Lupus symptoms vary widely and can come and go. When lupus is active and symptoms get worse, it’s called a flare. When symptoms are under control and labs are stable, it’s called in remission.

Common symptoms can include:

• Extreme fatigue – a deep exhaustion that doesn't go away, even after rest.

• Joint pain, stiffness or swelling commonly in hands, wrists and knees.

• Hair thinning or loss.

• Fever without signs of an infection.

• Skin rashes, especially a butterfly-shaped rash across the cheeks and nose.

• Sun sensitively, which can cause a rash and trigger lupus flares.

• Sores (ulcers) in the mouth or nose.

• Raynaud's Phenomenon, causing fingers and toes to turn white, purple and red.

• Widespread muscle pain (which can also indicate fibromyalgia).

• Headaches.

• Kidney complications.

• Chest pain or trouble breathing (pleurisy, costochondritis, pericarditis).

• Memory and thinking problems, referred to “brain fog” or “lupus fog.”

• Problems with the heart, lungs, kidneys, skin, blood cells or nervous system.

If you have any of the following signs or symptoms, please refer to your healthcare provider.

Many lupus symptoms are “invisible.” A person with lupus might look healthy on the outside, but feel very sick on the inside. Just because you cannot see someone's symptoms, it doesn't mean they aren't real and valid. People with lupus often feel isolated because others don't understand what they are going through.

There is no single test for lupus. It can take an average of 2 to 6 years for individuals to receive a diagnosis of lupus after experiencing symptoms. This delay is due to the fact that lupus symptoms can mimic other illnesses, vary greatly from person to person and can fluctuate in intensity. For a lupus diagnosis, a physician or a rheumatologist will identify current symptoms, conduct blood tests and review your medical or family history. A thorough medical examination is essential for an accurate diagnosis.

Possible tests a doctor may order include:

• Antinuclear Antibody (ANA) titer blood test. This test is positive in over 95% of people with lupus and is often the first test done. However, a positive result is not a definitive diagnosis.

• CBC (complete blood count) to check for low blood cell counts.

• Creatinine and urine studies to assess your kidney function.

• Other blood tests: Anti-dsDNA, Anti-Smith, antiphospholipid antibodies and complement levels (C3 and C4)

Conditions that can look like lupus, complicating a diagnosis, include:

• Fibromyalgia, which causes widespread pain and fatigue.

• Rheumatoid arthritis that presents as joint pain and swelling.

• Lyme disease, transmitted through the bite of infected deer ticks that cause fever, fatigue and joint pain. 

• Sjögren's Syndrome that causes dry eyes and mouth.

• Rosacea, a facial redness that can look like a lupus rash.

• Certain infections like mononucleosis or hepatitis.

While the exact cause of lupus is unknown, research shows it’s a combination of genetic, hormonal and environmental factors. People with an inherited predisposition for autoimmune may develop the disease when they come into contact with something in their environment that triggers the immune system to become hyperactive.

Systemic Lupus Erythematosus (SLE)

The most common type of lupus is called systemic lupus erythematosus (SLE). It can affect multiple organ systems and cause widespread inflammation, especially of the kidneys, joints and skin. Other types of lupus, such as cutaneous, drug-induced or neonatal lupus, primarily affect specific organs or systems rather than the whole body.

Cutaneous Lupus Erythematosus (CLE)

Cutaneous lupus is limited to the skin and accounts for about 10% of cases. It causes rashes and lesions, often triggered by UV rays (sunlight). There are multiple subtypes of CLE, many of which can appear or worsen with sun exposure. Subtypes include:

Discoid Lupus (DLE)

Chronic, scaly, thick rashes that can cause permanent scarring and hair loss.

Subacute Cutaneous Lupus: Rashes that appear on sun-exposed skin, which may not scar.

Acute Cutaneous Lupus: Often associated with an active flare of systemic lupus (butterfly rash).

Drug-Induced Lupus (DIL)

Drug-induced lupus is a temporary autoimmune condition triggered by certain medications. It causes lupus-like symptoms such as joint pain, fatigue, muscle aches, rash and sometimes fever. Unlike SLE, DIL rarely involves the kidneys or central nervous system. Once the medication is stopped, symptoms usually improve, though it could take several weeks or months for them to fully resolve.

Neonatal Lupus Syndrome (NLS)
Neonatal lupus occurs when certain lupus-related autoantibodies cross the placenta from the mother to the infant. These autoantibodies can cause temporary skin, liver and blood abnormalities, which typically resolve within a few months. The most serious complication, congenital heart block, may be permanent and require a pacemaker.

The goal of treating lupus is to find a balance between controlling your symptoms, preventing organ damage and having fewer side effects. Currently there is no cure, only medications to manage the symptoms.

Understanding Your Medications

There are different classes of medications used to treat lupus. It’s important to understand what they do and why they are needed to be adhere to your treatment plan. Medications are used to control symptoms, reduce inflammation and prevent organ damage. Most patients take a combination of therapies depending on disease severity and organ involvement. Like no two cases of lupus are alike, treatment is tailored for every patient.

Common medications include:

Antimalarials (Hydroxychloroquine/Plaquenil)
Often considered the foundation of lupus treatment, antimalarials are widely used long-term for most patients.

• What they are: Originally developed to treat malaria but highly effective in autoimmune conditions.

• What they do: Help control fatigue, joint and muscle pain and skin rashes; reduce flares over time; may also protect against organ damage and improve longevity.

Corticosteroids (Prednisone)
Used for rapid control of inflammation, especially during flares.

• What they are: Powerful anti-inflammatory medications that mimic natural hormones produced by the adrenal glands.

• What they do: Quickly suppress the immune system to reduce swelling, pain and organ inflammation.

• While very effective, they should be minimized when possible. Long-term use can cause significant side effects.

Immunosuppressants

Immunosuppressants are used when lupus affects major organs or when symptoms are not controlled by milder medications.

• What they are: Medications that dampen or regulate the immune system.

• What they do: Reduce immune system activity to prevent it from attacking healthy tissues.

Common immunosuppressants include:

• Azathioprine (Imuran): Helps maintain disease control and reduce steroid use.

• Mycophenolate (CellCept, Myfortic): Often used for lupus nephritis (kidney involvement).

• Methotrexate: Commonly used for joint and skin symptoms.

• Cyclophosphamide (Cytoxan): A stronger option for severe, organ-threatening disease.

• Voclosporin (Lupkynis): Specifically used for lupus nephritis to help protect kidney function

Biologics

Biologics are targeted immunosuppressant therapies designed to interfere with specific parts of the immune system.

• What they are: Advanced medications made from monoclonal antibodies to target precise immune pathways.

• What they do: Help control disease activity when traditional treatments are not enough, often with fewer broad side effects than other immunosuppressants.

Examples of biologics include:

• Belimumab (Benlysta): An infusion or subcutaneous injection that reduces abnormal B-cell activity (a key part of lupus).

• Anifrolumab (Saphnelo): An infusion or subcutaneous injection that blocks interferon pathways involved in inflammation.

• Obinutuzumab (Gazyva): Targets B cells and used in lupus nephritis.

NSAIDs (Nonsteroidal Anti-Inflammatory Drugs)

NSAIDs are used for symptom relief in milder cases.

• What they are: Over-the-counter or prescription pain relievers (e.g., ibuprofen, naproxen).

• What they do: Reduce joint pain, stiffness and inflammation.

• Important note: Helpful for day-to-day symptom control but do not treat the underlying disease.

Lupus treatment is rarely one-size-fits-all. Most patients use a combination of these medications, adjusted over time based on symptoms, flares and organ involvement. The overall goal is to control disease activity, minimize flares and protect long-term health while limiting medication side effects.

Self-Care

Visit the University of Michigan’s website, conquerlupus.com, to learn self-care techniques that can help you manage some aspects of your lupus symptoms including diet, yoga, meditation and sleep.

While the exact cause of lupus is unknown, it develops from a combination of factors rather than a single cause. Experts have found lupus develops when genetic risk + environmental trigger + immune dysfunction all intersect.

People with an inherited predisposition for autoimmune diseases may develop the disease when they come into contact with something in their environment that triggers the immune system to become hyperactive. Triggers can include sunlight, stress, physical illness, infections and certain medications. Since lupus is much more common in women, especially during childbearing years, this suggests hormones like estrogen may also play a role in triggering or worsening the disease. There is no cure.

Overlapping autoimmune diseases and conditions are common in patients with SLE. These arise from the broader impact lupus has on the body and immune system. The high level of inflammation and immune response can trigger multiple autoimmune responses at once. Some overlapping diagnoses aren’t separate autoimmune diseases, but conditions that commonly develop alongside lupus.

Common overlapping conditions and autoimmune diseases include:

Fibromyalgia

• What it is: Chronic pain processing disorder (not autoimmune)

• Common overlap symptoms: Widespread pain, fatigue, brain fog and poor sleep.

• Inflammation is not the driver, but symptoms can mimic lupus flares

Sjogren’s Syndrome

• What it is: Autoimmune disease targeting moisture-producing glands.

• Common overlap symptoms: Dry eyes, dry mouth, dental issues and fatigue.

• Why it overlaps: It shares b-cell dysfunction and autoantibody patterns with lupus.

Rheumatoid Arthritis (RA)

• What it is: Autoimmune joint disease.

• Common overlap symptoms: Persistent joint swelling, stiffness and joint damage over time.

Raynaud’s Phenomenon

• What it is: Blood vessel spasms in fingers and toes causing them to turn white/blue with numbness, pain and tingling. Can be triggered by cold or stress.

• Why it’s common: Lupus affects blood vessels and circulation.

Antiphospholipid Syndrome (APS)

• What it is: An autoimmune clotting disorder that requires specific monitoring and often blood thinners.

• Common overlap symptoms: Blood clots, pregnancy complications and stroke risk.

Scleroderma (Systemic Sclerosis)

• What it is: An autoimmune disease that causes skin thickening and organ fibrosis.

• Common overlap symptoms: Tight skin, Raynaud’s and digestive issues. Mixed connective tissue disease often includes features of both lupus and scleroderma.

Polymyositis / Dermatomyositis

• What they are: Autoimmune muscle diseases due to shared inflammatory pathways.

• Common overlap symptoms: Muscle weakness, difficulty climbing stairs or lifting, sometimes skin rashes.

Mixed Connective Tissue Disease (MCTD)

• What it is: An autoimmune condition that blends features of several other connective tissue diseases, including lupus, scleroderma and polymyositis.

• Often associated with a specific antibody (anti-U1 RNP).

Thyroid Disease (Hashimoto’s or Graves’)

• What it is: Autoimmune thyroid dysfunction.

• Common overlap symptoms: Fatigue, weight changes and temperature sensitivity.

Celiac Disease

• What it is: An autoimmune condition where the body reacts to gluten (a protein in wheat, barley and rye).

• Overlap symptoms can include: chronic fatigue, abdominal pain, bloating, weight loss and brain fog.

A rheumatologist usually leads care for those living with lupus. Other specialists may include:

• Dermatologist (skin)

• Nephrologist (kidneys)

• Pulmonologist (lungs)

• Cardiologist (heart)

• Neurologist (nervous system)

• Hematologist (blood)

• OB/GYN (pregnancy & family planning)

• Mental health providers (anxiety, depression, stress)