From the Guidelines
Myalgia in lupus is primarily caused by inflammation from the autoimmune process, and treatment should focus on controlling the underlying disease with medications such as antimalarials, glucocorticoids, and immunosuppressive agents. In lupus, the immune system mistakenly attacks healthy tissues, including muscles, leading to inflammation that results in pain, tenderness, and weakness. Several specific mechanisms contribute to lupus myalgia: direct muscle inflammation (myositis), vasculitis affecting blood vessels that supply muscles, medication side effects, and fibromyalgia which commonly co-occurs with lupus. According to the EULAR recommendations for the management of systemic lupus erythematosus 1, antimalarials and/or glucocorticoids are of benefit and may be used in the treatment of SLE without major organ manifestations. Some key points to consider in the management of myalgia in lupus include:
- The use of NSAIDs may be considered for limited periods of time in patients at low risk for their complications 1
- Immunosuppressive agents such as azathioprine, mycophenolate mofetil, and methotrexate should be considered in non-responsive patients or patients not being able to reduce steroids below doses acceptable for chronic use 1
- Controlling the underlying lupus through appropriate medication is essential for long-term relief of myalgia
- Physical therapy, gentle exercise, and adequate rest are also important components of managing muscle pain in lupus patients.
From the Research
Causes of Myalgia in Lupus
- Myalgia in lupus can be caused by the disease itself, as it is a chronic inflammatory autoimmune disease that affects multiple organ systems 2
- The production of autoantibodies and the formation of immune complexes can lead to inflammation and damage to healthy tissue, resulting in myalgia 2
- Musculoskeletal manifestations of pain, such as arthralgia, arthritis, and myalgia, are commonly reported as initial symptoms of systemic lupus erythematosus (SLE) 3
- Chronic widespread pain, typical of fibromyalgia (FM), is frequently associated with SLE and can contribute to myalgia 3
- The exact etiologic mechanism of myalgia in lupus is unknown, but genetic, hormonal, and environmental factors, as well as immune abnormalities, have been identified as potential contributing factors 2
Associated Factors
- Age, sex, geography, and race have been associated with the onset of lupus, which may also contribute to the development of myalgia 2
- Fibromyalgia (FM) is often associated with SLE, and secondary FM can interfere with the daily activities of SLE patients, making it essential to identify and treat its symptoms promptly 3