Early Signs of Lupus in Females

Cory Martin
·7 min read

Medically reviewed by Sameena Zahoor, MDMedically reviewed by Sameena Zahoor, MD

Early signs of lupus in females, such as fatigue, joint pain, and rashes, are commonly mistaken for other conditions. Lupus is an autoimmune disease in which the immune system attacks the body's own tissues. It can affect any part of the body and is difficult to diagnose.

Although lupus can affect anyone, females are 9 times more likely than males to develop the disease. The onset of symptoms typically begins between the ages of 15 and 45.

This article will discuss the signs of undiagnosed lupus in females, how symptoms start and flare in mild lupus, testing methods for lupus, and specialists to see for suspected lupus.

<p>Westend61 / Getty Images</p>

Westend61 / Getty Images

Verywell Health acknowledges that sex and gender are related concepts, but they are not the same. To accurately reflect our sources, this article uses terms like “female,” “male,” “woman,” and “man” as the sources use them.

While lupus signs can be similar to other conditions, experiencing a combination of these symptoms simultaneously or at different points in time can signal lupus in females.

Many people with lupus experience a malar, or butterfly, rash. Typically triggered by exposure to sunlight, this is often the first sign of lupus. This rash appears on the face over the bridge of the nose and on the cheeks in the shape of a butterfly.

People with lupus may also experience other rashes across their body, especially in areas exposed to the sun. These rashes appear as red or discolored raised areas that can sometimes scar. People with darker skin may experience loss of pigmentation in the areas affected by rashes.

Pain in the joints or arthritic-type pain on a regular or continuous basis can be a first sign of lupus. Inflammation from lupus can cause joint stiffness. Stiffness typically occurs upon waking and may take 30 minutes or longer to loosen.

Pain from lupus manifests in several different ways. Pain levels can vary from mild to severe and can have a profound effect on daily life. Chronic widespread pain that affects the muscles, joints, and skin can also affect people with lupus. This type of pain is typical of fibromyalgia (a condition of chronic widespread pain) but occurs in lupus too.

Lupus is often called the great mimicker because many of its symptoms are like those of other conditions such as Hashimoto’s thyroiditis (an autoimmune thyroid disease) or fibromyalgia. It is important to mention all symptoms to your healthcare provider so that they can determine whether they are due to lupus or another condition.

Depression and anxiety are common in people with lupus. People with lupus are twice as likely to experience depression and anxiety than the general population.

These mood changes can be a direct effect of lupus on the body but can also occur due to the decreased quality of life from living with other symptoms of lupus, such as pain and fatigue.

Fatigue is a common symptom of lupus. Fatigue may be the first sign that something is wrong.

Fatigue is a tiredness that occurs for seemingly no reason and cannot be relieved with a nap. People with lupus fatigue may go from having no issue walking around the block to feeling like they have run a marathon after walking that same block.

Taking a shower can feel exhausting with fatigue. For this reason, fatigue is often noted as the most bothersome symptom, having a large effect on quality of life.

Females can experience loss of hair with lupus. The loss of hair can present in different ways. Hair can be patchy with complete bald spots, or areas that have thinned. Hair around the hairline can become weak and break.

In some people, scarring can also occur—leaving bald or thinned areas with red spots or loss of pigmentation.

Because of its difficulty to diagnose, it is not uncommon to go to the hospital with symptoms of lupus and leave with a different diagnosis or no answers at all. Unfortunately, diagnosis of lupus can take up to 10 years. Being aware of symptoms and advocating for yourself can help speed things along.

Lupus symptoms are unpredictable. People with lupus go through periods of remission, in which there are no symptoms, and flares, in which existing symptoms worsen, or new symptoms occur. This pattern can make diagnosis difficult since remission periods can make people believe their symptoms have gone away.

In mild lupus, the typical flare or onset of new or worsening symptoms includes symptoms such as fatigue, fever, weight loss, joint pain or arthritis, and rashes. About 70% to 80% of flares are mild to moderate, meaning they don't involve major organs such as the heart or lungs.

While lupus is difficult to diagnose due to its nonspecific symptoms (symptoms that could be due to a number of causes) and pattern of symptoms coming and going, tests can help. These include blood and urine tests and, in some cases, biopsies (taking a tissue sample to analyze in the lab).

Common blood tests for lupus include:

  • Antinuclear antibodies (ANA): Most people with lupus have a positive ANA. However, having a positive ANA does not mean you have lupus.

  • Antiphospholipid antibodies, anti-Smith, and anti-double-strand DNA antibodies can all be used to determine lupus when ANA is positive.

  • Complete blood cell count (CBC) can show changes associated with lupus, such as low platelet, red blood cell, and white blood cell counts.

  • Complement levels, such as low C3 and C4, can indicate lupus.

Urine tests look for abnormal levels of protein in the urine, which can indicate kidney involvement. If these tests are positive, a kidney biopsy may become necessary.

For people with rashes or scarring, a skin biopsy can be used to diagnose lupus.

Women and people within certain underrepresented racial and ethnic groups are disproportionately affected by lupus than others. Black women have more severe cases of lupus and poorer outcomes than White women.

Most people with lupus will see a rheumatologist, a specialist in rheumatic diseases such as arthritis and autoimmune conditions. A rheumatologist can diagnose and treat lupus. A clinical immunologist can also diagnose and treat the disease.

Because lupus can affect any part of the body, other specialists may become necessary depending on organ involvement.

For example, a person whose kidneys are affected by lupus may need to be seen by a nephrologist. Other specialists include:

  • Cardiologists who specialize in the heart

  • Endocrinologists, specialists in hormones and glands such as the thyroid

  • Hematologists, who look at blood

  • Dermatologists, specialists in skin conditions

  • Pulmonologists, lung specialists

  • Neurologists, brain, nerve, and spine specialists

Lupus is an autoimmune condition that can affect any part of the body. Diagnosis is difficult because many of its symptoms resemble other conditions and come and go.

Females with lupus often experience fatigue, pain, rashes, hair loss, and mood changes as early symptoms. These symptoms are unpredictable. The relapsing and remitting nature of lupus can also make it difficult to diagnose.

Blood tests, such as ANA, and urine samples can be used to diagnose the condition. In some cases, a biopsy of the skin or kidneys may be necessary to confirm the disease.

Rheumatologists are specialists who diagnose and treat lupus. Depending on organ and system involvement, other specialists, such as a nephrologist, a kidney specialist, or a cardiologist who specializes in the heart, may also be necessary for care.

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