Interview with Dr. Daniel Wallace, Lupus Specialist on Symptoms, Diagnosis, Pregnancy, and Heart Health

Systemic lupus erythematosus, commonly called lupus, is an autoimmune disease that can affect nearly every part of the body. It is also often invisible. A person may look well while living with intense fatigue, joint pain, chest symptoms, headaches, rashes, blood-clotting complications, or pregnancy concerns.

In this interview, Toni Braxton and Dr. Daniel Wallace join Dr. Thais Aliabadi and Mary Alice Haney to explore how lupus is recognized, why diagnosis can take years, what an ANA result does and does not mean, how lupus may affect the heart and lungs, and what thoughtful pregnancy planning can look like. We also cover the importance of listening to persistent symptoms and building a coordinated care team.

Table of Contents

• Lupus Basics: Symptoms, Diagnosis, and the Importance of Being Heard
• Understanding ANA Tests and Autoimmune Workups
• Lupus, Chest Symptoms, Blood Clots, and Heart Health
• Lupus and Pregnancy: What Planning Can Change
• Important Misconceptions About Lupus
• How We Can Advocate for Better Lupus Care

Lupus Basics: Symptoms, Diagnosis, and the Importance of Being Heard

What is lupus?

Lupus is an autoimmune disease, meaning the immune system becomes misdirected and can attack the body’s own tissues. Unlike autoimmune conditions that primarily target one organ or tissue, lupus can involve several body systems. These may include the skin, joints, blood cells, kidneys, heart, lungs, nervous system, and blood vessels.

Systemic lupus erythematosus, or SLE, is the form most people mean when they use the word lupus. Its effects can vary greatly from one person to another. Some people have relatively mild symptoms, such as fatigue, joint pain, and low-grade fever. Others have organ-threatening disease involving the kidneys, heart, lungs, brain, bone marrow, or blood-clotting system.

Why can lupus be difficult to diagnose?

Lupus does not have one defining symptom, one universal blood test, or one predictable pattern. Diagnosis depends on the complete clinical picture: symptoms, physical examination findings, medical and family history, and laboratory evidence. The symptoms can overlap with many other conditions, including chronic fatigue, fibromyalgia, thyroid disease, infections, depression, anxiety, and other autoimmune disorders.

That uncertainty can be exhausting. Toni Braxton’s experience illustrates how a person can spend years seeking answers while serious symptoms are attributed to other possible explanations. Her path to a lupus diagnosis included recurring symptoms, pericarditis, low blood counts, fatigue, body pain, blood-pressure concerns, and episodes of collapse before lupus was identified.

We should treat ongoing symptoms as meaningful clinical information, especially when they are new, recurrent, worsening, or affecting daily function. A symptom diary can help us identify patterns and communicate clearly during appointments.

What are common lupus symptoms?

Lupus symptoms may appear gradually, come and go, or change over time. Common concerns discussed in this interview include:

• Unusual or persistent fatigue that is different from ordinary tiredness
• Body aches and joint pain, with or without visible joint swelling
• Low-grade fevers
• Swollen glands
• Rashes, including rashes triggered or worsened by sun exposure
• Chest pain or pain when taking a deep breath
• Shortness of breath
• Headaches or migraines
• Color changes in the fingers in cold temperatures, which may suggest Raynaud’s phenomenon
• Palpitations or rapid heart rate

None of these symptoms proves that someone has lupus. However, a pattern of symptoms, especially alongside abnormal blood counts, inflammation, kidney findings, clotting concerns, or autoimmune antibodies, deserves medical evaluation.

How should we prepare for a medical appointment when lupus is a concern?

Clear documentation can make it easier for a clinician to see a pattern that may not be obvious in a short appointment. Before a visit, write down:

• When each symptom began and whether it is intermittent or constant
• Possible triggers, such as sun exposure, stress, infections, menstrual changes, or pregnancy
• Photographs of rashes, swelling, or color changes in fingers and toes
• Any episodes of chest pain, breathing symptoms, fainting, or palpitations
• All medications, supplements, and prior test results
• Family history of autoimmune disease, blood clots, miscarriages, or unexplained early illness
• How symptoms affect work, exercise, sleep, mood, and normal responsibilities

It is reasonable to ask whether a referral to an internist or rheumatologist is appropriate when symptoms have persisted without an explanation. People who feel dismissed should seek another evaluation rather than assume the symptoms are not real. For more on the broader problem of women’s symptoms being overlooked, see why women are so often misdiagnosed.

Understanding ANA Tests and Autoimmune Workups

Does a positive ANA mean that we have lupus?

No. An antinuclear antibody, or ANA, result is an important clue, but it is not a lupus diagnosis by itself. ANA positivity can occur in people with different autoimmune diseases, including thyroid disease, rheumatoid arthritis, Sjögren’s syndrome, scleroderma, myositis, inflammatory bowel disease, and celiac disease. It may also occur in people who do not have an autoimmune disease.

In practical terms, a positive ANA is a reason to look more closely at symptoms, examination findings, and additional testing. It should not be treated as proof of lupus, and it should not be ignored when someone has symptoms that suggest autoimmune disease.

What tests may be part of a lupus evaluation?

The exact workup should be individualized. A clinician may begin with a thorough physical examination and a review of the skin, joints, lymph nodes, heart, lungs, and neurologic symptoms. Depending on the situation, testing may include:

• Complete blood count to assess white blood cells, red blood cells, and platelets
• Blood chemistry panel to evaluate organ function
• Urinalysis and urine protein testing to look for kidney involvement
• ANA and more detailed antibody panels
• Antiphospholipid antibody testing when there is a history of clots, recurrent miscarriage, or certain pregnancy complications
• Electrocardiogram, echocardiogram, or chest imaging when symptoms or history suggest heart or lung involvement

Kidney evaluation is particularly important. Protein in the urine can signal kidney involvement, even when a person does not feel obvious kidney-related symptoms. Baseline assessments create a useful starting point for monitoring changes over time.

Can someone have autoimmune symptoms without meeting lupus criteria?

Yes. Some people have symptoms, antibodies, and a response to treatment but do not meet formal criteria for lupus or another named connective-tissue disease. This may be described as undifferentiated connective tissue disease or subclinical autoimmunity.

These labels do not mean that symptoms are imagined or unimportant. They mean the condition does not fit neatly into one diagnostic category at that point in time. Continued follow-up can be valuable because autoimmune disease can evolve.

Lupus, Chest Symptoms, Blood Clots, and Heart Health

Can lupus affect the heart and lungs?

Yes. Lupus can affect the cardiovascular and respiratory systems in several ways. Pericarditis, or inflammation around the heart, can cause chest pain. Pleurisy, inflammation around the lungs, may cause pain that worsens with deep breathing. Lupus may also be associated with blood-clotting problems, vascular inflammation, and coronary artery concerns.

Chest pain is never something we should casually self-diagnose, especially for someone with lupus or a history of cardiovascular disease. A normal initial test does not automatically explain away recurring symptoms. Medical professionals must evaluate the individual situation and decide what additional testing is needed.

What are antiphospholipid antibodies and why do they matter?

Antiphospholipid antibodies are antibodies associated with an increased tendency to form blood clots in some people. In this discussion, clotting risk was described as “sticky blood,” a simple way to explain that clots can form in veins, arteries, the lungs, or placental blood vessels.

Not everyone with antiphospholipid antibodies has antiphospholipid syndrome. The syndrome generally involves both relevant antibodies and a clinical event such as a blood clot or a pregnancy complication. This distinction matters because management depends on the person’s history, antibody profile, pregnancy status, and overall clotting risk.

When should chest symptoms or possible clot symptoms be treated as urgent?

We should seek urgent medical evaluation for new, severe, or worsening chest pressure or pain, shortness of breath, fainting, coughing blood, sudden one-sided leg swelling, new neurologic symptoms, or a rapid heartbeat with concerning symptoms. A severe or unfamiliar headache can also require prompt evaluation, particularly when there is a personal history of clotting risk.

Lupus can make people accustomed to discomfort, but becoming used to symptoms can create risk if a new problem is mistaken for an old one. A helpful rule is to take symptoms seriously when they are different from baseline, more intense than usual, persistent, or associated with breathing, circulation, neurologic, or fainting concerns.

Lupus and Pregnancy: What Planning Can Change

Can people with lupus have a healthy pregnancy?

Yes. Many people with lupus have successful pregnancies and healthy babies. The best outcomes usually begin with preconception planning, disease control, medication review, and coordinated care involving rheumatology and obstetrics. Pregnancy with lupus is often considered high risk because complications are more likely than in the general population, not because a good outcome is impossible.

One of the most important principles is to avoid trying to conceive while lupus is active or uncontrolled whenever possible. Active inflammation can make conception more difficult and may increase the chance of complications after pregnancy begins. The priority is to control disease activity first, then plan pregnancy with the appropriate specialists.

Our detailed resource on autoimmune disorders and high-risk pregnancy explains how care is coordinated for lupus, antiphospholipid syndrome, rheumatoid arthritis, immune thrombocytopenia, and related conditions.

Does lupus cause infertility?

Lupus itself does not automatically cause infertility. When lupus is minimally active or in remission, fertility may be normal. However, active inflammation can make pregnancy more difficult to achieve, and some medications may affect fertility or need to be changed before conception.

Difficulty becoming pregnant or staying pregnant has many possible causes. Structural concerns, such as fibroids or endometriosis, hormonal imbalances, genetic factors, and immune or clotting conditions may all contribute. We should not assume every pregnancy loss is caused by lupus, but autoimmune and clotting evaluation can be an important part of a recurrent miscarriage assessment.

What should happen before pregnancy with lupus?

Preconception care should include a clear discussion between the patient, rheumatologist, and obstetric clinician. A practical planning checklist includes:

• Assessing current lupus activity and aiming for stable disease control
• Reviewing all medications for pregnancy safety
• Checking baseline blood counts, chemistry, kidney function, and urine protein
• Evaluating blood pressure and cardiovascular history
• Testing for relevant antibodies, including antiphospholipid antibodies and SSA/Ro antibodies when clinically appropriate
• Reviewing prior blood clots, miscarriages, preeclampsia, preterm birth, growth restriction, or kidney disease
• Making a monitoring plan before conception rather than waiting for a complication

Some lupus medications can cause fetal abnormalities or affect blood counts. We should never stop, start, or change lupus medications without guidance from the prescribing specialist and pregnancy care team.

What is the role of aspirin, anticoagulants, hydroxychloroquine, and steroids in pregnancy?

Treatment is individualized. Depending on disease activity, antibody results, prior miscarriages, clotting history, and other risk factors, clinicians may consider medicines such as low-dose aspirin, heparin-based anticoagulation, hydroxychloroquine, or corticosteroids. Some people may need other immune-modulating medicines.

These decisions require specialist oversight. Low-dose aspirin may be used to lower preeclampsia risk in appropriate patients. Heparin-based anticoagulation may be used during pregnancy for certain clotting risks because warfarin is not advisable in pregnancy. Hydroxychloroquine is an established lupus medication that may be continued or used as part of the treatment plan. Steroids can help manage inflammation but must be weighed against individual risks and tolerance.

No universal “full treatment package” fits every person with lupus. The right plan balances the risks of active disease against the benefits and potential adverse effects of treatment.

How is lupus monitored during pregnancy?

Monitoring is based on the person’s starting health, lupus activity, antibody profile, and prior obstetric history. Care may include repeat blood-pressure checks, blood and urine testing, kidney monitoring, fetal growth assessments, and evaluation of fetal heart development when indicated.

SSA/Ro antibodies deserve special attention because they can cross the placenta and are associated with rare neonatal lupus and congenital heart block. In affected pregnancies, clinicians may recommend targeted fetal heart monitoring, including fetal echocardiography.

As pregnancy progresses, the team watches closely for preeclampsia, HELLP syndrome, clotting complications, kidney changes, high blood pressure, fetal growth restriction, and preterm delivery. Some pregnancies require earlier delivery because of maternal or fetal complications.

Important Misconceptions About Lupus

Is lupus only a women’s disease?

No. Lupus is much more common in women, especially during reproductive years, but men can develop lupus as well. The discussion notes that lupus in men can sometimes be more severe. Everyone with symptoms suggestive of autoimmune disease deserves evaluation, regardless of gender.

Can diet or supplements cure lupus?

There is no established lupus diet or supplement that replaces medical treatment. Some people explore foods, fish oil, turmeric, berries, herbs, and stress-reduction practices as supportive habits, but these should not be viewed as a cure or a substitute for prescribed care.

Nutrition, sleep, movement, stress management, and medication adherence can all support overall health. Yet active lupus and organ involvement require professional medical management.

What type of exercise may be more manageable with lupus?

Movement should be adapted to current symptoms and disease activity. During significant inflammation, high-impact or repetitive joint-loading activities may be difficult. The discussion highlights gentler options such as Pilates, tai chi, yoga, stretching, strengthening, and relaxation-based practices.

We should choose exercise with a clinician’s guidance, particularly when there is active joint inflammation, heart disease, lung involvement, severe fatigue, or a recent flare. The goal is consistency and physical function, not pushing through warning symptoms.

Can lupus affect mental health and relationships?

Yes. Chronic symptoms, uncertainty, stigma, changing appearance during steroid treatment, disrupted work, and repeated dismissal can all contribute to anxiety and emotional distress. Stress, fatigue, illness, and some medications may also affect libido and sexual wellbeing.

Mental health support is a meaningful part of lupus care. Bringing concerns about anxiety, low mood, sleep, intimacy, or self-image to the care team can lead to practical support and treatment options. There is no shame in needing help for the emotional impact of chronic illness.

How We Can Advocate for Better Lupus Care

What should we do if we think symptoms are being minimized?

Start by naming the pattern clearly. Instead of saying only “I am tired,” explain what has changed: “I need to rest after routine activities, this has persisted for six months, I have joint pain and low-grade fevers, and it is limiting my ability to work.” Specific information helps clinicians assess urgency and next steps.

Ask direct questions:

• What conditions are you considering?
• What findings make lupus more or less likely?
• What tests would help clarify the cause?
• Could this be another autoimmune or connective-tissue condition?
• Should we evaluate kidney function, blood counts, urine protein, or clotting risk?
• When should I seek urgent care rather than wait for my next appointment?
• Would a rheumatology referral be appropriate?

We can also bring a trusted support person, request copies of test results, and seek a second opinion when symptoms remain unexplained. Self-advocacy is not confrontation. It is active participation in our care.

What is the most practical takeaway for someone newly diagnosed with lupus?

Build a care plan that reflects the type of lupus you have, the organs involved, your medications, reproductive goals, and your daily quality of life. Keep regular follow-up appointments, report new symptoms early, and make sure each clinician involved understands the full picture.

For people considering conception, pregnancy planning should begin before a positive pregnancy test whenever possible. For people living with fatigue, pain, or invisible symptoms, the most important message remains simple: persistent symptoms deserve thoughtful care.

Frequently Asked Questions About Lupus

What are the first signs of lupus?

Early lupus symptoms may include unusual fatigue, body aches, joint pain, low-grade fever, swollen glands, rashes, headaches, chest discomfort, or shortness of breath. These symptoms overlap with many conditions, so diagnosis requires a full medical assessment.

Is a positive ANA the same as lupus?

No. A positive ANA can occur with lupus, other autoimmune diseases, and in people without autoimmune disease. It is a starting point for further evaluation, not a diagnosis by itself.

Can lupus cause chest pain?

Yes. Lupus can be associated with inflammation around the heart or lungs, blood-clotting complications, and other cardiovascular concerns. New, severe, or worsening chest pain requires prompt medical assessment.

Can we get pregnant with lupus?

Many people with lupus can become pregnant and have healthy pregnancies. The safest approach is to plan conception when lupus is well controlled, review medications in advance, and work with rheumatology and high-risk obstetric specialists.

Does lupus always cause miscarriage?

No. Lupus does not mean miscarriage is inevitable. Risk depends on disease activity, kidney involvement, blood-pressure concerns, relevant antibodies, clotting history, medications, and other pregnancy factors. Individualized preconception and prenatal care can improve outcomes.