Lupus

Why am I hurting ?Stuart Green MD

Chief Rheumatology TBHC

Common Complaints in SLE

• Arthralgias• Arthritis• Myalgias• Myositis• Tendonitis• Fibromyalgia• Thyroid Disease

SLE, Joint Involvement

• The most common presenting symptom• Often the initial manifestation of SLE• Arthralgia vs. Arthritis• Jacoud Arthropathy• Nonerosive vs. Erosive

SLE Arthritis

• Morning stiffness not as long as in RA, <60min• Pain usually > then findings• Usually < 24 hours• Migratory• Symmetrical

Jacoud’s Arthopathy

• Hypermobile joints with reducible deformities• Inflammation of tissues surrounding the joint• Typically NOT erosive • USA Prevalence 3-5%

SWAN NECK DEFORMITY

BOUTONNIERE DEFORMITY

Arthritis

• Erosive vs. Non erosive( Xray vs. MRI vs. US)• Erosive much less common 15-50%• Rhupus! ( RA + SLE) CCP antibody • Osteonecrosis, femoral head

Osteonecrosis

• Risk 2-30%( depending on exam technique)• MRI, most sensitive.• Lupus patients at risk• Steroids increase risk• Hip most common joint

Tendonitis

• Rotator Cuff tendonitis• Achilles tendonitis• Epicondylitis• Infrapatellar tendonitis• Posterior Tibialis tendonitis

• Tendon Rupture

Myalgias/Myositis

• Muscle pain• Proximal Weakness; less common (7-15%)• Elevated muscle enzymes; CPK

• Other causes include steroids & antimalarials

Myalgias/Myositis

• Muscle pain• Proximal Weakness; less common (7-15%)• Elevated muscle enzymes; CPK

• Other causes include steroids & antimalarials

Fibromyalgia

• May complicate the picture for some( 25%)• Diffuse pain syndrome• Associated with: Tension/migraine headaches,

IBS, TMJ, Interstitial cystitis, esophageal dysmotility, non-cardiac chest pain

• Atypical Raynauds• Malar flush• Non Restorative Sleep

FIBROMYALGIA TENDER POINTS

Fibromyalgia

• Low impact aerobic exercise• Tricyclics• Tamadol• Duloxetine• Milnacipran• Pregabalin

Treatment

• Physical therapy/OT• NSAIDS• Steroids• Hydroxychloroquine• Methotrexate• Bellimumab------------------------• ? Tocilizumab

Thyroid Disease

• Common in woman• Maybe more common in AI diseases• Musculoskeletal complaints may initial

complaint in AI Thyroid disease.

Autoimunne Thyroid Disease

• Hypothyroid: Hashimotos– Arthralgias– Polyarthritis– CTS– Myopathy

• Hyperthyroid: Graves disease– Arthralgia, shoulders– Myopathy– Thyroid acropachy

Autoimunne Thyroid Disease

• Hypothyroid: Hashimotos– Arthralgias– Polyarthritis– CTS– Myopathy

• Hyperthyroid: Graves disease– Arthralgia, shoulders– Myopathy– Thyroid acropachy