From the Research
Arthralgias in lupus are primarily caused by inflammation of the joint lining (synovitis) due to the autoimmune process that characterizes systemic lupus erythematosus (SLE). This occurs when the immune system mistakenly attacks healthy joint tissues, leading to pain, swelling, and stiffness. The inflammatory process involves autoantibodies and immune complexes that deposit in joint tissues, activating complement and recruiting inflammatory cells. Cytokines like TNF-alpha, IL-1, and IL-6 further promote inflammation.
Key Points
- Joint pain in lupus typically affects multiple joints symmetrically, particularly the small joints of hands, wrists, and knees.
- Morning stiffness lasting more than an hour is common.
- Treatment usually involves NSAIDs like ibuprofen (400-800mg three times daily) or naproxen (500mg twice daily) for mild symptoms, as noted in studies such as 1 and 2.
- For moderate to severe arthralgias, antimalarials such as hydroxychloroquine (200-400mg daily) are effective, as discussed in 3.
- In persistent cases, methotrexate (7.5-25mg weekly) or other immunosuppressants may be necessary, as suggested by 3.
- Corticosteroids like prednisone (5-10mg daily) can provide rapid relief during flares but should be used at the lowest effective dose for the shortest duration possible due to side effects.
- Regular gentle exercise, heat/cold therapy, and joint protection techniques can help manage symptoms alongside medication.
Considerations
- The musculoskeletal system is involved in nearly all patients with SLE, with transient arthralgias and arthritis being commonly observed, as mentioned in 4 and 5.
- Differentiation of SLE from rheumatoid arthritis (RA) is crucial and can be done with diagnostic imaging, tests for anticitrullinated peptide antibodies (anti-CCP) and rheumatoid factor, and analysis of the clinical picture, as discussed in 5.