From the Guidelines
Lupus can cause abdominal pain due to its effects on multiple organ systems, including the gastrointestinal tract. Systemic lupus erythematosus (SLE) is a multisystem disease that can be diagnosed on clinical grounds in the presence of characteristic serological abnormalities, as stated in the 2019 update of the EULAR recommendations for the management of SLE 1. Abdominal pain in lupus patients may result from several mechanisms, including direct inflammation of the peritoneum (serositis), lupus-related vasculitis affecting blood vessels in the abdomen, pancreatitis, or inflammation of the bowel.
The treatment goals for SLE, as outlined in the 2019 EULAR recommendations, include long-term patient survival, prevention of organ damage, and optimization of health-related quality of life 1. In the context of abdominal pain, this means that management typically involves addressing the underlying cause, which might include adjusting lupus medications, adding protective medications for the stomach, or treating specific complications. Some medications used to treat lupus, particularly NSAIDs like ibuprofen or naproxen, can cause stomach irritation and pain, highlighting the need for careful medication management.
Key considerations in managing abdominal pain in lupus patients include:
- Identifying and treating the underlying cause of abdominal pain
- Adjusting lupus medications to minimize gastrointestinal side effects
- Adding protective medications for the stomach as needed
- Monitoring for and addressing potential complications, such as lupus flares or comorbid conditions like irritable bowel syndrome or fibromyalgia. If you have lupus and experience persistent or severe abdominal pain, you should consult your healthcare provider promptly, as it could indicate a lupus flare or complications requiring specific treatment, in line with the principles of SLE care being multidisciplinary and based on a shared patient-physician decision 1.
From the Research
Abdominal Pain in Lupus
- Abdominal pain is a common symptom in systemic lupus erythematosus (SLE) patients, with studies suggesting it occurs in up to half of all SLE patients at some point in their disease course 2.
- The causes of abdominal pain in SLE patients can be varied, including:
- Lupus enteritis (gastrointestinal vasculitis) 3, 4
- Mesenteric vasculitis 5, 3
- Non-mesenteric vasculitis 3
- Surgical conditions such as cholecystitis, perforated ulcer, colonic perforation, diverticulitis, and adhesions 2
- Peritonitis from polyserositis, dyspepsia from reflux, nausea and vomiting from bowel edema, ascites, mesenteric ischemia, pancreatitis, pneumatosis intestinalis from necrotizing enterocolitis, and hepatobiliary abnormalities 2
Diagnosis and Treatment
- Diagnosis of abdominal pain in SLE patients often requires a combination of clinical investigation, laboratory tests, and imaging studies such as computed tomography (CT) scans 5, 3.
- Treatment of abdominal pain in SLE patients depends on the underlying cause, but may include corticosteroids and immunosuppressive drugs for lupus enteritis and mesenteric vasculitis 3, 4.
- Surgical intervention may be necessary for certain conditions such as cholecystitis, perforated ulcer, colonic perforation, diverticulitis, and adhesions 2.
Disease Activity and Abdominal Pain
- Studies have shown that SLE patients with higher disease activity, as measured by the SLE Disease Activity Index (SLEDAI), are more likely to develop vasculitis and experience abdominal pain 5, 3.
- However, the SLEDAI score does not always correlate with the occurrence of lupus enteritis, and other factors such as leucopenia may be more important in predicting the development of this condition 4.