Lupus Symptoms | Johns Hopkins Lupus Center

Lupus affects everyone differently, but certain signs and symptoms are common. [A sign is medical evidence your doctor finds during a physical exam, such as a specific rash; a symptom is a subjective indication of disease, such as joint stiffness or a headache.] In addition, other conditions, such as fibromyalgia, occur commonly in people with lupus but are not directly due to disease activity. These co-occuring conditions are known to doctors as “comorbidities.” Several signs, symptoms, and comorbidites of lupus are detailed below.

Fever

The average human body temperature is around 98.5°F, but many people run just above or below that mark. A temperature of 101°F is generally accepted as a fever. Many people with lupus experience reoccurring, low-grade temperatures that do not reach 101°. Such low-grade temperatures may signal oncoming illness or an approaching lupus flare. Fever can also signal inflammation or infection, so it is important to be aware of the patterns of your body and notify your physician of anything unusual.

Joint Stiffness

Many lupus patients experience joint stiffness, especially in the morning. People often find that taking warm showers helps to relieve this problem. If this habit does not offer comfort and joint stiffness prevents you from daily activity, be sure to speak with your doctor. He/she will examine you for any signs of joint swelling and can speak with you about medications that may ease some of this pain and inflammation, such as over-the-counter pain treatments and NSAIDs. Tenderness of a joint in known as arthralgia, and it is important that your doctor distinguish this from the arthritis (true swelling) that may accompany lupus.

If you experience a fever lasting a few days or fevers that come and go over the course of a few days, you should take your temperature twice daily and keep a record. Certain trends may alert your doctor to specific processes occurring in your body. In addition, a fever of 101°F or more should be given medical attention. If you are taking steroid medications such as prednisone, be alert for any sign of infection, since steroids can suppress your immune system while also masking symptoms of infection. Immunosuppressive medications such as azathioprine, methotrexate, cyclophosphamide, and mycophenolate also suppress the immune system, so if you begin to feel ill when taking one of these medications, notify your doctor immediately.

Weight Changes

Weight Loss

Increased lupus activity can sometimes cause weight loss, and certain medications can cause loss of appetite. No matter what the cause of your weight loss, you should speak to your doctor to ensure that the loss does not indicate a more serious condition. If you experience a loss of appetite due to your medications, your doctor may suggest alternative medications or solutions to ease stomach discomfort.

Weight Gain

Other medications, such as corticosteroids, can cause weight gain. Therefore, it is very important that you speak to your doctor about maintaining a balanced diet while taking these medications. You may need to reduce your calorie consumption; your physician can refer you to a nutrition counselor if needed. Light to moderate exercise can also help you to maintain a healthy weight and cardiovascular system, while also boosting your mood.

Please remember that it is very easy to gain weight, especially when taking steroids, but it is much more difficult to lose it. It is very important that you try to achieve a healthy weight, because women with lupus between the ages of 35 and 44 are fifty times more likely to experience a heart attack than the average woman. In addition, maintaining a healthy weight helps to alleviate stress on your joints and keeps your organs working productively and efficiently.

Fatigue and Malaise

Ninety percent of people with lupus will experience general fatigue and malaise at some point during the course of the disease. Some people find a short 1 ½ hour afternoon nap to be effective in reducing fatigue. However, exceeding this time frame might lead to problems sleeping at night. If you feel that you are tired throughout most of the day and that fatigue prevents you from engaging in daily activities, speak to your doctor. Fatigue accompanied by pain at certain parts of your body may be a sign of a treatable condition called fibromyalgia. Other fatigue-inducing conditions, such as anemia, low thyroid, and depression, can also be treated. If you and your doctor decide that your malaise is due solely to lupus, try to stay as active and mobile as possible during your daily routine. Often this can be difficult, but many people find that slightly pushing themselves to engage in light to moderate exercise actually increases their energy levels. However, you should never push yourself beyond reasonable discomfort.

Sjogren’s Syndrome

As many as 10% of people with lupus may experience a condition called Sjogren’s syndrome, a chronic autoimmune disorder in which the glands that produce tears and saliva do not function correctly. Sjogren’s can also affect people who do not have lupus. People with Sjogren’s often experience dryness of the eyes, mouth, and vagina. They may also feel a gritty or sandy sensation in their eyes, especially in the morning. This dryness occurs because the immune system has begun to attack the moisture-producing glands of the eyes and mouth (the lacrimal and parotid glands, respectively), resulting in decreased tears and saliva.

It is important that you speak to your doctor if you experience dryness of the eyes and mouth, since the medications for these conditions must be taken on a regular basis to prevent discomfort and permanent scarring (especially of the tear glands). The Schirmer’s test is usually performed to check for Sjogren’s and involves placing a small piece of litmus paper under the eyelid. Eye symptoms can be relieved by frequent use of Artificial Tears, and an eyedrop medication called Restasis is often used to prevent worsening of Sjogren’s. Evoxac (or pilocarpine) can be used to increase both tear and saliva production, and certain lozenges (Numoisyn) can also be helpful for dry mouth.

Depression

Depression and anxiety are present in almost one third of all people with lupus. Clinical depression is different than the passing pangs of sadness that can haunt all of us from time to time. Rather, clinical depression is a prolonged, unpleasant, and disabling condition. The hallmark characteristics of depression are feelings of helplessness, hopelessness, general sadness, and a loss of interest in daily activities. Depression also often involves crying spells, changes in appetite, nonrestful sleep, loss of self-esteem, inability to concentrate, decreased interest in the outside world, memory problems, and indecision. In addition, people who are depressed may suffer from certain physiologic signs, such as headache, palpitations, loss of sexual drive, indigestion, and cramping. Patients are considered to be clinically depressed when they experience symptoms that last for several weeks and are enough to disrupt their daily lives. Patients suffering from depression also often experience a general slowing and clouding of mental functions, such as memory, concentration, and problem-solving abilities. This phenomenon is sometimes described as a “fog.” The cause of depression is not known; sometimes a genetic component predisposes an individual to the condition. Depression is almost never due to active lupus in the brain.

While clinical depression can be caused by the emotional drain of coping with a chronic medical condition and the sacrifices and adjustments that are required of the disease, it can also be induced by steroid medications (e.g., prednisone) and other physiological factors. It is important that you speak with your doctor if you feel you are experiencing clinical depression, because many people who are physically ill respond well to anti-depressant medications. In addition, your doctor may treat your depression in different ways depending on the cause.

Gastrointestinal Problems

Many people with lupus suffer from gastrointestinal problems, especially heartburn caused by gastroesophageal reflux disease (GERD). Peptic ulcers can also occur, often due to certain medications used in lupus treatment, including NSAIDs and steroids. Occasional heartburn or acid indigestion can be treated with an over-the-counter antacid, such as Rolaids, Maalox, Mylanta, or Tums. Your doctor may also include an antacid or another form of GI medication (a proton-pump inhibitor, histamine2 blocker, or promotility agent) in your treatment regimen. Antacids are effective when used to treat occasional symptoms, but you should try to avoid heartburn and acid indigestion altogether by eating smaller meals, remaining upright after eating, and cutting down on caffeine. If heartburn and acid reflux persist (e.g., for more than two weeks), you should speak with your doctor, because your heartburn symptoms could indicate a larger problem.

Thyroid Problems

The thyroid is the gland in your neck associated with your metabolism—the processes by which your body makes use of energy. Autoimmune thyroid disease is common in lupus. It is believed that about 6% of people with lupus have hypothyroidism (underactive thyroid) and about 1% have hyperthyroidism (overactive thyroid). A thyroid gland that is functioning improperly can affect the function of organs such as the brain, heart, kidneys, liver, and skin. Hypothyroidism can cause weight gain, fatigue, depression, moodiness, and dry hair and skin. Hyperthyroidism can cause weight loss, heart palpitations, tremors, heat intolerance, and eventually lead to osteoporosis. Treatment for both underactive and overactive thyroid involves getting your body’s metabolism back to the normal rate. Hypothyroidism is usually treated with thyroid hormone replacement therapy. Hyperthyroidism is treated with anti-thyroid medications or radioactive iodine.

Osteoporosis

Osteoporosis (bone thinning) occurs when the bones lose calcium and other minerals that help keep them strong and compact. This condition can lead to fractures, bone pain, and shorter stature. Everyone is at risk for osteoporosis as they age, but women experience a greater risk of the condition after menopause. Studies have shown that people with lupus are at an increased risk for osteoporosis due to both the inflammation they experience with the disease and the use of prednisone.

Your bones are constantly being remodeled in a process that removes old bone cells and deposits new ones. In people with osteoporosis, the bones lose minerals faster than they can be regenerated. Medications called bisphosphonates (e.g., Actonel, Fosamax, Boniva, and Reclast) can be taken to help prevent your bones from losing calcium and other minerals by slowing or stopping the natural processes that dissolve bone tissue. In doing this, bisphosphonates help your bones remain strong and intact. If you have already developed osteoporosis, these medications may slow the thinning of your bones and help prevent bone fractures. In fact, studies have shown that bisphosphonates can lower your risk of fractured vertebrae—bone segments that make up your spine—by 50%. Similar studies demonstrate that these medications can lower the chance of breaking other bones by 30-49%. However, when bisphosphonates are not successful, patients may need a daily injection of parathyroid hormone (Forteo) to build bone.

Sources

• Wallace, Daniel J. The Lupus Book: A Guide for Patients and Their Families. 1st ed. New York: Oxford University Press, 1995.

General Manifestations of SLE – Lupus Erythromatosus A TO Z

Overview

Fatigue is a nearly universal complaint
of patients with SLE even when no
other manifestations of the disease are
present. The cause of this debilitating
fatigue is not known. The patient
should be evaluated for factors that
may exacerbate fatigue, such as
hypothyroidism, adrenal dysfunction,
overexertion, insomnia, depression,
stress, anemia, and other inflammatory
diseases. Fatigue in SLE patients may be
lessened by adequate rest, healthful diet,
exercise, and attention to psychosocial
factors. One common cause of fatigue in
SLE patients is fibromyalgia.

Many patients with SLE experience
changes in weight. At least one-half
of patients report weight loss before
being diagnosed with SLE. Weight loss
in SLE patients may be attributed to
a decreased appetite, side effects of
medications, GI problems, or fever.
Weight gain can occur in some patients
and may be due in part to prescribed
medications, especially corticosteroids,
or fluid retention from kidney disease.

Episodic fever is experienced by more
than 80 percent of SLE patients, and
there is no particular fever pattern.
Although high fevers can occur during
a lupus flare, low-grade fevers are more
frequently seen.

A complicating infection is often the
cause of an elevated temperature in a
patient with SLE. The patient’s WBC
count may be normal to elevated with
an infection, but low with SLE alone.
However, certain medications, such as
immunosuppressives, will suppress the
WBC count even in the presence of
fever. Therefore, it is important to rule
out other causes of a fever, including
an infection or a drug reaction. Urinary
and respiratory infections are common
in SLE patients.

Some patients with SLE experience
racing of the heart, or tachycardia.
This rapid pulse is frequently the result
of inflamed heart tissue. However,
tachycardia may have other causes as
well, such as an infection.

Psychological
Manifestations

People with lupus often experience
psychological and emotional effects,
such as grief, depression, and anger.
These effects can be related to outward
changes, such as skin alterations caused
by the disease. They can also be related
to concerns about the future, and about
other aspects of the disease and its
treatment. It is important for health
professionals to be alert to potential
psychological repercussions and to
assist in alleviating them.

Potential Problems

1. inability to complete activities
of daily living because of fatigue,
weakness, and psychological
difficulties

2. changes in weight

3. fever

Nursing Interventions

Objective: Minimize fatigue.

1. Assess the patient’s general fatigue
level.

2. Assess for the presence of
depression, anxiety, and other
stressors.

3. Conduct an assessment to
determine the patient’s daily
activities that contribute to fatigue.

4. Help the patient to develop
an energy-conserving plan for
completing daily and other
activities and work. Many people
with lupus need to take a daily
nap.

5. Encourage the patient to get 8 to
10 hours of sleep at night.

6. Encourage exercise as tolerated.

Objective: Maintain weight at optimal
range.

1. Assess the patient’s prescription
and nonprescription drug
regimen and dosages.

2. Assess the patient’s usual daily
dietary intake by asking her or
him to keep a food diary.

3. Develop a dietary plan with
the patient that encourages
healthful eating. If the patient
has nutrition-related lupus
complications, refer her or him
to a registered dietitian for
specialized counseling.

4. Encourage exercise as tolerated.

5. Record the patient’s weight at
each visit.

6. Instruct the patient to weigh
herself or himself at home once a
week and record it.

Objective: Teach the patient to
recognize fever and signs and
symptoms of infection.

1. Assess the patient’s prescription
and nonprescription drug
regimen and dosages.

2. Monitor the patient’s WBC count.

3. Teach the patient to monitor
temperature during a lupus flare.

4. Teach the patient to look for
signs and symptoms of infection,
particularly urinary and
respiratory infections. (Note:
The cardinal signs of infection
may be masked because of
corticosteroids and antipyretic
medications.)

5. Instruct the patient to call a
physician if signs and symptoms
of an infection appear or if a
fever is elevated above 101°F.

Objective: Assist the patient in
adjusting to physical and lifestyle
changes.

1. Allow the patient to express
feelings and needs.

2. Assess the patient’s usual coping
mechanisms.

3. Acknowledge that feelings of
denial and anger are normal.

4. Explore with the patient
sources of potential support and
community resources.

5. Explore possible ways of
concealing skin lesions and hair
loss.

6. Encourage the patient to discuss
interpersonal and social conflicts

that arise.
7. Encourage the patient to accept
help from others, such as
counseling or a support group.

Objective: Recognize the signs and
symptoms of depression and initiate a
plan of care.

1. Assess the patient for the
major signs and symptoms of
depression.

2. Assess the patient’s interpersonal
and social support systems.

3. Encourage the patient to express
feelings.

4. Initiate a referral to a mental
health counselor or psychiatrist.

For further information and nursing
interventions, see the section on
infection. Also
see the Patient Information Sheets
in the chapters on Living With Lupus,
Preventing Fatigue Due to Lupus, Skin
Care and Lupus, and Fever and Lupus.

Source: National Institutes of Health, U.S.Dept of Health and Human Services

Signs and Symptoms of Lupus

A variety of complications can arise with lupus, causing an array of additional symptoms. Some of these complications include the following conditions.

Lupus Nephritis

Lupus nephritis, inflammation of the kidneys, is one of the most common complications of lupus. (13) “Sometimes we see patients that don’t have other symptoms at all but do have nephritis,” says Francis Luk, MD, an assistant professor of rheumatology and immunology at Wake Forest Baptist Medical Center in Winston-Salem, North Carolina. 

People with lupus nephritis are at a higher risk of developing end-stage renal disease, requiring dialysis or a transplant, says Kaplan. Symptoms of the condition include high blood pressure; swelling of the hands, arms, feet, legs, and area around the eyes; and changes in urination, such as blood or foam in the urine, needing to go to the bathroom more frequently at night, or pain or trouble urinating.

Blood Disorders

Lupus can cause problems with the blood, too, including anemia, or low red blood cell count. Anemia can cause symptoms such as weakness and fatigue. (14) Thrombocytopenia is another blood disorder that may develop, resulting in lower platelet counts. (Platelets are the blood cells that help the blood clot.) Symptoms of thrombocytopenia can include bruising easily, nosebleeds, and petechiae, when the blood appears as red pinpoints under the skin. (15)

Atherosclerosis

Atherosclerosis, or clogging of the arteries, can develop in people with lupus. This can cause chest pain and raise the risk of stroke, heart attack, and heart failure. People with lupus nephritis may be at a greater risk of developing atherosclerosis, according to a study published in the April 2017 issue of PLoS One. (16)

Pericarditis

Pericarditis, or inflammation of the sac that surrounds the heart, can be an early complication of lupus, says Kramer. Symptoms include a sharp pain in the chest and shortness of breath. Chronic inflammation can damage the heart tissue, making it more difficult for the heart to pump blood. (17)

Myocarditis

Inflammation of the heart, called myocarditis, can cause chest pain, says Dr. Luk. Other symptoms include unexplained rapid or irregular heartbeat, and heart failure is possible.

Pleuritis and Pleural Effusion

Inflammation of the lining surrounding the lungs, or pleuritis, can occur in people with lupus. This can cause symptoms such as chest pain and shortness of breath, says Luk. The pain can worsen when taking a deep breath, sneezing, coughing, or laughing. (18) Pleural effusion, or fluid around the heart and lungs, may also develop and can cause shortness of breath or chest pain, says Caricchio.

Central Nervous System Inflammation

Inflammation of the central nervous system can cause confusion, seizures, and psychosis, says Luk. It can contribute to an increased risk of depression, headache, and stroke, as well as problems with vision in people with lupus. (19)

Miscarriage and Preterm Labor

Women with lupus have a higher risk of miscarriage and preterm labor, says Kaplan. Pregnant women with lupus also have a higher risk of preeclampsia, or high blood pressure, and signs that the kidneys and liver may not be functioning well. (20) If you have lupus and do get pregnant (or if you have lupus and are trying to get pregnant), see a high-risk maternal-fetal medicine specialist who has expertise in how to best handle such pregnancies.

What Is Lupus? – Symptoms and Treatment

Living with lupus

When you are first diagnosed with lupus, you may have conflicting feelings. You may be relieved to finally know what is causing your symptoms. You may also have feelings of sadness, fear, confusion, and anger. Some people who have lupus have bouts of depression because of the challenges of living with this disease. Learning all you can about your illness can help you better cope with your symptoms, prevent flares, and deal with side effects and complications.

Lupus can affect and damage different parts of your body.

Kidneys

Your kidneys get rid of waste and other toxins from the body. Lupus can affect the kidneys and cause the structures that filter the blood to swell. Without treatment, lupus can lead to permanent kidney damage. If lupus affects your kidneys, you will probably need medicine to prevent serious damage. The most common symptom of kidney problems is swelling in your feet, legs, hands, or eyelids.

Heart

Lupus can inflame the sac around your heart and cause chest pain. Though less common, but more serious, it can harden the walls of your coronary arteries. This can lead to angina (chest pain) and an increased risk of coronary artery disease. Lupus can also cause inflammation of the heart itself, which can lead to scarring and possible heart failure.

Lungs

Inflammation can also occur in the lining of your lungs. This can cause chest pain, which is often felt with deep breathing. People who have lupus are at risk of getting pneumonia.

Joints

Most people who have lupus have swollen and painful joints. These symptoms can come and go and may affect several joints at once. Usually, there is no long-term damage.

Skin

People who have lupus often get a butterfly-shaped, red rash across their nose and cheeks. This is called a malar rash. Other parts of the skin may be affected. You could have raised bumps or dry patches, often on areas that are exposed to the sun. You could get sores inside your mouth or nose. Hair loss (alopecia) is common during flares. You may notice a blotchy purple color on your hands, fingers, or toes. This happens when blood does not flow well to the skin’s surface. It is called Raynaud’s Disease.

Central Nervous System

Lupus can affect your brain and the nerves in your spinal cord. Symptoms include headaches, dizziness, mild confusion or memory problems, vision problems, and changes in your mood. It can lead to more serious health issues, such as seizures or a stroke.

Blood

Lupus can cause the number of red blood cells, white blood cells, and platelets to decrease. Fewer red blood cells can lead to anemia, which is common in people who have lupus. White blood cells help the body fight infection. Rarely, do white blood cells get low enough to cause infection. Platelets help your blood to clot. A low platelet count can lead to easy bruising, nosebleeds, and other bleeding. It can also cause your blood to clot too easily or in unneeded places. If the blood clot breaks away and travels through the bloodstream, it can block blood vessels and cause serious problems, such as a stroke, blood clots in the lungs (thrombosis), or repeated miscarriages.

Talking to others about lupus

Others won’t be able to see most of the symptoms caused by your lupus. When symptoms like pain, fatigue, depression, or joint stiffness make your regular tasks more difficult, it’s important to know how to talk to those around you.

It may help to start by explaining what lupus is not. Let people know that is not contagious, nor is it like cancer or HIV or AIDS. Then explain what lupus is. Let them know that it is chronic, which means you will have it forever, and that it affects each person differently.

Your conversations with others about lupus may change depending on who you are talking to.

1. Tell your family and friends. Tell your loved ones about your symptoms and treatment. Make sure they understand that you will be okay, but that sometimes you may say “no” to things. They can help you to manage your schedule. They can also pitch in when you need help with things, like childcare or household tasks.
2. Tell your job. If you feel it is okay to do so, you may want to work with your employer to make your workplace more comfortable for you. This might mean getting a better desk chair or requesting a flexible work schedule. If your employer won’t work with you, you may want to find a job that’s more manageable with your lupus. Remember, health problems like lupus are protected by the Americans with Disabilities Act.
3. Tell your school. You will want to register with your school’s accessibility office and learn about financial assistance opportunities. Talk to your professors, advisors, and maybe even your roommates about your lupus and what will you do if it causes you to miss something. Make sure not to overload your course schedule.

If you don’t feel that you have anyone you can talk to about your lupus, or if you’d like more resources, it may be helpful to seek out a therapist or an online support group.

Managing your lupus

It may take time to find the right combination of treatment options for your lupus. Work with your doctor to take an active role in managing your lupus. You can do this by:

• Tracking your symptoms. Use a journal to track what your symptoms are and when they are worst. If you are taking medications, track any side effects you may notice.
• Take the medications your doctor prescribes. If you experience side effects from a medicine, don’t just stop taking it. Talk to your doctor first.
• Communicate regularly with your doctor. Managing your lupus will require a team approach. Keep your doctor updated on how you’re feeling. Make sure you express any questions or concerns. It can be helpful to bring your journal with you to doctor appointments so that you remember everything you want to talk about.

Talking with your doctor about all of your symptoms and getting the right lab tests are important steps to arriving at an accurate diagnosis.

If you aren’t sure where to begin, the Lupus Foundation of America can help you to find the resources and support you need. These resources include:

Lupus symptoms & treatments – Illnesses & conditions

There is currently no cure for systemic lupus erythematosus (SLE), but treatments that can ease the symptoms and make it easier to live with are available.

In most cases, treatment will involve a combination of self-care measures and medication.

Protecting yourself from the sun

Exposure to sunlight can sometimes make symptoms such as rashes worse, and it’s important to protect your skin when in the sun.

This means wearing clothing that covers your skin, a wide-brimmed hat and sunglasses. You will also need to apply sunscreen with a high SPF to prevent sunburn. However, some people with lupus are not sun-sensitive and do not need to take extra precautions.

As people get most of their vitamin D as a result of direct sunlight on the skin, there is a risk you may not get enough of this vitamin if you need to avoid sun exposure. This means you may need to make an extra effort to include good sources of vitamin D in your diet to avoid problems such as osteoporosis (weakened bones), and you may be advised to take vitamin D supplements.

Non-steroidal anti-inflammatory drugs (NSAIDs)

Non-steroidal anti-inflammatory drugs (NSAIDs) are a common painkilling medication that reduces inflammation in the body. If you experience joint or muscle pain as a result of SLE, you may be prescribed a NSAID to help ease your symptoms.

Commonly prescribed NSAIDs for SLE include ibuprofen, naproxen and diclofenac.

You can buy some NSAIDs, such as ibuprofen, over the counter. These NSAIDs may be suitable if your joint or muscle pain is mild. For more severe pain, you will need stronger medication prescribed by your GP.

NSAIDs may not be suitable for people who have stomach, kidney or liver problems, or have had these problems in the past. They may also be unsuitable for people with asthma. Your GP will advise about which NSAID is right for you.

Side effects

If taken in high doses or over long periods of time, NSAIDs can damage your stomach lining, which may cause internal bleeding.

If you need to take NSAIDs on a long-term basis, your GP will carefully monitor you to check for any problems, and you may be prescribed an additional medication called a proton pump inhibitor (PPI) to protect your stomach.

Hydroxychloroquine

Hydroxychloroquine is a medicine that has been used to treat malaria, but is also effective in treating some of the symptoms of SLE, such as rashes, joint and muscle pain, and fatigue.

You will usually have to take hydroxychloroquine for 6 to 12 weeks before you notice any benefit.

Most expert doctors recommend people with SLE take hydroxychloroquine on a long-term basis as a way of controlling their symptoms, helping to prevent flare-ups and to prevent development of more serious problems from lupus.

Side effects

Side effects of hydroxychloroquine are uncommon, but may include indigestion, diarrhoea, headaches and rashes.

Hydroxychloroquine may also cause more serious side effects in a small number of people. For example, in rare cases, this medicine can cause eye damage. Contact your GP or specialist immediately if you experience vision problems while taking hydroxychloroquine.

If your GP or specialist feels it is necessary, you may need regular eye examinations.

Corticosteroids

Corticosteroids are a type of medicine that help reduce inflammation quickly. They can be very effective in treating symptoms of SLE, but are usually only prescribed if the condition is severe.

If you have severe symptoms of SLE, or if you are experiencing a flare-up, you may be given a large dose of corticosteroids to help bring your symptoms under control. As your symptoms ease, your dosage can gradually be reduced.

Side effects

When prescribing corticosteroids, the lowest effective dosage is always given. This is because high doses or long-term use of corticosteroids can cause side effects. These may include:

Corticosteroids are a safe and effective form of treatment, provided they are taken correctly and under the supervision of your GP or specialist. They will tailor the steroid dose to your disease activity, to minimise side effects while effectively controlling the condition.

Immunosuppressants

Immunosuppressants are a type of medicine that suppress your immune system. They can help improve your symptoms of SLE by limiting the damage your immune system causes when it attacks healthy parts of your body.

Commonly prescribed immunosuppressant medicines include azathioprine, methotrexate, mycophenolate mofetil and cyclophosphamide.

Immunosuppressants are sometimes used in conjunction with corticosteroids (see above) because these medicines may ease your symptoms more effectively when used together. Alternatively, the use of immunosuppressant medication may allow your corticosteroid dose to be reduced.

Side effects

Immunosuppressant medication is usually only prescribed if you have severe SLE. This is because this type of medication is powerful and can cause side effects such as:

• loss of appetite
• vomiting
• diarrhoea
• swollen gums
• bruising or bleeding more easily
• headache
• acne
• extra hair growth
• weight gain
• liver damage
• an increased risk of infection (see below)

Methotrexate, mycophenolate mofetil and cyclophosphamide can also cause birth defects if they are taken during pregnancy, so you should use a reliable form of contraception if you are taking these medications and are sexually active. If you are trying to become pregnant, an alternative medication such as azathioprine can be used.

Tell your GP if a side effect becomes particularly troublesome, as it may mean your dose needs to be adjusted.

Infection risk

Taking immunosuppressant medication can increase your risk of developing an infection. This is a particularly serious concern for people with SLE, because the organ damage that can occur as a result of the condition means infections are more likely to be life-threatening.

It is therefore very important to report any symptoms of a possible infection to your GP immediately.

Symptoms of infection may sometimes be similar to a flare up of SLE and include:

• a fever (high temperature)
• a cough or breathlessness
• burning when passing urine or passing blood in your urine
• diarrhoea

You should also try to avoid contact with anyone known to have an infection – even if it is an infection you were previously immune to, such as chickenpox or measles.  This is because your previous immunity to these conditions will probably be suppressed (lowered).

Rituximab

Rituximab is a new type of medication used in people with severe SLE that doesn’t respond to other treatments.

Rituximab was originally designed to treat certain types of cancer, such as lymphoma, but it has since proved effective in treating a number of autoimmune conditions, such as SLE and rheumatoid arthritis.

Rituximab works by locking on to and killing cells called “B-cells”, which produce antibodies responsible for the symptoms of SLE. It is administered directly into your vein over the course of several hours, known as an infusion.

Rituximab is not currently licensed for treating SLE in the UK, but your specialist may consider it an appropriate treatment for you. If your doctor suggests using rituximab, they should tell you that there are currently some uncertainties about how effective or safe it is in treating SLE.

Side effects

Common side effects of rituximab include:

• flu-like symptoms, such as chills and a high temperature
• dizziness
• vomiting

In rare cases, rituximab can cause a more serious allergy-like reaction. Most reactions occur during or shortly after the treatment is given, so you will be closely monitored once your treatment begins.

Belimumab

Belimumab is a new medication given to people with active SLE who don’t respond to other treatments.

It works by binding to growth factors that are needed for the survival of B-cells. It is given directly into your vein over several hours, known as an infusion. The first 3 doses are given 14 days apart, and the medication is usually given once a month thereafter.

Belimumab is licensed for treating SLE in the UK, and there may be instances where your specialist may consider it an appropriate treatment for you. If your doctor suggests using belimumab, they should tell you that there are currently some uncertainties about how effective or safe it is in treating SLE.

Side effects

Common side effects of belimumab include:

• flu-like symptoms, such as chills and a high temperature
• nausea and diarrhoea
• headache
• difficulty sleeping (insomnia)
• a cough, sore throat and blocked or runny nose
• joint pain
• increased risk of infections
• changes in blood pressure

In rare cases, belimumab can cause a more serious allergy-like reaction. Most reactions occur during or shortly after the treatment is given, so you will be closely monitored once your treatment begins.

Low-Grade Fever: Definition, Causes, Treatments

Most medical experts define a low-grade fever as a body temperature between 99 F and 100.3 F. Others use a less narrow definition, referring to a low-grade fever as a body temperature ranging from 100 F to 102 F.

Your body normally maintains a temperature of about 98.6 F. Research shows that even in healthy people, normal body temperatures can vary by as much as 1.8 degrees F.

Normal body temperature can fluctuate based on several factors. Some of those factors include how your temperature is taken (for example, orally or rectally), what time of day it’s taken (your temperature tends to be higher in the evening than in the morning), and where a person who menstruates is in their menstrual cycle.

Theresa Chiechi / Verywell

Symptoms

Outside of an elevated body temperature, some people with a low-grade fever won’t have any noticeable symptoms. Others may experience:

• Headache
• Fatigue
• Muscle aches
• Sweating
• Chills
• Loss of appetite
• Lower urine output

Causes

A fever, even a low-grade one, is a sign that something is wrong with your body. A fever indicates that your immune system is mounting a defense against a foreign invader, be it a virus, bacterium, or other matter.

Experts aren’t exactly sure why the body responds to infections and illnesses with a raised body temperature, but they think some disease-causing germs are less likely to thrive in higher temperatures. They also theorize that increased body temperatures might better enable certain immune cells to seek out and destroy whatever is attacking the body.

What are the frequent causes of low-grade fevers?

Infections

Both viral and bacterial infections can cause low-grade fevers. Some common culprits include:

• Rhinoviruses (aka the common cold)
• Flu
• Viral gastroenteritis (otherwise known as the stomach flu). Examples of these include the rotavirus, common in babies, and norovirus, which generally affects adults and is highly contagious.
• Measles
• Mumps
• Chickenpox (varicella-zoster virus)
• Rubella (also called German measles)
• COVID-19
• Urinary tract infections
• Pneumonia
• Ear infections
• Strep throat
• Cellulitis, an infection of the skin and the tissues around it
• Escherichia coli (E. coli): While some strains of E.coli, a bacterium that lives in the intestines, are harmless, others can produce serious illness.
• Sinus infections
• Infectious mononucleosis (mono): This is a highly contagious illness, usually affecting teens and young adults, that’s often caused by infection with the Epstein-Barr virus.

Non-Infectious Illnesses

Certain autoimmune diseases, such as rheumatoid arthritis and lupus, can display a low-grade fever. In fact, up to 86% of people with lupus experience fever, usually a low-grade one. 

Some malignant tumors (cancers) can cause cellular changes in the body that produce fevers. What’s more, the chemotherapy used to treat some cancers can destroy your body’s disease-fighting white blood cells, making you more susceptible to infections and the fevers that come with them. 

Other Causes

Other causes of low-grade fever include:

• Stress: Some people, particularly young women, respond to stress with higher core body temperatures. This is known as psychogenic fever.
• Vaccines: Low-grade fever is a common side effect of many vaccines, including the flu shot and childhood immunizations. The fever is a sign your body is building immunity to the disease. Fever can occur in up to 10% of children receiving routine childhood vaccines and up to 70% when receiving multiple vaccines. 
• Sensitivity to certain drugs: Up to 7% of fevers can be attributed to adverse reactions to certain drugs, including antibiotics and drugs that treat seizures.  This type of fever is called a drug fever.

Diagnosis

You may look flushed and feel warm when you have a fever, but the only way to accurately tell what your temperature is to measure it with a thermometer.

Digital thermometers, placed used under the tongue or with the tip inserted into the anus (rectal temperature-taking is recommended for babies and very young children) offer the most reliable readings (change the batteries periodically; weak batteries can cause inaccurate readings).

Thermometers placed under the armpit (called axillary) can give inaccurate readings. The same is true for plastic strip, smartphone temperature apps, and pacifier thermometers.

Thermometers that scan the forehead or are placed inside the ear (called tympanic) are OK to use, but don’t use a tympanic thermometer if you’re taking the temperature of baby younger than 3 months of age or anyone with an ear infection.

One thing you shouldn’t rely on when trying to figure out if a fever is present is touch. It can miss or underestimate fevers in up to 40% of people, even when the fever is as high as 102 F.

Treatment

The general rule of thumb is to treat a low-grade fever only if it’s causing you discomfort. And some experts say that doesn’t happen until a temperature hits 102 F to 103 F and higher. 

There’s also a pretty vocal school of thought that says when you suppress a fever, you also suppress the immune system’s production of disease-busting white blood cells, thereby prolonging the illness.

When you want to treat a low-grade fever, acetaminophen (Tylenol) and ibuprofen (Advil) are good choices (read package directions for proper dosage or ask your healthcare provider).

Aspirin is another option, but never give aspirin to children or teens unless instructed by your doctor. Aspirin use in this age group has been associated with a serious and potentially deadly disorder called Reye’s syndrome.

Self-help measures include:

• Staying hydrated: Fevers can cause your body to lose water (via things like sweating or rapid breathing), increasing the chances you may become dehydrated.
• Resting
• Wearing light clothing
• Eating light, easy-to-digest foods, such as broth-based soups

When to Call the Doctor

Most low-grade fevers run their course in a few days and don’t require medical attention. But definitely call your healthcare provider or make a trip to the emergency room if any of the following apply to you or someone you’re caring for:

• You have a baby under 3 months of age with any fever (don’t give fever-reducing medicines, such as Infants’ Tylenol, without consulting your doctor).
• You have a fever and a stiff neck. This is a symptom of a life-threatening condition called meningitis, which affects the brain and spinal cord.
• You have a fever and a rash. The two combined can indicate some serious conditions, such as toxic shock syndrome and Rocky Mountain spotted fever. 
• You’re feeling dehydrated (signs include dry mouth, dry skin, sunken eyes and dark urine).
• Your child has a fever and experiences a seizure. Fevers—especially ones that rise quickly—can sometimes trigger what’s known as febrile seizures in young children. 
• You feel very sick.
• You have a fever and severe pain or inflammation anywhere in your body.
• You have pain when you urinate or your urine is foul-smelling. This may be a sign of a urinary tract infection (UTI) that needs treatment with an antibiotic.
• You’re disoriented.
• Your fever lasts more than two days.

Prevention

The best way to prevent fevers is to prevent the infections that cause them:

• Wash your hands regularly with soap and water for 20 seconds—particularly after you use the bathroom and change diapers and before you prepare food or eat.
• To help prevent urinary tract infections, urinate before and after sex, drink plenty of fluids, and wipe from front to back after a bowel movement.
• Stay up to date on immunizations. Yes, certain vaccines can cause a low-grade fever in some people. But that can be a small price to pay for the protection they offer from severe or potentially life-threatening diseases.
• Avoid touching your eyes, mouth, and nose, which are prime entry points for germs.

A Word From Verywell

Fevers of any kind can be stressful. But it’s important to remember that most mild fevers are harmless and run their course in a few days or less. If your symptoms are bothersome, you can try over-the-counter fever reducers. Don’t hesitate, though, to call your doctor if you’re worried about any of your symptoms or you simply want to ask for advice and reassurance.

Lupus Fever Explained: Symptoms, Causes and Prevention

One of the most common symptoms of lupus, or Systemic Lupus Erythematosus (SLE), is running a fever. According to Dr. Donald Thomas Jr., author of the Lupus Encyclopedia, approximately 50 to 60 percent of lupus patients develop a fever. In fact, fever is one of the earliest signs of the autoimmune disease.

In the early stages of lupus, many patients report having similar symptoms as the flu.  However, unlike the flu, lupus is often accompanied with other symptoms like dry eyes, mouth sores, hair loss, weight loss (and gain), etc.

Running a fever is considered as a normal symptom of SLE, but when should it be a cause of concern?

Lupus patients typically experience a chronic, low-grade fever

A healthy human being’s temperature should be 37 degrees Celsius or 98.6 degrees Fahrenheit. Though temperature varies from one person to the other, this temperature is considered as universally normal. If the temperature goes up to about 37.5 degrees Celsius or 99.6 degrees Fahrenheit, it is considered to be a fever.

For a person living with lupus, if the temperature goes up by one or two degrees from the normal temperature, he or she is said to be running a chronic low-grade fever. If there are no other symptoms such as mouth sores or muscle aches, then the fever might be a sign of another disease.  If, however, it goes beyond 38.9 degrees Celsius or 102 degrees Fahrenheit, there is a cause for worry, especially if other lupus symptoms are present.

Lupus patients experience a fever with infections and flares

A lupus patient can lead a normal life with the right treatment and lifestyle, but patients are still exposed to flares. The patient will most likely run a fever when he or she experiences a flare. In lupus, the body’s immune system attacks various cells in the body, causing them to fail. This makes lupus patients vulnerable to getting infections.

The medications that are usually given to these patients, which include large doses of aspirin, corticosteroids, nonsteroidal anti-inflammatory drugs (NSAIDs) and immunosuppressive drugs, also expose them to various infections, like respiratory and urinary tract infections Symptoms of an infection such as nausea, diarrhea, breathing troubles, swelling and cramping are often accompanied by a high fever.

In lupus patients, the immune system is not able to differentiate a healthy cell from a non-healthy cell. This makes identifying infections in lupus patients complicated. According to studies, infections are among the number one causes of death in lupus patients.

When a patient is exposed to other serious symptoms, see a doctor

Usually, the drugs prescribed to patients suppress the fever. While a patient might feel sick and show other signs, a temperature should be in the normal range.

A fever in lupus will often lead to a loss of fluids through diarrhea and vomiting. These two conditions dehydrate bodies at a rapid rate. When a patient experiences dehydration, it can also be a sign of a dangerous response in the patient’s immune system. Patients should ensure that they take in enough fluids to keep their body hydrated.

How to avoid a fever in lupus patients: Preventing infections and lupus flares

Treating infections in a lupus patient can be complicated and difficult, especially because certain medications cause severe reactions in patients. Also, it might be safe to say that the number one cause of a fever in lupus patients is an infection. However, flares may also cause a fever. If patients can avoid infections and reduce their risk of getting one, they might be able to keep their at bay. Reducing flare triggers can also help reduce a fever.

Here are a few things patients can do to reduce their temperature:

• Stay away from anyone who has an infection: This goes without saying. If you know someone has an infection, stay away from them You do not want to increase your chance of getting sick.
• Observe Hygiene: Infections and poor hygiene go hand-in-hand. Patients can keep infections away by observing simple routine of hygiene, like washing their hands. Making sure your hands are thoroughly cleaned, along with your surroundings, can help you avoid infections

• Prompt treatment of bruises and cuts: Patients are prone to cuts and bruises, which can pick up germs when they come into dirty surfaces. If you have a cut or a bruise, treat it immediately.

• Immunization: Make sure to get all your vaccines when you need them. Consult with your doctor about the available immunizations that you need.

• Stay healthy: Eat a balanced diet and exercise when you can. By maintaining a healthy lifestyle, you are improving your immune system.

• Consult a doctor before certain procedures: There will be times when a lupus patient needs a surgical or dental procedure done on them. These two will expose them to infections. The patient should consult his or her doctor before undertaking such procedures. The doctor will prescribe a preventive antibiotic that they can use to prevent such infections.

• Avoid Germs: Germs are everywhere, and they are the number one cause of infections. Lupus patients should avoid any item that is capable of harboring germs,dirty kitchen sponges and rags.

• Avoid stress: Avoiding stress is also helpful, especially if the person is battling a chronic disease like lupus. Lupus patients can talk to their doctors to recommend a safe drug that can help them manage stress or talk to a professional, such as a counselor.

• Stick to the prescribed medication: Altering the way a doctor has prescribed medication can be bad for the patient. If you feel the need to change any drug or include another supplement or herbal treatment, check with your doctor first.

• Avoid sunlight: Prolonged exposure to sunlight, fluorescent, and halogen lights is harmful for lupus patients. If you have to be exposed to the sun, use a sunscreen with an SPF of 70 and wear protective clothing.

Systemic lupus erythematosus “Lakhta Clinic

Systemic lupus erythematosus

Systemic lupus erythematosus (SLE, lat. Lupus erythematodes, ie, “wolf’s redness”, in English-speaking sources is often used simply “lupus”) – one of the most famous autoimmune disorders. In diseases of this kind, the immune system aggressively attacks and tries to destroy the tissues of its own body, instead of protecting them from foreign proteins.The historically well-established name is associated with the characteristic symmetrical red butterfly-shaped rash (“wolf bites”), which appears with SLE, gradually worsening, on the bridge of the nose, cheekbones and cheeks. According to another version, the modern name goes back to medieval France, where many women wore wolf-shaped masks in order to hide the traces of dermatoses, which were very common in those days, primarily infectious. In any case, the diagnosis of lupus erythematodes was introduced into the medical lexicon by the French physician, the famous dermatologist Pierre Caznav (1851).In the future, several outstanding doctors were engaged in the study of this disease (in particular, the founder of the Vienna dermatological school Ferdinand von Gebra and his no less famous son-in-law Moritz Kaposi, after whom malignant hemorrhagic sarcomatosis, or Kaposi’s sarcoma is named). In 1895, the legendary Canadian, author of many key medical discoveries and still relevant aphorisms, one of the four founding fathers of the American Johns Hopkins Clinic, Sir William Osler (he was awarded a title of nobility in Great Britain) for the first time described in detail complications from internal organs. showing that an erythematous rash on the face is not an obligate symptom of lupus erythematosus: in this disease, in the absence of a rash, pathology of the joints, lungs, muscles, heart, etc.can develop.e. The autoimmune nature of SLE was established in the middle of the twentieth century thanks to the research of specialists of the world famous today Mayo Clinic (USA).

Thus, systemic lupus erythematosus is not a dermatological, but a rheumatic disease; this is collagenosis, i.e. the progressive pathology of the connective tissue throughout the body.

The global prevalence of SLE is estimated at 2-7 people per 10,000 population, i.e. it is the most common of all collagen diseases (the second place is occupied by etiopathogenetically related systemic scleroderma). Annual incidence, i.e. the number of new diagnosed and confirmed cases, for unknown reasons, fluctuates over time and, in addition, varies according to gender, ethnicity and region of residence. Thus, people of European descent are generally less likely to get sick than people of other races and nationalities (the highest frequency of occurrence has so far been noted among representatives of the Afro-Caribbean ethnic group). Women suffer several times more often than men; this is a general trend in autoimmune diseases.The peak incidence occurs in middle age, although there are also childhood forms that usually manifest in the age range from 3 to 15 years.

Reasons

The etiology of systemic lupus erythematosus remains essentially unknown. Domestic sources consider neuroendocrine imbalances and the activity of herpes viruses as the most probable reasons (most patients have 4 subtypes, i.e. Epstein-Barr virus), Western sources – hereditary predisposition combined with exposure to provoking environmental factors and vitamin D deficiency.

Symptoms

Systemic lupus erythematosus in most cases manifests with symptoms that, it would seem, have nothing to do with a specific clinic of collagenosis, namely: general malaise, low-grade body temperature, asthenic syndrome, rapid weight loss. Obviously, on the basis of the listed symptoms alone, several thousand diseases can be assumed. However, characteristic changes in the skin soon appear, Raynaud’s syndrome, musculoskeletal pains and other symptoms, sometimes completely unexpected against the background of recent full health (for example, “causeless” psychopathological phenomena in the form of asthenic-depressive symptom complexes, explosiveness, irritability, expressed to a paradoxical degree mood swings, etc.NS.).

Joint lesions, photodermatoses, cardiovascular disorders, nephropathies, gastrointestinal tract dysfunction, etc. are very typical. Connective tissue, as is known, accounts for most of the body weight; it forms the stroma (histological framework, basis) of all specialized organs, and wherever this tissue is present, with collagenoses, clinically significant disorders develop over time

The proportion between them may be different, however, specific erythema (not being, as shown above, a strictly obligatory symptom) occurs in the vast majority of patients.

Diagnostics

SLE is diagnosed mainly clinically and laboratory: there are sufficiently informative criteria to establish the correct diagnosis and differentiate it from symptomatically similar diseases. However, at the earliest stages, this is quite problematic, which often leads to an erroneous diagnosis of syphilis, photodermatosis, atopic dermatitis, etc. Instrumental studies are prescribed as needed – to assess the state of internal organs.

Treatment

The primary task is the prevention of severe complications, the maximum possible preservation of the quality of life and its normal duration. It is necessary to observe a certain sparing regimen (in particular, avoid direct sun exposure, alcohol consumption, provoking exacerbation of emotional upheavals, etc.).

In terms of drug therapy, the drugs of choice are glucocorticosteroid hormones and non-steroidal anti-inflammatory drugs.In recent years, stem cell therapy, various detoxification procedures, and inhibitors of the inflammatory cytokine TNF (the so-called tumor necrosis factor) have been widely and successfully, even in severe cases, used. In general, to date, systemic lupus erythematosus in most cases can be taken under reliable therapeutic control – with timely seeking help, prescribing adequate comprehensive treatment and patient compliance with all medical prescriptions.

Rheumatology | www.vashdoctor76.ru

Reception is conducted by a rheumatologist Petrova Lyudmila Olegovna

Who is a rheumatologist?

A rheumatologist is a doctor who diagnoses and treats diseases associated with damage to the musculoskeletal system, heart (acquired heart defects), systemic connective tissue diseases, joint diseases (rheumatism, rheumatoid arthritis, systemic lupus erythematosus, vasculitis, etc.).

What diseases does a rheumatologist treat?

Doctor-rheumatologist treats more than a hundred diseases affecting connective tissue and joints.In addition, rheumatology studies systemic diseases (when, in addition to connective tissue, internal organs are affected).

• rheumatic arthritis
• ankylosing spondylitis (ankylosing spondylitis)
• acute rheumatic fever
• gouty arthritis
• rheumatism
• juvenile (juvenile) rheumatoid arthritis
• systemic slroderma
• acquired rheumatic heart defects
• Raynaud’s phenomenon (lesion of the small arteries of the fingers)
• osteoporosis
• systemic lupus erythematosus
• bursitis (periarticular soft tissue disease)
• systemic vasculitis
• psoriartic arthritis
• systemic lupus erythematosus
• systemic vasculitis
• polymyalgia rheumatica
• giant cell arthritis
• polymyositis
• dermatomyositis
• juvenile rheumatoid arthritis
• erythema nodosum

When should I see a rheumatologist?

If for at least 1-2 weeks:

• Joint pain persists
• There is stiffness in the morning and it takes at least 30 minutes to “stretch” the joints for more comfortable movement
• a feeling of stiffness in the back, especially in the lumbosacral region in men
• there is a high body temperature
• there is deflection of the joints due to bone changes, swelling or swelling in the area of ​​the joints
• the joint feels warmer than the surrounding tissue to hot
• pain, muscle aches, weakness in the limbs
• knotty formations from pink to purple-cyanotic on the skin
• recently, at least 1 month. , previous acute intestinal infection, urogenital infection
• redness of the cheeks and forehead, no tendency to decrease
• areas of skin tightening, with impaired sensitivity, change in appearance
• Reduced growth and bone fractures
• the appearance of striae, stretch marks on the skin without prior weight loss or pregnancy
• acute headaches with a clear localization, especially in combination with low-grade fever or pouring sweat, or weakness
• the above symptoms in various combinations, or after provoking factors
• obstetric pathology in the form of miscarriage, spontaneous abortion
• among blood relatives of the presence of rheumatic disease and the appearance of similar symptoms, then one should suspect a possible manifestation of rheumatological disease and consult a rheumatologist for examination.

What examinations can a rheumatologist prescribe?

• Clinical blood test.
• Biochemical blood test.
• Rheumatoid factor.
• Antinuclear antibodies (ANA).
• Antibodies to double-stranded (native) DNA.
• ADC.
• Anti-MCV.
• Ultrasound of the joints.
• Analysis of synovial fluid.
• X-ray of the bones of the skeleton and joints.
• Computed tomography of the joints (CT).
• Isotope scanning of the skeleton.
• Magnetic resonance imaging (MRI).
• Densitometry.
• Diagnostic joint puncture with biopsy.
  Arthroscopy.
• Electrocardiogram (ECG).
• Echocardiography (Echo-KG, ultrasound of the heart).

The need for certain examinations in each individual case is determined by the doctor.

When examining a patient with suspected rheumatological disease, it is often necessary to consult other narrow specialists, i.e.This is because the rheumatological sphere constantly merges with different fields of medicine, where similar syndromes can occur (cardiology, phthisiology, oncology, infection, hematology, etc. ). This is the insidiousness of rheumatology, that the disease does not always manifest itself with a set of symptoms and syndromes characteristic of it, and in most cases it disguises itself as others. Therefore, rheumatological patients need to stock up on great patience, punctuality and discipline when following the recommendations and prescriptions of a rheumatologist, because the choice of drugs will depend on the accuracy of the diagnosis.Up

PHOTO PIXABAY.COM

Body temperature is one of the most important indicators of the state of the body. However, each of us has our own rate of this indicator, which varies depending on gender, age, time of day, and in women also the days of the menstrual cycle.

– Doctors distinguish between subfebrile temperature – 37.0-37.9 ° C, febrile – 38.0-38.9 ° C, pyretic – 39-41 ° C, – says the general practitioner of the 32nd city clinical outpatient clinics in Minsk Elizaveta Petrovskaya. – It is believed that the difference in thermometer readings from 36. 4 to 37.0 is the norm. At the same time, there is a certain list of conditions in which an increase in temperature to 37.2 should also not cause concern: evening fatigue, stressful situation, overheating when being in a stuffy room or in the sun, the middle of the menstrual cycle in women. Sometimes the body reacts in this way to taking a new medicine.

Insignificant – by 0.5-1 degrees – temperature rise can cause any infectious inflammation, even ordinary caries.This is how the body is trying to cope with the roaming viruses and bacteria

The subfebrile temperature can also rise and stay for a long enough period in case of chronic pathological processes in the body, the specialist says. In this case, if your condition is accompanied by additional symptoms characteristic of the disease, but there is no cough, sore throat, pain when swallowing, headache, bone aches or a runny nose, it is better to consult a doctor as soon as possible for a more detailed examination and testing . ..The reasons for an increase in body temperature in such cases may be tuberculosis (for its diagnosis, it is recommended to undergo fluorography once a year), urinary tract infections (you may experience pain and discomfort when urinating, frequent urge to go to the toilet, pain in the lower back or in the sides), low maintenance iron in the body.

Thyrotoxicosis, an increased production of thyroid hormones, can also cause low-grade fever. In this case, the disease is usually accompanied by rapid fatigue, nervousness, heart palpitations, hot flushes, and changes in weight.In the presence of such symptoms, an endocrinologist’s consultation is necessary. In addition, such an “innocent” indicator of 37 degrees sometimes indicates the presence of autoimmune (lupus, multiple sclerosis, rheumatoid arthritis) and cancer. It is important to listen to your body: maybe for some time you have been experiencing incomprehensible painful sensations throughout the body, your weight has begun to dramatically decrease and sweating has increased. It is impossible to ignore these symptoms: it is better to consult a doctor as soon as possible and undergo an examination.

If the reason for a slight increase in temperature is only a cold or a viral infection that has entered the body, a much clearer picture emerges: sore throat, cough, runny nose, urge to sneeze. Many, at the first such symptoms, sweep anti-inflammatory, analgesic and antipyretic drugs from pharmacy shelves in order to attack the incipient disease and bring down the temperature.

– This is a big mistake: an increase in body temperature to subfebrile levels occurs under the influence of pyrogens – active substances synthesized in response to toxins, irritants and pathogenic bacteria.Pyrogens irritate certain areas of the hypothalamus, in which the heat-regulating center is located, which, as a result, leads to an increase in body temperature. In fact, fever in both adults and children is a protective reaction in response to pathological reactions occurring in the patient’s body. In simple terms, at such a temperature, we develop specific immunity, which helps to cope with the disease as soon as possible, – explains Elizaveta Petrovskaya. – Therefore, a competent approach to the treatment of colds is to start taking an antiviral drug on the very first day after the onset of the disease (which one, you can ask your doctor or consult a pharmacist at a pharmacy) and vitamin C.Do not forget to gargle with furasol, best of all, as it creates a film on the tonsils and prevents the infection from entering the respiratory tract. But with soda, you should be careful: according to the latest data, it dries the mucous membrane of the tonsils, which adversely affects the reproduction of beneficial bacteria and the creation of immune microflora. Also remember that inhalations and heating pads are not the best helpers in this case: in the presence of temperature, thermal physiotherapy procedures are contraindicated, they can be prescribed exclusively for the treatment of the disease.

Infection enters our body in different ways, including through the nose, so do not be lazy to rinse with saline solutions up to 7 times a day. This will have a beneficial effect on treatment, in contrast to the vasoconstrictor agents that we instill so that the nose breathes: they do not cure the disease, but only remove one of its symptoms – a runny nose, and are often addictive. Try not to use them for more than 3-4 days and be sure to avoid hypothermia.

Only if, despite all the measures taken, the subfebrile temperature lasts longer than 4 days, you need to see a doctor.

GOOD TO KNOW

Do I need to warm up the sinuses of a stuffy nose with a bag of salt or a hard-boiled egg in case of a cold?

Doctors assure that this is not worth doing. The problem is that the nose lays down for absolutely different reasons: at an early stage of the development of the disease, it may be associated with swelling of the nasal passages, at later stages – with sinusitis (inflammation of the mucous membrane of one or more sinuses). With a viral infection, trying to warm up the sinuses can increase the spread of viruses.In addition, if the disease is accompanied by sinusitis, warming up is categorically contraindicated: it will only aggravate the purulent process.

BTW

• It is necessary to distinguish between antiviral drugs and antibiotics. The latter act not on viruses, but on bacteria, destroying them or preventing reproduction. An uncomplicated cold is caused only by viruses, so you should not treat it with antibiotics, so as not to disturb the microflora once again. Pathogenic bacteria appear in the body already weakened by viruses, if the cold has not been treated in time.

• The virus in the human body reproduces in the following way: it attaches to a healthy cell, and then is absorbed by it. Inside the cell, the virus multiplies, simultaneously destroying it. Antiviral drugs prevent the cell from fusing with the virus (blocking the fusion), which prevents the infection from spreading. Therefore, treatment is more effective at the initial stage of a cold, at the first symptoms.

90,000 treatment and diagnosis of causes, symptoms in Moscow

Rheumatoid arthritis is the most common inflammatory disease of the joints, characterized by erosive symmetric polyarthritis in combination with systemic immunoinflammatory damage to internal organs (lungs, liver, heart, peripheral nervous system, skin).One of the most severe and common inflammatory diseases of the joints. Rheumatoid arthritis is a common disease that occurs in all countries and among all peoples of the world in about 1% of the total population, in Russia it affects about 0.6% of the population. Both a child and an old man can get rheumatoid arthritis, but women of active age are more likely to get sick (women get rheumatoid arthritis 3 times more often than men). The peak of the onset of the disease occurs at 40–55 years.

The cause of the disease is unknown. It is only known that some people are genetically predisposed to rheumatoid arthritis, but the disease is not transmitted from parents to children directly. Smoking has been shown to increase the risk of developing rheumatoid arthritis. In 20-30% of patients, the disease begins after a previous infection, most often nasopharyngeal infection. However, a long-term search for a specific microorganism that causes rheumatoid arthritis has not led to success, so there is no reason to consider this disease infectious.Another significant factor provoking the development of the disease is strong emotional stress (quarrels, divorces, exams, etc.). At the same time, in about a third of patients, the first symptoms appear in full health, for no apparent reason.

It has been established that the inflammation in RA is based on the malfunctioning of the immune system. For some reason, the cells of the immune system are activated and begin to produce special regulatory proteins – pro-inflammatory cytokines – that cause an inflammatory reaction and disruption of the functioning of the cells of the joint membrane, the inner lining of blood vessels, bone tissue, etc. As a result, a self-sustaining constantly ongoing inflammatory process is formed. Inflammation in RA is a consequence of the excessive, too active (albeit improper) work of the immune system. Therefore, rheumatoid arthritis can be attributed to the group of autoimmune diseases – that is, conditions when the immune system is actively working against its own body.

Manifestations and course of the disease

The main manifestation of the disease is pain and swelling in various joints, primarily the joints of the fingers of the hands.Symmetrical lesion of the small joints of the hands and feet is characteristic. Pain increases during movement and at rest, morning stiffness, swelling, dysfunction of the joints. Over time, the process may involve the feet, ankle, knee, elbow joints. In some patients, on the contrary, the joints of the legs (knee, ankle), shoulder joints, and only then – of the arms may be affected first. Chronic inflammation of the joint leads to the destruction of the articular cartilage and deformation of the joint, which in turn disrupts its function – there are pains during movement and stiffness.

Diagnostics

The diagnosis is made after interviewing the patient, examining the condition of the joints.

Additional examination:

• general blood test – characterized by a decrease in hemoglobin levels, accelerated ESR.
• rheumatoid factor, antibodies to cyclic cetrillinated peptide (ACCP).
• biochemical parameters – AST, ALT, urea, creatinine. They are necessary to assess the safety of prescribing therapy and in the future its tolerability
• Radiography of hands and feet.Erosive changes characteristic of rheumatoid arthritis develop primarily in these joints, but not earlier than 6 months. To monitor the condition of the lungs and heart, a chest x-ray is done, and for special indications, a computed tomography of the lungs. MRI or ultrasound – especially if the disease is at the initial stage, when the external deformity of the joints is not so noticeable, and it is important to track minor changes.

Of course, the earlier the patient seeks medical help, the more favorable the prognosis for the course of the disease. If you notice problems with joints in yourself or your loved ones, do not postpone contacting a specialist. This is a serious disease that is irreversible, i.e. the longer the patient delays to see a doctor, the more damage it causes to the quality of his own life, even after a course of treatment in the future.

Treatment of rheumatoid arthritis

The doctors of our center are very attentive to the management of patients with rheumatoid arthritis, because the progression of this disease can lead not only to a decrease in the quality of life, but also to disability, serious restrictions on movement, especially given the older age of most patients.

The task of the attending physician is to stop, i.e. eliminating pain and establishing control over the course of the disease: even if it is impossible to return the condition of the joints to the defeat, then progression can be prevented. We warn our patients that the treatment of rheumatoid arthritis can be lifelong: periodic visits to the doctor will be required for consultation and treatment that will maintain the condition of the joints in an unchanged state. Only proven, proven methods are used.

Therefore, only proven, proven methods are used. First of all, this is drug therapy, which is aimed at quickly relieving inflammation in the joints or in the body, if it has spread to other organs. For the effectiveness of treatment, some drugs (for example, glucocorticosteroids) are administered intra-articularly. Non-steroidal anti-inflammatory drugs are used, pain relievers, to relieve severe pain symptoms.

The mainstay of treatment for rheumatoid arthritis is the prescription of basic anti-inflammatory drugs (DMARDs), such as methotrexate, leflunomide, sulfasalazine. Drugs in this group are able to suppress inflammation and pathological activation of the immune system. Due to this, not only the manifestations of inflammation are suppressed, but also the process of destruction of the tissues of the joint. In recent years, we have begun to use the so-called genetically engineered biological drugs. These are modern drugs that have a point effect on the key links of the inflammatory process.They are human or animal antibodies to inflammatory mediators. Highly effective drugs.

For the convenience of our patients, the department of rheumatology has been equipped with all the necessary medical and diagnostic equipment, its own laboratory is also successfully functioning, and not only standard physiotherapy is available for rehabilitation, but also massage courses, acupuncture, therapeutic gymnastics courses – and all this within one center under sensitive guidance of specialists.

Publications in mass media

Almost any term in Latin with the ending “it” means inflammation: bronchitis – inflammation of the bronchi, tonsillitis – inflammation of the tonsils, etc.e. Myocarditis – inflammation of the muscle tissue of the heart. Akin to inflammation of any skeletal muscle after stretching or hypothermia, which is manifested by pain, muscle dysfunction, local edema and redness, pain also occurs in the heart muscle, decreased contractility. Due to inflammation, the current of impulses through the conducting system of the heart slows down – a blockade develops, heart rhythm disturbances.

Myocarditis can occur in any acute or chronic sluggish infectious disease.Most often, myocarditis develops with viral infections. Non-infectious factors that cause myocarditis include some drugs, including antibiotics, sulfonamides, etc., as well as vaccines and vaccinations. In addition, myocarditis is often associated with systemic connective tissue diseases, for example, systemic lupus erythematosus, rheumatoid arthritis, vasculitis. Among the causes of myocardial inflammation, a special place is given to rheumatism, in which myocarditis is one of the main and leading manifestations of the disease along with endocarditis and pericarditis – inflammation of the inner and outer lining of the heart, respectively.

Also, idiopathic (that is, without an obvious known cause) myocarditis, which is called Abramov-Fiedler, is isolated. At the same time, in the classical course of the disease, according to the examination and blood tests, the infection that provoked inflammation of the myocardium is not detected.

Acute, subacute and chronic myocarditis are distinguished along the course. In a chronic course, depending on the frequency of relapses, the function of the heart can be significantly reduced and chronic heart failure develops.

Quite often, myocarditis is not accompanied by significant symptoms of the disease and is recognized only by instrumental examination, sometimes carried out for another reason. Complaints can be limited to general weakness, chest discomfort, palpitations, a slight increase in body temperature – nonspecific complaints in which not everyone goes to the doctor, and almost no one comes to the cardiologist.

In typical, clinically pronounced cases, complaints of prolonged, not related to physical activity, pain in the heart, weakness, increased fatigue, shortness of breath and palpitations even at rest, interruptions in the work of the heart are characteristic.Body temperature is often subfibril: 37-37.90C.

Myocarditis begins against the background of an acute infectious disease or soon after. The malaise intensifies and the above complaints appear. Sometimes the pain in the heart is persistent and long-lasting. Body temperature is normal or slightly elevated The severity of symptoms is determined by the prevalence of the inflammatory process in the myocardium – how much of the heart muscle is involved in inflammation and starts to work worse – to contract.Due to a decrease in myocardial tone, the size of the heart increases, the normal functioning of the valves is disrupted, and cardiac output decreases. Myocarditis can be complicated by the development of acute heart failure – a reason for emergency hospitalization and intensive care.

Myocarditis can occur in two clinical forms: infectious-toxic (heart lesions appear during a period of severe intoxication against the background of an infection) and infectious-allergic (an infectious agent triggers an excessive immune response of the body and its own immune cells begin to fight and destroy their own cells in different organs, including the heart, which in a number of ways are a bit like bacteria and viruses.Therefore, immunity cannot distinguish body cells from harmful microbes. That is why infectious-allergic myocarditis can occur and continue after the end of the infectious process that caused it.

Idiopathic myocarditis

Idiopathic myocarditis, in which there is no clear established cause of the development of inflammation in the myocardium, is characterized by a more severe, sometimes fulminant course with the rapid development of a large “flabby” heart and heart failure.Without timely assistance, most often, such myocarditis is fatal or requires an urgent heart transplant, which, unfortunately, is not always possible in our country. In a large heart, blood flow is significantly slowed down, the work of the valves is disrupted, and cardiac output decreases. The walls of the heart are stretched so much that even after successful treatment, changes in the myocardium may be irreversible. In idiopathic myocarditis, both rhythm disturbances and the formation of blood clots inside the heart due to its expansion and turbulent blood flow, which can enter the brain and lungs, are deadly, leading to fatal thromboembolic complications – pulmonary heart attacks, strokes, etc.d.

Myocarditis in children

Myocarditis in a child, as well as in an adult, occurs as a result of an infectious factor. In children, due to the failure of the immune response to a number of bacteria and viruses, with which adults are more “familiar”, even a mild infection can lead to generalization – a complication from other organs, more often the heart and kidneys. For childhood, the presence of two types of myocarditis is characteristic:

1. Congenital – in this case, from the day of his birth, the child shows lethargy, pallor, shortness of breath, ECG changes, low blood pressure, weak sucking reflex, etc.The child is not gaining weight. Jaundice is prolonged due to insufficient blood supply to the liver. The situation requires immediate treatment. Most often, this condition is associated either with an intrapartum infection – then antibiotics are quite effective and the process is reversible. If congenital myocarditis is associated with impaired immunity and flows as part of an autoimmune process, the treatment is more complicated, the prognosis is worse, and deaths are possible.

2. Acquired. This type of myocarditis, like in adults, is subdivided into acute, subacute and chronic, is a consequence, most often, of ARVI.The child’s appetite decreases, there is anxiety during the day and sleep disturbance at night, episodes of cyanosis – (blue face) and shortness of breath, an increase in body temperature. In this case, examination and supervision of a cardiologist is mandatory.

Instrumental examination methods

In the blood test , the level of inflammation indicators increases – leukocytes, ESR, C-reactive protein, etc., but, unlike a common infection with myocarditis, the level of enzymes in the blood increases – MV-CPK and troponin.These enzymes are normally found inside the muscle cells of the heart. With inflammation, which leads, among other things, to a violation of the integrity of cell membranes, enzymes enter the bloodstream and their level is proportional to the number of damaged cells. This happens when the myocardium is inflamed or damaged during a heart attack.

According to ECG , certain changes characteristic of myocarditis, although often difficult to distinguish from ischemic ones, are recorded. Almost always, with myocarditis, the ECG reveals cardiac arrhythmias and conduction disturbances.

Ultrasound of the heart – decrease in myocardial contractility, expansion of heart cavities, accumulation of fluid around the heart and other specific changes.

Forecast

With Abramov-Fiedler’s myocarditis, myocarditis against the background of sepsis (the most severe generalized infection and damage to almost all organs), the prognosis for life is unfavorable – mortality is up to 50-60%.

In case of infectious myocarditis, with timely and adequate treatment, in most cases, myocarditis is asymptomatic and ends in full recovery.Occasionally, ECG changes or heart ultrasound findings will persist for a long time. Most often, there are no signs of myocarditis in 2-3 months after the end of the disease. Other forms of myocarditis with acute and subacute course in at least 1/3 of cases complete with complete recovery, and mortality in Russia reaches 5-10%.

Prevention

Prevention consists in the prevention and timely effective treatment of infectious diseases. If signs of infection appear, you should consult your doctor.Of course, a runny nose can be treated at home, but you cannot distinguish between a “prolonged” runny nose and the onset of an inflammatory process in the heart without a doctor and an elementary examination. It is also important to complete the treatment of infectious diseases. Do not stop early therapy, including antibiotics, even if nothing is bothering you anymore.

If you have had myocarditis, you should be examined and treated with greater care and attention for any, even “harmless” infection. If you are planning to undergo any surgical intervention, including tooth extraction, warts or papillomas on the skin, etc.it is imperative to undergo antibiotic prophylaxis under the supervision of a physician.

Indications for hospitalization

In this matter, everything is extremely simple. Suspicion of acute myocarditis or exacerbation of chronic myocarditis is an undeniable indication for hospitalization. At home, myocarditis is not treated, no matter how severe it is. Severe rhythm disturbances and acute heart failure can develop suddenly, and you miss the moment of starting adequate treatment.

Treatment of myocarditis is carried out exclusively in a hospital with dynamic medical supervision.Antibiotics and anti-inflammatory drugs, including hormonal ones, are prescribed, the pulse rate decreases and, if necessary, drugs are prescribed against disturbances in heart rhythm and conduction.

Cardiologist, Ph.D. Zaykina Alexandra

90,000 Causes of low-grade fever – Medical portal “Healthy Chuvashia”

Causes of low-grade fever

Nothing hurts, but on the thermometer again then 37.2, then 37.7? There is no runny nose, no cough, or any other symptoms of a cold.And this has been going on for more than a week. In the language of doctors, such a temperature (from 37 to 38 degrees) is called subfebrile condition. There are many reasons for low-grade fever.

It is believed that the normal human body temperature is 36.6 degrees, and anything higher or lower is considered a deviation from the norm. But this is not the case. Numerous studies and cases from the practice of doctors have proven that the most common average body temperature is 37 degrees. A decrease or increase in temperature can be influenced by many factors that are in no way related to disease.If you find small fluctuations in temperature up or down, don’t panic. This condition can be caused by natural causes.

Natural temperature fluctuations

representatives of the stronger sex, on average, are slightly “cooler” than women, by about a degree; with age, the temperature gradually decreases; the child’s temperature may rise from long crying or after active play; dishes with the addition of hot spices can slightly raise the temperature and speed up the heartbeat; after eating and after physical exertion, the temperature rises, this is quite natural; in women, fever can be observed during premenstrual syndrome; during the first trimester of pregnancy, the temperature can rise to 37.5 degrees; the difference between evening and morning temperatures can be about a degree – in the morning hours it usually decreases, and in the interval between 18 and 22 hours it rises.

Neuroses and temperature “tail”

Everyone knows the saying “all diseases are from the nerves.” In the case of subfebrile condition, this often turns out to be true. A third of people suffering from temperature fluctuations owe their unpleasant symptom to neurosis. Such stress is most often caused by problems at work or in the family, mental or physical strain. Subfebrile temperature in such cases can be observed for several years. There is a special term that defines this condition – “thermoneurosis”.Most often, adolescents, young women and students are susceptible to thermoneurosis.

Another common cause of subfebrile condition is a temperature tail. When a person has an infectious disease, the temperature may remain elevated for several months after recovery. Sometimes the temperature tail can stretch for six months.

Remember to measure the temperature correctly. The armpit must be completely dry. The thermometer should be knocked down to the “35” mark and kept for at least ten minutes.

Causes of subfebrile condition associated with diseases

There are two main groups of diseases that cause low-grade fever:

1. Non-inflammatory diseases.

Subfebrile condition can cause diseases that are not inflammatory in nature. These include blood diseases, immune and endocrine diseases.

Thyrotoxicosis. With thyrotoxicosis, the thyroid gland releases too much thyroid-stimulating hormone into the bloodstream.In addition to the increased temperature, the patient is worried about nervousness, insomnia, heart palpitations, tremors of the hands, sweating.

Iron deficiency anemia. A low amount of hemoglobin in the blood weakens the immune system, which often leads to such an unpleasant symptom as low-grade fever.

Systemic lupus. It is a chronic autoimmune disease. In the first few weeks after the onset of the disease, fever is the only symptom. After that, symptoms of damage to the skin, joints and internal organs appear.

2. Inflammatory diseases.

Tuberculosis. In the presence of prolonged low-grade fever, the first step is to exclude such a disease as tuberculosis. In addition to subfebrile condition, the patient is worried about weakness, lethargy, chest pains, and a cough that does not stop for more than three weeks.

Infective endocarditis. Inflammation of the inner lining of the heart in the initial stage can manifest itself with only one symptom – increased body temperature.

Chronic focal infection.These include chronic inflammatory processes that are localized in a specific organ: tonsillitis, prostatitis, chronic andexitis and 90 180 90 180 etc. Most people tolerate such diseases without fever, but when the immune system is weakened, low-grade fever occurs.

Chronic infectious diseases. Diseases such as Lyme disease, toxoplasmosis, brucellosis are accompanied by low-grade fever. Very often, an elevated body temperature remains the only symptom of the disease for a long time.

How to determine the cause of low-grade fever

Subfebrile temperature may be due to many diseases, and there is no exact and unique diagnostic method. To find out the cause, you need to seek help from a general practitioner. He will prescribe the necessary tests – blood biochemistry, urinalysis, blood tests for hormones, ultrasound examination of internal organs. Based on the test results, the doctor will prescribe the desired treatment regimen.

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Erythema multiforme – Symptoms, diagnosis and treatment

Erythema multiforme is a self-limiting, potentially recurrent mucocutaneous inflammatory disease of mild severity.

Characterized by bull’s-eye target lesions. They usually appear within 24–48 hours and last 1–2 weeks.

As a rule, is a symmetrical distribution of lesions on the dorsal surfaces of the extensors of the limbs with minimal damage to the mucous membrane.

Erythema is usually associated with an infectious disease rather than drug exposure. The most common associated infections are herpes simplex virus and Mycoplasma pneumoniae. Other less common associated infections include hepatitis B, Epstein-Barr virus, cytomegalovirus, histoplasmosis (with concomitant erythema nodosum), contagious pustular dermatitis (parapoxvirus, which can be transmitted from sheep or goats to humans), coccidioidomycosis, Kawasaki disease, and herpes zoster gardnerell.

Associated drugs include aminopenicillins, docetaxel, tumor necrosis factor-alpha inhibitors, antimalarials, anticonvulsants, and lidocaine injections. Phenylbutazone, triclocarban, paclitaxel, and statins are associated with photoinduced lesions. Vaccines, including vaccines against hepatitis B, smallpox, chickenpox, meningococcal disease, human papillomavirus, hantavirus, and an allergic response to contact allergens, also stimulate the onset of the disease.

Supportive care and treatment of the causative infection remains an essential element of therapy.

Erythema multiforme (ME) is usually an acute, self-limiting, often recurrent mucocutaneous inflammatory disease. It is a hypersensitivity reaction that is associated with certain infections, vaccinations and, less commonly, drugs. The disease is clinically characterized by the presence of target-like lesions, which can be characterized as circular erythematous rings with an external erythematous border and a central blister, between which there is a zone of normal skin tone.They are not at all similar to the target lesions that can also be observed, but are characterized by a lower frequency and absence of blisters in the central part. In general, lesions cover <10% of the total body surface area. Mild symptoms of an upper respiratory tract infection, including low-grade fever, may sometimes occur before or at the beginning of an episode. Orolabial lesions are noted in two thirds of patients; in 40.9% of cases, only lesions of the mucous membrane of the lips are noted. Erosions, blisters, and crusts can occur on any of the mucous membranes and are usually painful.This can lead to difficulty eating and urinating, requiring hospitalization. [1] Lerch M, Mainetti C, Terziroli Beretta-Piccoli B, Harr T. Current perspectives on erythema multiforme. Clin Rev Allergy Immunol. 2018 Feb; 54 (1): 177-84. http://www.ncbi.nlm.nih.gov/pubmed/29352387?tool=bestpractice.com [2] Sokumbi O, Wetter DA. Clinical features, diagnosis, and treatment of erythema multiforme: a review for the practicing dermatologist. Int J Dermatol. 2012 Aug; 51 (8): 889-902.http://onlinelibrary.wiley.com/doi/10.1111/j.1365-4632.2011.05348.x/full http://www.ncbi.nlm.nih.gov/pubmed/22788803?tool=bestpractice.com [3] Grünwald P, Mockenhaupt M, Panzer R, et al. Erythema multiforme, Stevens-Johnson syndrome / toxic epidermal necrolysis - diagnosis and treatment. J Dtsch Dermatol Ges. 2020 Jun; 18 (6): 547-53. http://www.ncbi.nlm.nih.gov/pubmed/32469468?tool=bestpractice.com [4] Trayes KP, Love G, Studdiford JS. Erythema multiforme: recognition and management.Am Fam Physician. 2019 Jul 15; 100 (2): 82-8.