, purpura often appears suddenly, without any injury, and is not tender or swollen.

In lupus, purpura can be caused by low platelet counts (thrombocytopenia) or inflammation of small blood vessels (vasculitis). According to the Lupus Foundation of America, skin findings like purpura may be the first sign of an underlying blood disorder or active disease flare.

If you notice new or unexplained red or purple spots on your skin—especially if they are widespread, increasing in number, or accompanied by other symptoms such as nosebleeds or gum bleeding—seek medical attention promptly. Purpura can signal a serious blood disorder requiring urgent evaluation and management in the context of lupus.

40. Dry, Itchy, or Peeling Skin

Dry, itchy, or peeling skin is a common but often underestimated symptom of lupus. The disease can cause inflammation that disrupts the skin’s natural barrier, leading to persistent dryness, flaking, and a rough texture. This is different from eczema, which is usually characterized by well-defined patches, intense itching, and sometimes oozing or crusting due to allergies or irritants. Lupus skin changes often appear on sun-exposed areas and may be accompanied by rashes or heightened sensitivity to sunlight.

According to the Lupus Foundation of America, up to two-thirds of people with lupus develop some form of skin involvement, making skincare a vital aspect of disease management.

Practical tips for skin care include using gentle, fragrance-free cleansers, applying thick moisturizers immediately after bathing, and protecting skin from UV exposure with sunscreen and clothing. If you notice persistent dryness, peeling, or irritation—especially alongside other lupus symptoms—consult your healthcare provider. Early intervention can provide relief and help prevent complications from lupus-related skin changes.

41. Swelling or Pain in the Abdomen

Swelling or pain in the abdomen can be a sign of inflammation caused by lupus, known as lupus peritonitis. This condition occurs when the lining of the abdominal cavity becomes inflamed, leading to discomfort, bloating, and sometimes the accumulation of fluid (ascites). Unlike appendicitis—which usually causes sharp, localized pain in the lower right abdomen, often accompanied by nausea and fever—lupus-related abdominal pain is frequently diffuse, less severe, and may wax and wane with disease activity.

Lupus can also affect other abdominal organs, such as the liver, pancreas, or intestines, resulting in more varied symptoms. According to the Johns Hopkins Lupus Center, abdominal symptoms in lupus are sometimes mistaken for digestive disorders or infections, delaying appropriate treatment.

If you experience persistent, recurring, or unexplained abdominal swelling or pain—especially if it is associated with fever, weight loss, or gastrointestinal changes—seek a thorough medical evaluation. Ongoing abdominal symptoms should not be ignored, as early intervention can help prevent complications and improve outcomes for those with lupus.

42. Dizziness or Fainting

Dizziness or fainting (syncope) in lupus can arise from both circulatory and neurological factors. Lupus may cause inflammation of blood vessels (vasculitis), abnormal heart rhythms, or low blood pressure due to kidney involvement, all of which can reduce blood flow to the brain and trigger lightheadedness. Neurological involvement, such as lupus cerebritis, can also affect balance and coordination. This is different from the brief dizziness caused by dehydration or standing up too quickly, which usually resolves with rest and hydration.

According to the Lupus Foundation of America, dizziness, confusion, and fainting can signal active disease or complications like arrhythmias or blood clots.

Fainting should always be considered a red flag, especially if it is sudden, recurrent, or accompanied by chest pain, palpitations, or shortness of breath. If you experience ongoing dizziness or any episode of fainting, seek prompt medical evaluation to rule out serious lupus-related complications and ensure appropriate treatment.

43. Sore Throat Without Infection

A persistent sore throat without signs of infection can be a symptom of lupus-related inflammation. In lupus, the immune system can target the tissues lining the throat, causing chronic irritation, soreness, or even ulcers. This differs from viral pharyngitis, which is usually accompanied by fever, swollen glands, and resolves within a week or two with supportive care.

Lupus-related sore throat may wax and wane with disease activity and might not respond to typical treatments like antibiotics or lozenges. According to the Lupus Foundation of America, mouth and throat ulcers or chronic irritation are recognized features of lupus, especially during flares.

If you experience a sore throat that lingers for weeks, recurs frequently, or is accompanied by other unexplained symptoms such as mouth ulcers, joint pain, or fatigue, it’s important to seek medical review. Chronic sore throat should not be ignored, as it may be an early sign of lupus or require treatment to prevent further complications.

44. Unexplained Bone or Joint Fractures

Lupus can have a significant impact on bone health, sometimes resulting in unexplained bone or joint fractures. Chronic inflammation from lupus, combined with long-term use of corticosteroids, can weaken bones and increase the risk of fractures even with minimal trauma. While osteoporosis is a well-known cause of bone fragility—often related to aging, menopause, or nutritional deficiencies—lupus-related bone loss may occur at a younger age and progress more rapidly.

According to the Lupus Foundation of America, people with lupus are at higher risk for both osteoporosis and avascular necrosis, a condition where reduced blood supply causes bone tissue to die and collapse. This makes bones more susceptible to unexpected breaks or joint problems.

If you experience a fracture without a clear cause or with minor injury, or have a history of chronic steroid use, it’s important to consult your healthcare provider. Early bone density testing and preventive strategies—such as calcium, vitamin D, and tailored exercise—can help protect bone health and prevent future complications in lupus.

45. Difficulty Swallowing

Difficulty swallowing, or dysphagia, can occur in lupus due to inflammation and scarring of the esophagus or muscles involved in swallowing. The immune system’s attack on these tissues can lead to stiffness, narrowing, or decreased coordination of the esophageal muscles, making it hard to swallow solid foods and sometimes even liquids. This is different from acid reflux (GERD), which is typically caused by stomach acid irritating the esophagus and is often accompanied by heartburn or regurgitation.

Lupus-related swallowing difficulties may be persistent and associated with other symptoms such as dry mouth, hoarseness, or chest discomfort. According to the Johns Hopkins Lupus Center, esophageal involvement is not uncommon and can also overlap with other autoimmune diseases like scleroderma.

If you notice ongoing or worsening difficulty swallowing, choking, or unexplained weight loss, it’s important to seek medical evaluation. Prompt assessment can help identify the cause, prevent complications like aspiration or malnutrition, and allow for appropriate management of lupus-related esophageal involvement.

46. Persistent Hoarseness

Persistent hoarseness can be a subtle but important symptom of lupus-induced inflammation. The immune system may attack the tissues of the vocal cords or the structures supporting the larynx, leading to chronic swelling, irritation, or even nodules. This differs from acute laryngitis, which is most commonly caused by viral infections and typically resolves within a week or two. Lupus-related hoarseness, on the other hand, can linger for weeks or months and may not respond to typical remedies like rest or hydration.

Voice changes may present as a raspy, weak, or breathy quality, sometimes accompanied by discomfort or a sensation of a lump in the throat. According to the Lupus Foundation of America, chronic inflammation in the mouth and throat can be an overlooked feature of lupus.

If you experience hoarseness that persists beyond three weeks, worsens over time, or is associated with swallowing difficulties or other throat symptoms, seek medical evaluation. Chronic hoarseness is a warning sign that warrants further investigation for underlying autoimmune or structural causes, including lupus.

47. Red, Painful Eyes (Uveitis or Scleritis)

Red, painful eyes can signal serious inflammation such as uveitis or scleritis in people with lupus. These conditions occur when the immune system mistakenly attacks the deeper tissues within or around the eye, causing pain, redness, sensitivity to light, and sometimes blurred vision. Unlike conjunctivitis (pink eye), which is usually caused by viral or bacterial infection and tends to be itchy with mild discharge, lupus-related eye inflammation is often more severe, persistent, and not accompanied by crusting.

Scleritis involves the white part of the eye (sclera) and can lead to deep, boring pain, while uveitis affects the middle layer of the eye and may cause floaters or vision loss. According to the Lupus Foundation of America, untreated ocular inflammation can result in permanent vision loss, making early detection and treatment critical.

Red, painful eyes should always be treated as an urgent concern, particularly if accompanied by decreased vision or severe discomfort. If you experience these symptoms, seek immediate evaluation by an ophthalmologist or healthcare provider to prevent lasting eye damage from lupus-related inflammation.

48. Swollen Gums or Gum Bleeding

People with lupus are at increased risk for gum disease, often presenting as swollen gums or frequent gum bleeding. The immune system’s attack on the oral tissues can lead to chronic inflammation, making the gums more sensitive, puffy, and prone to bleeding even with gentle brushing or flossing. This differs from gum problems caused solely by poor dental hygiene, which are usually preventable with regular brushing, flossing, and professional cleanings.

Lupus-related oral symptoms can also include mouth ulcers, dry mouth, and an increased risk of oral infections. According to the Lupus Foundation of America, dental complications are more common in lupus patients and can flare with active disease or certain medications.

If you have lupus or suspect it, inform your dentist about your diagnosis. Persistent gum swelling or bleeding should always be evaluated, as early intervention helps prevent periodontal disease, tooth loss, and infection. Good oral hygiene, regular dental check-ups, and communication between your dentist and healthcare team are essential for maintaining oral health in lupus.

49. Chronic Hives or Welts

Chronic hives (urticaria) or welts that last longer than six weeks can sometimes be an early sign of lupus or another autoimmune condition. In lupus, immune system dysfunction can trigger inflammation within the skin’s blood vessels, resulting in raised, red, and often itchy patches that move around the body. Unlike allergy-induced hives, which are usually triggered by foods, medications, or environmental exposures and resolve quickly with antihistamines, lupus-related hives may persist, recur frequently, or be resistant to standard allergy treatments.

According to the Lupus Foundation of America, chronic urticaria is less common than rashes but can be associated with disease activity and may signal vasculitis or other immune-mediated processes.

If you experience hives or welts that last for weeks, shift locations, or are accompanied by joint pain, fever, or other systemic symptoms, it’s important to consult your healthcare provider. Persistent or unexplained hives may warrant autoimmune testing to identify lupus or related conditions and ensure proper treatment.

50. Delayed Wound Healing

Delayed wound healing is a lesser-known but important symptom of lupus. The chronic inflammation and immune dysfunction seen in lupus can impair the body’s normal repair processes, resulting in cuts, scrapes, or sores that take longer to heal. This impaired healing is similar to what is seen in diabetes, where poor circulation and high blood sugar slow tissue repair, but in lupus, the problem is driven primarily by immune-mediated inflammation and, sometimes, the effects of medications like corticosteroids or immunosuppressants.

According to the Lupus Foundation of America, people with lupus may notice wounds that remain open, become infected, or scar more easily than expected. These issues are often more pronounced during lupus flares or periods of active disease.

If you observe that minor wounds persist for weeks, show signs of infection, or heal poorly despite good care, it’s important to monitor them closely and report these changes to your healthcare provider. Persistent wound healing problems should prompt further evaluation for underlying autoimmune or vascular complications, especially in the context of other lupus-related symptoms.

Conclusion

Recognizing the diverse and sometimes subtle symptoms of undiagnosed lupus is crucial for early intervention and better health outcomes. Because lupus can mimic many other conditions and affect almost any organ system, awareness of these warning signs helps individuals and doctors catch the disease before complications arise. If you or a loved one experience persistent, unexplained symptoms—especially when they cluster or resist standard treatments—don’t hesitate to seek professional advice. Proactive communication with your healthcare provider and early screening can make a significant difference in timely diagnosis and effective management. For more information and support, resources like the Lupus Foundation of America are invaluable. Your vigilance and advocacy are powerful tools in the journey toward health.

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