CONSTITUTIONAL SYMPTOMS Fatigue, fever, and weight loss are typically present some time during the course

e of the disease, occurring in 50 to 100 percent of patients. Fatigue Fatigue is the most common complaint, and occasionally the most debilitating. It occurs in 80 to 100 percent of patients and its presence in not clearly correlated with other measures of disease activity. Fatigue is strongly associated with diminished exercise tolerance However, fatigue may not be due to active SLE, but to one or more of the following: increased work load, depression, unhealthful habits (smoking, fad diets, sedentary living, drug abuse), stress, anemia, hypothyroidism, use of certain medications (including prednisone, beta-blockers), any inflammatory and/or infectious disease, coexistent fibromyalgia , sleep disturbances and/or deconditioning, or a perception of poor social support .Fatigue associated with SLE may respond to glucocorticoids , antimalarials, and/or dehydroepiandrosterone (DHEA) . Myalgia Myalgia is common in SLE. Myalgia and muscle weaknes. Weight changes Weight changes are frequent in patients with SLE and may be related to the disease or its treatment. Weight loss Weight loss often occurs prior to the diagnosis of SLE. Unintentional weight loss may be due to decreased appetite, the side effects of medications (particularly diuretics), and gastrointestinal disease (eg, due to gastroesophageal reflux, abdominal pain, peptic ulcer disease, or pancreatitis). ( Arthritis Joint symptoms occur in over 90 percent of patients at some time during the illness and are often the earliest manifestation [12]. The arthritis tends to be migratory and asymmetrical. Only a few joints are usually affected, especially those of the hands. The arthritis is moderately painful, and rarely deforming MULTIPLE ORGAN INVOLVEMENT SLE affects multiple organ systems. The course is marked by remissions and relapses and may vary from mild to severe.. Fever Fever that is thought to be due to active disease is seen in over 50 percent of patients with SLE . Weight gain Weight gain in SLE is usually due to one of two factors: salt and water retention associated with hypoalbuminemia (eg, due to nephrotic syndrome or protein losing enteropathy); or increased appetite associated with the use of glucocorticoids.

Mucocutaneous Most patients have skin lesions at some time during the course of the illness. The most common lesion is the butterfly rash, erythema over the cheeks and nose, which appears after sun. It lasts only a few days, but often recurs. Some patients will develop discoid lesions which are more inflammatory and have a tendency to scar. Typical discoid lesions in a malar distribution are illustrated in a patient who had no systemic feature of lupus . Hair loss (alopecia) is common, but baldness is not. Many patients develop oral and/or nasal ulcers, which are usually painless, in contrast to herpetic chancre sores. Such ulceration has been noted in 12 to 45 percent of patients. Perforation of the nasal septum occurs infrequently Raynaud phenomenon Cold or emotioninduced color changes of the digits of the hands and/or feet, the Raynaud phenomenon, is a frequent problem and may antedate other features of the disease .Self reported skin color changes consistent with Raynaud phenomenon occurred in 16 to 40 percent of patients in two large series. Renal Renal involvement becomes clinically apparent in approximately 50 percent of patients; however, most of the remaining patients have subclinical disease that can be demonstrated by renal biopsy. Renal involvement usually develops in the first few years of illness, and should be detected early by periodic urinalyses, quantitation of proteinuria, and estimation of the glomerular filtration rate (usually by monitoring the plasma creatinine concentration). Several forms of glomerulonephritis can occur and renal biopsy is useful to define the type and extent of renal involvement.

Gastrointestinal tract The gastrointestinal tract is often involved, but more commonly from medication side effects than from active SLE. On the other hand, SLE vasculitis can lead to pancreatitis, peritonitis, and colitis. Symptoms of esophageal irritation or reflux may occur. Nonspecific abdominal pain is frequent. Liver involvement from lupus is unusual and presentation with liver abnormalities and a positive ANA is more consistent with chronic active Pulmonary Pleurisy, pleural effusion, pneumonitis, interstitial lung disease, pulmonary hypertension, and alveolar hemorrhage can all occur in SLE. The risk of thromboembolic involvement is increased in those with antiphospholipid antibodies. Dyspnea, episodic pleuritic chest pain, progressive decrease in lung volume in the absence of interstitial fibrosis or significant pleural disease suggests the shrinking lung syndrome. Pulmonary function tests are often significantly abnormal, with restrictive abnormalities, prior to complaints of dyspnea. Cardiovascular There are a variety of cardiovascular manifestations of SLE. Pericarditis is relatively common, while verrucous (Libman-Sacks) endocarditis is usually clinically silent but can produce valvular insufficiency and serve as a source of emboli .Patients with SLE have an increased risk of coronary artery disease).Neonatal lupus can cause heart block of varying degrees that may be noted in utero and or present as congenital heart block. Neurologic Neurologic complications include cognitive defects, organic brain syndromes, delirium, psychosis, seizures, headache, and/or neuropathies. Other less common problems are movement disorders, cranial neuropathies, myelitis, and meningitis.

Psychosis which may be due to SLE or to glucocorticoid treatment, is one of several psychiatric manifestations of SLE. Others include: depression, anxiety, and mania). Ophthalmologic The eye is frequently involved in SLE with the most common manifestation being keratoconjunctivitis sicca. Uncommon or rare ophthalmologic manifestations of SLE include: Cotton wool exudates due to retinal vasculitis. Episcleroitis or scleritis.. Anterior uveitis (iritis, iridocyclitis).