Early Signs of Lupus in Females

posted in Diagnosing Lupus on November 2, 2023 by

Updated February 15, 2025

What is Lupus?

Systemic Lupus Erythematosus (SLE) is an autoimmune condition where the immune system cannot differentiate between foreign invaders (like bacteria and cancer cells) and healthy tissues. The person’s immune system mistakenly attacks the healthy tissues and organs. Lupus can affect all body parts, including the skin, joints, kidneys, heart, brain, and lungs.

The kidneys are one of the most common major organs involved. Doctors call this problem lupus nephritis. Lupus nephritis affects around 40% of SLE patients. Lupus nephritis causes no symptoms at all in its early stages. Therefore, we will not discuss it in this article. However, lupus nephritis can be the first significant problem SLE patients encounter. It is diagnosed by finding high protein levels in the urine (proteinuria).

Early Signs of Lupus in Females

Lupus symptoms can vary widely from person to person. However, these symptoms may be subtle in some cases, making early diagnosis challenging.

Classification criteria exist that can help guide doctors in diagnosing SLE more accurately. Some of these early lupus symptoms are included in the classification criteria. These will be pointed out below.

Here are some common early symptoms of lupus in females:

1. Skin Rashes

Skin rashes are often one of the earliest indicators of lupus. The classic “butterfly rash” (or malar rash) across the cheeks and nose is a well-known sign. However, lupus rashes (called cutaneous lupus) can take various forms, including red patches, sores, mottled skin, dilated blood vessels, or a scaly appearance. These rashes often worsen with sun exposure. Seeing a medical dermatologist can help accurately diagnose cutaneous lupus.

2. Joint Pain and Swelling

Joint pain and swelling, called arthritis, are common early lupus symptoms. However, this can be mistaken for other joint-related conditions (like fibromyalgia). Lupus-related joint pain typically affects multiple joints and can move from one joint to another.

Inflammatory arthritis affecting more than one joint is one of the classification criteria. However, joint pains without evidence of inflammation (called arthralgia or polyarthralgia) are not a classification criterion.

3. Fatigue and Malaise

Unexplained and persistent fatigue is another early sign of lupus in females. This fatigue can be severe and disruptive to daily life. Also, it is often accompanied by a difficult-to-explain feeling of not feeling well (called malaise).

Fatigue and malaise are nonspecific symptoms. Many other problems can cause fatigue and malaise, like depression, anxiety disorder, fibromyalgia, infections, cancer, and related systemic autoimmune diseases (like rheumatoid arthritis and Sjogren’s disease). Therefore, it is not a classification criterion.

4. Fever

Lupus can cause recurrent fevers without any apparent infection. While these fevers may come and go, they are usually low-grade.

Fever is a nonspecific symptom. Many other problems can cause fever, like infections, cancer, and related systemic autoimmune diseases (like rheumatoid arthritis and vasculitis). Therefore, it is not a classification criterion.

5. Photosensitivity

Many lupus patients also experience increased sensitivity to sunlight, known as photosensitivity. This is due to a part of light called ultraviolet light. Exposure to any ultraviolet light source (especially the sun) can trigger or worsen skin rashes and other lupus symptoms. Lupus patients need to reduce UV light exposure as part of their therapy.

6. Hair Loss

Also known as alopecia, hair loss can be another common early sign of lupus in females. Hair may become thin and brittle with diffuse thinning, and hair loss can be patchy.

There are many possible causes of hair loss in lupus patients, and each has different effective therapies. Getting a correct diagnosis from a medical dermatologist is crucial to figuring out the proper treatment. See Dr. Thomas’ video about hair loss causes and treatments produced in conjunction with The Lupus Foundation of America:

How to Stop Lupus Hair Loss:

7. Mouth or Nose Ulcers

Ulcers inside the mouth or nose (called oral ulcers and nasal ulcers, respectively) are another frequent symptom in SLE patients. These sores are often painless and not noticed by the patient until a healthcare provider sees them on physical exam. However, they can also be painful, requiring medicines to help reduce inflammation and pain. These ulcers are often one of the first signs.

However, oral and nasal ulcers can be caused by other disorders like aphthous ulcers (canker sores), infections like herpes, Behcet’s disease, Crohn’s disease, and other types of vasculitis. These other diseases must be considered before ascribing them to SLE.

Oral and nasal ulcers are part of the SLE classification criteria.

8. Raynaud’s Phenomenon

Raynaud’s phenomenon is a condition where fingers and toes turn white or blue when exposed to cold temperatures or stress. It’s common in lupus patients.

Raynaud’s is nonspecific. Many other problems can cause Raynaud’s, like fibromyalgia and related systemic autoimmune diseases (like mixed connective tissue disease and scleroderma or systemic sclerosis). Since other systemic autoimmune disorders commonly cause Raynaud’s, it is not a classification criterion.

9. Chest Pain and Breathing Difficulties

Inflammation of the lungs, heart, heart lining, or chest cavity lining can cause chest pain and breathing difficulties. When lupus causes inflammation of the heart’s lining, it is called pericarditis. It is called pleurisy or pleuritis when it affects the lining of the lungs. Pericarditis and pleuritis are two of the most common problems in SLE. They typically cause chest pain that is worse when breathing in, making it difficult to breathe. Doctors call this type of chest pain (worse with breathing) pleuritic chest pain. Pericarditis often worsens while lying down.

Pleurisy and pericarditis are part of the SLE classification criteria.

10. Cognitive Dysfunction

Some lupus patients may also experience cognitive dysfunction, often referred to as “brain fog” or “lupus fog.” This can affect memory, concentration, and overall cognitive function.

If cognitive dysfunction is due to brain inflammation (CNS lupus) it is treated with high doses of steroids and strong immunosuppressant drugs. Some doctors call this problem “lupus cerebritis” or “lupus CNS vasculitis.”

If cognitive dysfunction is due to active, inflammatory CNS lupus, it is part of the SLE classification criteria. However, memory problems and chronic lupus fog that affects many lupus patients are not part of the classification criteria.

Seeking Medical Attention for Early Signs of Lupus in Females

If you or someone you know is experiencing any of these early signs, seeking medical attention promptly is crucial. Lupus is a complex condition; early diagnosis and intervention can significantly improve outcomes. A rheumatologist, a specialist in autoimmune diseases, is often the healthcare provider who diagnoses and manages lupus.

The antinuclear antibody test (ANA) is the most important initial blood test to help diagnose SLE. Almost all SLE patients have a positive ANA.

Early signs of lupus in females can be subtle and varied, making diagnosis challenging. Symptoms like fatigue, malaise, and joint and muscle pains are common in many disorders and are not specific to SLE. SLE can begin with just a couple of problems (like fatigue and joint pain) but nothing else, making it almost impossible to diagnose early.

Although our current tests help diagnose many SLE patients early in their disease course, they are insufficient in many to most patients. Almost all tests (like ANA, anti-dsDNA, anti-Smith, anti-SSA, etc) were developed in the 1960s and are inadequate for diagnosing many patients. Newer and better labs have great difficulty getting insurance coverage. For example, labs like CB-CAPs used in the AVISE Lupus Test are more sensitive and specific for diagnosing SLE than the older tests but are not covered by most insurance companies. This results in most patients having a delay in their SLE diagnosis by four to six years. To read more about this problem, see Dr. Thomas’ article on the topic of novel biomarkers and the roadblocks preventing their use:

What’s Holding Back Biomarker Innovation, & How Can We Solve It?

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Lupus Symptoms vary in Women from Puberty to Menopause

To learn much more about how and why lupus affects women so much, see my video (done in conjunction with Kaleidoscope Fighting Lupus):

For more in-depth information on early signs of lupus in females:

Read chapters 1, and 5 to 17 of The Lupus Encyclopedia, edition 2

Look up your symptoms, conditions, and medications in the Index of The Lupus Encyclopedia

If you enjoy the information from The Lupus Encyclopedia, please click the “SUPPORT” button at the top of the page to learn how you can help.

For more in-depth information on Early Signs of Lupus in Females:

Look up your symptoms, conditions, and medications in the Index of The Lupus Encyclopedia

If you enjoy the information from The Lupus Encyclopedia, please click the “SUPPORT” button at the top of the page to learn how you can help.

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