Systemic Lupus Erythematosus: Symptoms, Diagnosis, and Modern Approaches

What is systemic lupus erythematosus (SLE)?

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease in which the body's immune system mistakenly attacks its own healthy tissues, causing inflammation in various organs and systems. Due to its systemic nature, SLE can affect the skin, joints, kidneys, heart, lungs, blood vessels, brain, and other parts of the body, leading to a wide range of symptoms and requiring an individualized approach to diagnosis and treatment.

Diversity of symptoms: from skin to the nervous system

SLE symptoms can be extremely diverse and mimic many other diseases, which complicates diagnosis. Among the most frequent manifestations are:

• Skin changes: Although the classic "butterfly" rash on the face is a characteristic sign, other skin manifestations may also be observed. For example, inflammatory, persistent redness (erythema) similar to rosacea may be linked to neurogenic mechanisms and accompanied by chronic pain and headaches [2]. In some cases, with other systemic scleroderma-like conditions, skin thickening and hyperpigmentation, as well as digital ulcers, may be noted [4].
• Raynaud's phenomenon: This is a condition in which the blood vessels of the fingers and toes narrow in response to cold or stress, causing skin color changes (paleness, blueness, redness), pain, numbness, and tingling. Studies show that a low body mass index (BMI) may be associated with a higher prevalence of cyanosis, hyperemia, and triphasic color changes, as well as thumb involvement in primary Raynaud's phenomenon. Comorbid fibromyalgia and migraine can also exacerbate pain and numbness [6]. Raynaud's phenomenon is frequently encountered in SLE and other systemic autoimmune rheumatic diseases (SARDs) [6].
• Gastrointestinal disorders: Gastrointestinal tract involvement occurs in systemic autoimmune diseases. For example, in scleroderma (systemic sclerosis), up to 90% of patients face GI issues, including weight loss, abdominal pain, bloating, vomiting, diarrhea, and loss of appetite. In rare cases, severe colonic dysmotility may develop [4].
• Neurological and neuropsychiatric manifestations: SLE can affect the nervous system, causing headaches, "brain fog," fatigue, and depression. Migraines, chronic fatigue, and "brain fog" are often associated with autonomic nervous system dysfunction and may be part of a multisystem condition [3, 6]. In rare cases, severe headaches, such as "thunderclap" headaches in reversible cerebral vasoconstriction syndrome, may be observed, which can be mistaken for other conditions [8].

Systemic manifestations and comorbid conditions

SLE is a systemic disease affecting multiple organs:

• Cardiovascular system: Patients with SLE are at risk of developing heart failure. Studies show that non-invasive transcutaneous vagus nerve stimulation (t-VNS) may be a promising method for improving cardiac function and alleviating symptoms in patients with heart failure by modulating the balance of the autonomic nervous system [5].
• Hematological disorders: These may include anemia and thrombocytopenia [1]. In severe cases, hyperviscosity syndrome may develop, which manifests as dyspnea, weight loss, hemoptysis, and generalized hemorrhagic diathesis. Diagnosis of hyperviscosity syndrome is confirmed by increased serum viscosity, and emergency plasmapheresis can significantly improve clinical manifestations [1].
• Autonomic nervous system dysfunction: Conditions such as postural orthostatic tachycardia syndrome (POTS), chronic fatigue, interstitial cystitis, and fibromyalgia are frequently found in patients with multisystem conditions and may be linked to SLE [3]. Treatment of comorbid conditions, such as pelvic venous disorders, can lead to improvements in neuropsychiatric indicators, including memory function and depression levels [3].
• Inflammatory markers: In systemic autoimmune diseases, including SLE, an increase in inflammatory markers such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), as well as the presence of antinuclear antibodies (ANA), is often observed [4].

Approaches to diagnosis and treatment: General principles

Diagnosis of SLE is based on a combination of clinical symptoms, laboratory tests (including ANA and inflammatory markers), and the exclusion of other diseases. SLE treatment is comprehensive and aimed at controlling inflammation, preventing organ damage, and alleviating symptoms. It often includes:

• Immunosuppressive therapy: Drugs such as mycophenolate mofetil are used to suppress the overactivity of the immune system. This drug is used, for example, in the treatment of severe manifestations of systemic sclerosis [4] and is also one of the options for SLE therapy.
• Symptomatic and supportive therapy: Includes medications to relieve pain and inflammation, as well as specific agents for treating comorbid conditions. For example, for GI disorders, rifaximin or hyoscine may be used [4].
• Specialized interventions:
  • Plasmapheresis: In emergency cases, such as hyperviscosity syndrome, plasmapheresis can be life-saving for the rapid improvement of the patient's condition [1].
  • Radiofrequency ablation: For the treatment of severe manifestations, such as neurogenic rosacea associated with chronic pain and headaches, radiofrequency ablation of the sphenopalatine ganglion may be used. In one case, this led to the complete disappearance of facial rosacea symptoms [2].
  • Endovascular procedures: For pelvic venous disorders (e.g., chronic pelvic pain of venous origin), endovascular stenting and sclerotherapy can be used, which may improve not only pain but also neuropsychiatric symptoms [3].
  • Vagus nerve stimulation: Non-invasive transcutaneous vagus nerve stimulation (t-VNS) is being studied as a potential method for improving heart function in patients with heart failure [5].

The importance of a comprehensive approach

Given the diversity of SLE manifestations and the frequent presence of comorbid conditions, a comprehensive, interdisciplinary approach to patient management is crucial. This includes regular follow-ups with a rheumatologist, as well as consultations with other specialists (cardiologists, neurologists, gastroenterologists, etc.) as needed. Early diagnosis and adequate treatment help control the disease, prevent complications, and improve quality of life.

Sources

• [1] Plasma cell leukemia and hyperviscosity syndrome. (Southern medical journal, 1990) https://pubmed.ncbi.nlm.nih.gov/2196691/
• [2] Radiofrequency ablation of the sphenopalatine ganglion for the treatment of severe facial rosacea manifestations. (Pain practice : the official journal of World Institute of Pain, 2026) https://pubmed.ncbi.nlm.nih.gov/41918220/
• [3] Case report: Neuropsychiatric improvement after treatment of pelvic venous disorder in a multisystem patient. (Frontiers in cardiovascular medicine, 2025) https://pubmed.ncbi.nlm.nih.gov/41602336/
• [4] Severe scleroderma colopathy at primary diagnosis of systemic sclerosis in a young man: a case report. (Frontiers in medicine, 2026) https://pubmed.ncbi.nlm.nih.gov/41907233/
• [5] Efficacy of transcutaneous vagus nerve stimulation in the treatment of heart failure – a systematic review and meta-analysis. (BMC cardiovascular disorders, 2025) https://pubmed.ncbi.nlm.nih.gov/40615792/
• [6] The impact of comorbidities and patient demographics on the symptom characteristics of Raynaud's phenomenon: implications for diagnosis and treatment. (Journal of scleroderma and related disorders, 2026) https://pubmed.ncbi.nlm.nih.gov/42256633/
• [7] Consensus statement on the management and treatment of Sturge-Weber syndrome: recommendations for neurology, neuroimaging, and ophthalmology. (Pediatric neurology, 2021) https://pubmed.ncbi.nlm.nih.gov/34153815/
• [8] Reversible cerebral vasoconstriction syndrome in psychiatric settings: context-dependent diagnostic bias and consultation-liaison psychiatry practice. (PCN reports : psychiatry and clinical neurosciences, 2026) https://pubmed.ncbi.nlm.nih.gov/41769064/

Disclaimer: The information in this article is for reference purposes only and is not intended for self-diagnosis or self-treatment. Always consult a qualified medical professional for diagnosis and treatment planning.