Joint Protection Advice for Lupus Arthritis
posted in Joint pain, arthritis, musculoskeletal on March 5, 2023 by
Updated December 22, 2024
Joint Protection Advice for Lupus Arthritis
Joint protection is essential in dealing with pain. When you rest a painful joint or tendon, you help decrease inflammation, damage, and degeneration. The techniques described below should be used for all types of arthritis, tendonitis, tenosynovitis, bursitis, and other causes of joint pains. Whenever you develop pain in any part of your body, practice the following general joint protection measures and the joint protection recommendations for that part. Overuse of joints, incorrect use of joints, and improper posture all contribute to injury and pain. If you take the recommended actions quickly enough in cases such as overuse tendonitis and arthritis, you may be able to stop the pain and may not need to see your doctor.
Much of the information on this page comes directly from “The Lupus Encyclopedia: A Comprehensive Guide for Patients and Health Care Providers, edition 2.” Read chapters 1, 7, 27, and 36 to learn about the causes and treatments for lupus joint pains.
CONTENTS
Identify and avoid activities that worsen pain
General joint protection advice
Joint protection advice for the:
What is Lupus Arthritis?
Most people with SLE develop arthritis with joint inflammation (inflammatory arthritis). On physical examination, an arthritis diagnosis is appropriate if the doctor finds evidence of inflammation, such as soft tissue joint swelling and decreased range of motion. Joint X-rays can be useful in ensuring there are no other reasons for joint pain.
Lupus inflammatory arthritis often causes morning joint stiffness that can take 30 minutes or longer to loosen up. Arthritis that is not due to inflammation (noninflammatory arthritis) typically causes mild and brief morning stiffness (if at all).
Lupus arthritis most commonly affects the elbows, wrists, knuckles, middle joints of the fingers, knees, ankles, and the joints where the toes connect to the foot.
Fortunately, the arthritis of lupus is usually not crippling or deforming. This differs from the related autoimmune disorder, rheumatoid arthritis, which commonly causes joint deformities if not treated.
Some people with lupus arthritis develop joint deformities. Jaccoud’s arthropathy (pronounced yah-COOZ) is one type, usually affecting the fingers. It is a reversible deformity in that the doctor can straighten them out during the physical exam (called reversible deformities), but it is not permanently reversible. After the doctor releases the affected fingers, they revert to their deformed shape. Unfortunately, when Jaccoud’s worsens over time, the joints can lose mobility, leaving the person with “fixed deformities” that cannot be straightened out.
Lupus Arthralgia vs Lupus Arthritis
The term arthralgia is used as an umbrella term meaning “joint pain.” Many lupus patients will have joint pains without having inflammation. In that case, they are said to have arthralgias rather than inflammatory arthritis or inflammatory joint pain. Arthralgias are common in other conditions, such as depression, fibromyalgia, thyroid problems, and sleep apnea. Therefore, having joint pain without actual joint inflammation is not part of the SLE classification criteria (chapter 1 of The Lupus Encyclopedia).
Many rheumatologists use ultrasound to help diagnose joint inflammation. It is one of the most accurate ways to tell if active inflammation occurs from lupus. See the ultrasound picture of a joint with active lupus inflammatory arthritis. The orange-colored areas at the link in the previous sentence are the regions of active inflammation. Normal joints should not have these areas of orange.
Ultrasound use has shown that we previously underdiagnosed inflammatory arthritis. Ultrasound examinations show that 25% to 75% of people previously diagnosed with noninflammatory arthralgia actually have joint or tendon inflammation (tendonitis and tenosynovitis). This is an important distinction for two reasons. First, a correct diagnosis (using ultrasound) of arthritis rather than of arthralgia, can lead to a faster SLE diagnosis. Second, lupus arthritis requires medications to calm inflammation rather than just using pain medicines.
When a person with SLE develops pain in the neck, shoulder muscles, back, and sides of the hips, it is usually caused by something other than SLE. Examples include bursitis, tendonitis, degenerative arthritis, pinched nerves, and fibromyalgia (chapter 27 of The Lupus Encyclopedia). Doctors treat fibromyalgia differently than lupus arthritis. Moreover, lupus does not typically cause “pain all over,” which is more commonly due to something else, such as fibromyalgia or depression. Diffuse (all-over) body pain is considered one of the type I symptoms discussed in chapter 5 of The Lupus Encyclopedia.
Joint Protection for Lupus Arthritis: Identify activities that increase pain
Whenever pain persists, it is vital to consider the possibility that you may be overstressing your joints and tendons. Think carefully about what you do at your job, at home, and while engaging in other activities and whether any of these may aggravate your condition. For example, a person may keep getting wrist pain and then realize that this often occurs the day after they crochet or knit. Repetitive tasks such as crocheting, computer typing, and cell phone texting are some of the most common contributors to joint and tendon damage. It is essential to identify activities that exacerbate your joint pain and do them less and for shorter periods. Using splints or braces to help reduce stress on affected tendons can also help.
Joint Protection for Lupus Arthritis: Learn not to be a perfectionist
Personality can play a significant role in causing and managing pain. Compulsive workers and perfectionists may have the attitude of “I’m going to finish this job if it kills me.” They should learn to respect their pains, pay attention to what their body tells them, and recognize their potentially self-destructive behavior. Learning how to change your expectations and not be a perfectionist can be important. Learning to avoid certain tasks can be just as important as learning to perform a job in a way that puts less stress on the joints. Ask your rheumatologist or physical therapist for specific joint protection advice.
Below is a list of joint protection advice tips for lupus arthritis.
General Joint Protection Techniques
| • Respect pain; pain should warn you to decrease or avoid certain activities. Pain should not last longer than two hours after an activity. |
| • Balance work and rest. |
| • Maintain strength and range of motion (see the later sections on exercise). Strengthening the muscles around involved joints reduces destructive stressors and forces on the cartilage, ligaments, and tendons of the joint. A physical therapist can be invaluable in learning proper strengthening exercises. |
| • Decrease effort during tasks when using the painful part of your body. |
| • Simplify work tasks by planning ahead of time, organizing, and not doing too much at one time. |
| • Avoid any body position that causes pain, unnatural postures, or deformity. |
| • Use stronger, larger joints (such as shoulders, elbows, hips, and knees) whenever possible. |
| • Avoid staying in one position for too long. |
| • Avoid activities that cannot be interrupted, such as standing in long lines, carrying a package for a long distance, or going to public places (such as banks and grocery stores) during peak customer times. • Reduce excess body weight. • Work on using proper body posture with all activities. |
Joint Protection Techniques for Specific Parts of the Body
(Note: parts of this list come from Soft Tissue Rheumatic Pain by Dr. Robert Sheon, et al.; and these lists come directly from “The Lupus Encyclopedia” first edition)
Head and neck:You can use these techniques for neck pain, neck and head injuries, temporomandibular joint syndrome (TMJ for short), “pinched nerves” in the neck, and tension headaches. | |
| • Avoid sitting or standing in one place for more than thirty minutes at one time. Long periods of sitting can cause more neck strain than lifting heavy objects. | |
| • Take frequent breaks during tasks in which your body does not move (for example, while knitting, typing, etc.). Include activities that allow your body greater movement (such as getting up and sweeping the floor for a few minutes after every fifteen minutes of computer work). | |
| • Try to keep your head, neck, and trunk in a straight line (proper posture or alignment) during rest and activities. | |
| • Avoid stressful head positions (e.g., lying on a sofa with your head propped up, falling asleep in a chair and allowing your head to drop forward, or using more than one pillow to sleep on). | |
| • Align your entire trunk, chest, and head on a slanted wedge or a huge pillow while watching television or reading in a reclining position. Proper body alignment decreases muscle strain and spasms. | |
| • Elevate the entire mattress or the head of the bed if it is necessary for you to sleep with your head elevated. In other words, do not rely on pillows to do this. | |
| • Sleep on your side or back, keeping your arms below chest level. | |
| • Clenching the jaw can cause muscle spasms in the neck; use relaxation techniques or a bite spacer that you can get from your dentist. | |
| • Store heavy items that you regularly use no higher than the shoulders and no lower than the knees. | |
| • Use a stepstool when lifting heavy items from shelves above your shoulders. | |
| • Avoid the “birdwatcher’s neck” that involves jutting the head forward as if watching birds through field glasses (such as what you get if you stare at a computer screen positioned too high). | |
| • Be conscious of stressful head positions when you concentrate, drive, or are tense. | |
| • Use headsets or speakerphones for prolonged or frequent telephone use. | |
| • Place your computer screen at eye level and use a “document holder,” “copyholder,” or “book holder” to place work at eye level next to the screen. | |
| • Use an adjustable chair and frequently vary the seat height during prolonged sitting. Consider using a desk that adjusts from sitting to standing use (sit & stand desks). | |
| • Maintain the proper hand-to-eye work or reading distance of sixteen inches. | |
| • Position your body and work materials so your neck remains straight during activities. | |
| • Use plastic goggles or eyeglasses with plastic lenses when playing sports. | |
| • Wear a safety helmet when cycling. | |
| • Vary swim strokes and head position during swimming and water exercise. When diving, be sure that pools are of proper depth. | |
Back and hips(for the hips, also use the measures used for the knees below) | |
| • Strengthen and use the abdominal muscles that support your back. Learn to do crunches that do not strain your back. Get advice from your physician, ask an exercise instructor, or ask for a physical therapy consult to learn how. | |
| • Perform trunk and hamstring flexibility exercises regularly. | |
| • Do a regular strengthening and stretching program for abdominal and back muscles. Doing all these exercises first thing in the morning, right after you get out of bed is best. | |
| • Attain and maintain ideal body weight. | |
| • Avoid prolonged periods of sitting or standing. Use active sitting techniques such as “wiggling the pelvis” and rocking to activate and relax the pelvic muscles. Break up seated tasks, such as deskwork and card games, by standing and moving around for a few minutes every fifteen to thirty minutes. | |
| • When standing for prolonged periods, place one foot on a higher surface (stool, brick, phone book) and alternate. | |
| • Wear supportive cushion-soled shoes when standing or walking on concrete surfaces. | |
| • Use proper rest and sleep positions. For example, sleep on your side with your legs slightly bent and a pillow between your knees. Or lie on your back with your knees and feet elevated with a cushion or pillow. These positions can decrease stress on your back. Do not sleep on your stomach. If this proves difficult, placing a tennis ball in a pocket sewn onto the front of a T-shirt is a simple method to produce pressure and awaken you if you roll on your stomach. You should keep your arms below your shoulders. | |
| • To release a painful “locked back,” lie on your back and elevate your legs to the 90/90 position (hips and knees both bent at 90 degrees). Rest your lower legs on a chair or piano stool. | |
| • Turn your body while moving your feet in alignment so that your toes point in the direction you are facing. | |
| • To move objects at your side, rotate your entire body by moving your feet. | |
| • When lifting an object, bend your knees, keeping your back straight. Use the palms of your hands or your forearm, instead of one hand, to pick up and carry an object. | |
| • To lift large or heavy objects, move the object to your chest, raise it with your arms, and use your thigh muscles for strength. Hold the object close and centered in front of you. | |
| • When lifting children and pets, be prepared for sudden weight shifts. Do not carry a child on your side. Carry small children using a front or back harness pack. | |
| • For a sore “tailbone” (coccyx), protect the point of tenderness at the tip. Sit on a foam cushion three inches thick and the seat cushion size. Cut a three-inch circle out of the cushion center for pressure relief. Place the cushion under your tailbone whenever you sit or do exercises on the floor. | |
| • A leg length discrepancy of more than a half-inch can cause back pain. Try a corrective insert to raise your shorter leg and determine if the pain is improved. | |
| • Use cruise control when driving long distances. | |
| • Do not carry a large wallet in a back pocket. Check for the pressure placed on the pelvic bones by a wallet, tight belt, or constricting jeans that can squeeze nerves in the pelvis or groin. | |
| • Always bend at the knees (keeping your back straight), not at the waist, even when you pick up something light off the floor, such as a penny. | |
| • Use a step stool to reach overhead objects. | |
| • Do trunk-stretching and leg-stretching warm-up exercises before sporting activities. | |
Shoulders | |
| • Prevent cumulative movement damage by frequently interrupting repetitive tasks such as washing windows, vacuuming, and working on an assembly line. Take a mini-break and change position every twenty to forty minutes. Keep your elbows close to your body. Change the angle of shoulder motion when possible. | |
| • Sleep with your arms below the level of your chest. | |
| • If using crutches, adjust them properly to about two inches below the armpits. Carry weight on your ribs and hands, not under your arms. A forearm cane may be preferred. | |
| • Rise from a chair by pushing off with your thigh muscles, not your hands. | |
| • Take frequent breaks when working with your arms overhead. | |
| • To grasp an object at your side or behind you, turn your entire body and face the object. | |
| • Use assistance devices such as extended handles on combs, hairbrushes, toothbrushes, utensils, and dustpan handles; use a small cart for carrying things. | |
| • Get rid of that large, bulky purse. Remove all items from your purse that you do not use regularly. Get out of thinking that you must carry everything “just in case.” | |
| •Use your far arm and hand across the front of your body to reach a car seat belt. | |
| • A swivel or wheeled chair may be useful when tasks done from a seated position are in various locations. | |
| • Keep your hands below the 3 o’clock and 9 o’clock position on the wheel when driving. If possible, use a steering wheel that tilts. | |
| • Swimming: Strengthen and maintain shoulder muscles with proper exercises. | |
| • Tennis: Learn the proper serving and stroke techniques. Respect pain, avoid overuse, use frequent rest breaks. Relax your grip between strokes. Maintain shoulder strength through exercise; be aware of proper posture and positioning of joints. | |
| • Weightlifting: Use proper lifting techniques. Consider getting assistance from a personal trainer or physical therapist to learn appropriate techniques if you are uncertain. | |
| • Cycling: Avoid falling onto an outstretched arm. Learn to fall by pulling your arm in and rolling onto your shoulder. | |
| • Golfing: Perform conditioning exercises year-round to avoid shoulder injuries. Learn proper swing and impact. Consider seeing a professional golf instructor to learn proper techniques if you are unsure. You may need to learn to move with fewer full strokes if you have significant tendonitis or arthritis of the shoulders. There should be no discomfort during your swing. | |
Elbows and forearms | |
| • Avoid pressure and impact on the elbow. | |
| • Do not contact any firm surface with your elbow when sitting. | |
| • Use your abdominal muscles to help roll over when getting out of bed. | |
| • Do not push off with your elbow against a hard surface when changing body position. | |
| • Use relaxation techniques focused on your hands and arms to protect your forearm muscles. | |
| • Recognize and avoid repetitive hand-clenching or excessive hard gripping. Wear stretch gloves with the seams to the outside for nighttime hand-clenching. | |
| • Avoid forced gripping or twisting. Use kitchen tools such as jar openers, enlarged grips on utensils, or power tools. Look for items such as OXO Good Grips. | |
| • Take periodic breaks and alternate tasks during manual activities. | |
| • Use a light, two-handed grip when shaking hands repeatedly. | |
| • Avoid prolonged use of tools requiring twist/force motions. | |
| • Hold tools with a relaxed grip. Use foam or plastic pipe insulation (sold at hardware stores) on tool handles. | |
| • Do not lean directly on your elbows; stabilize with your forearms. | |
| • Change to a better work position or use elbow pads for protection. | |
| • Use proper grip and play techniques with golf clubs, racquets, bats, or other pieces of sports equipment. Consult a pro for grip problems. | |
| • Use elbow-protective equipment when playing hockey, rollerblading, or skating. | |
| • Use stretch, strengthening, and relaxation exercises to condition the tissues that surround the elbow. Consider seeing a physical therapist to learn these exercises. • Follow all the advice below for joint protection of the hands. The forearm muscles move the finger and wrist joints. (Consider using a vertical mouse instead of a standard mouse at your workstation). | |
Hands | |
| • Recognize and avoid repetitive hand-clenching or excessive hard gripping. Wear stretch gloves with the seams to the outside for nighttime hand-clenching. | |
| • Avoid forced gripping or twisting. Use kitchen aids such as jar openers, enlarged grips on utensils, or power tools. Look for items such as OXO Good Grips. | |
| • When stirring food, hold the utensil with your thumb on top (as if you were stabbing a block of ice with an ice pick) and mix with shoulder motions. | |
| • Avoid carrying heavy objects such as suitcases or heavy purses. | |
| • Do not lean on your hands while standing by a table. | |
| • Open jars by putting pressure on the top. Push down with your palm and twist from the shoulder instead of gripping the lid with your fingers. | |
| • Pad the handles on utensils, tools, and the steering wheel with pipe insulation. | |
| • Use assistance devices such as special faucet turners/levers, button hooks, elastic shoelaces, door openers, loop scissors, self-opening scissors, luggage carriers, mitt potholders, rubber jar lid openers, and an electric toothbrush. | |
| • Wear stretch gloves while driving. | |
| • Take periodic breaks and alternate tasks during manual activities. | |
| • Use a light, two-handed grip when shaking hands repeatedly. | |
| • Avoid prolonged use of tools requiring twist/force motions. | |
| • Hold tools with a relaxed grip. Use foam or plastic pipe insulation (sold at hardware stores) on tool handles. | |
| • Enlarge the handles of work tools; a two-and-one-quarter-inch diameter is optimum for most people. | |
| • Texturize handle surfaces to provide a more comfortable hold with less squeezing. | |
| • Interrupt repetitive tasks (e.g., typing, peeling vegetables, knitting, and playing cards) with short breaks. | |
| • Interrupt lengthy writing and typing sessions by stopping for one to two minutes every ten minutes. | |
| • Rest your hands flat and open instead of tight-fisted. | |
| • Use stronger, larger joints, such as your shoulders, whenever possible. | |
| • Use your palms and forearms to carry heavy objects. | |
| • Push, slide, or roll objects instead of lifting them. | |
| • Use pencil grips and pad the stapler. | |
| • Keep your hands off chairs when standing up from a sitting position. | |
| • Bend and straighten (wiggle) your fingers and wrists often. | |
| • Grasp objects with your hand and all your fingers. Use both hands as much as possible when lifting heavy objects. | |
| • Use real tools, not your thumbs, to pinch and push in your daily job activities. Use pliers for hard-to-remove Velcro fasteners. | |
| • Power tools (e.g., screwdrivers and drills) are often preferable and easier to use than manual instruments. | |
| • Avoid uncomfortable hand positions. | |
| • Keep your hand and wrist extended for work activities. Adapt tools with handles designed so that your wrist is straight. | |
| • Use a wrist rest while working on a keyboard. Use a mouse pad that has a cushioned wristrest with it. • Use a vertical mouse instead of the standard mouse with your computer. | |
| • Use an appropriate tool to hit or move objects. | |
| • Fit the handles of vibrating tools with shock absorbers or rubber, or wear gloves with gel inserts. Avoid strong vibrations and vibrations lasting longer than an hour at a time. | |
| • Wear an appropriate splint or brace for rest and activity if joints are painful. Ask your doctor to refer you to an occupational therapist for a proper splint if you have difficulty finding one. | |
| • Ask your doctor to send you to an occupational therapist about work-induced and housework-induced problems, splinting, and modifying or adapting tools and equipment. | |
| • Use proper grip size for racquet sports and golf. Golfers with arthritis should try using cushion grips and the baseball grip style (i.e., no locking fingers). Relax your grip until just before the ball impact. Consult a pro for grip advice. | |
| • Use a bowling ball with five finger holes. Have the edges of the holes beveled or smoothed out instead of being sharp. | |
Knees and hips(for the hips, also use the protection measures used for the back) | |
| • Strengthen your thigh muscles (quadriceps and hamstrings). | |
| • If stair-climbing causes or increases knee pain, limit the activity and strengthen your thigh muscles. | |
| • Avoid deep knee bending; use reach tools to pick up items from the floor. | |
| • Avoid kneeling. If it is customary to kneel at church, remember that kneeling is not required to pray and is terrible for the knees. | |
| • Straighten your knees or stand up at least every thirty minutes during prolonged periods of sitting to relieve pressure and stretch tight muscles. This is especially important during long car and plane trips. | |
| •Short, brisk walks will increase leg circulation and exercise muscles. | |
| • Buy shoes with no heels and with shock-absorbing soles. Check them often for signs of wear. Wear shoes with proper arch supports. Do not wear women’s high-heeled shoes or flats without good arches. | |
| • Use your thigh muscles to rise from a chair. | |
| • Use a mechanic’s or gardener’s stool when working on the floor or the ground. Sit with your legs apart and reach forward to perform tasks such as gardening or scrubbing floors. | |
| • Use protective kneepads if you must work on your hands and knees. | |
| • Consider raised or container gardening to reduce stress and effort. | |
| • Consider assistance devices such as elevated seats with armrests, raised toilet seats, shower benches, extended shoehorns, long-handled reachers, bathtub grab bars, and walking tools such as a cane or walker if needed. | |
| • Stationary biking provides a safe, low-impact exercise. Adjust the seat height so that your knees bend slightly at the low point of the downstroke and no more than 90 degrees flexed on the upstroke. Increase resistance gradually. Consider a recumbent bike if you have a bad back. | |
| • Perform a regular stretching program for the muscles of your upper and lower legs. Tight muscles can contribute to knee problems. Ask your doctor to send you to a physical therapist to learn proper stretching techniques. | |
| • Treat knee injuries promptly with the RICE techniques (Rest, Ice, Compression, and Elevation). Seek medical attention if pain and instability persist. | |
| • Engage in exercise and sports activities regularly (instead of occasional weekend participation). Include warm-up and cool-down activities with appropriate stretching exercises. Ask your doctor to refer you to a physical therapist to learn proper exercise techniques. | |
| • Consider doing water exercise classes designed for people with arthritis several days a week. | |
| • Modify or avoid knee-twisting dance steps or exercises. | |
| • Avoid sitting with a leg folded under your other leg or buttock. | |
Feet and ankles | |
| • Choose footwear with comfort, support, and utility in mind. Do not wear shoes that cause pain or fatigue. Get professional advice when necessary. Appropriate shoes should provide support and comfort, allowing the toes to extend fully and broaden during weight-bearing. Do not wear shoes tapered or pointed at the toes (in other words, wear shoes with a squared “toe box”). A proper fit should be determined by measuring the foot size while standing, not sitting. You should wear cushioned soles with shock-absorbing material. Wear shoes with an excellent arch support. Do not wear women’s high-heeled shoes or flats. Do not wear sandals or flip-flops or go barefoot. | |
| • Loose-jointed people should be particularly careful to protect their ankles and feet. Sprains and strains can increase instability. | |
| • Orthotic inserts can provide needed support and positioning assistance. Consult an experienced professional about choosing an orthotic, whether having it custom-made or obtaining it over the counter. Use orthotics in sports shoes and everyday shoes. | |
| • Maintain an appropriate weight to reduce stress on your feet and ankles. | |
| • Running, walking, or aerobics shoes are more supportive and comfortable for flexible or arthritic feet. Good running shoes and arch supports are essential. | |
| • Use a metatarsal pad or bar to relieve pressure or pain at the forefoot. | |
| • Treat ankle sprains promptly with RICE techniques (Rest, Ice, Compression, and Elevation). Seek medical advice if swelling and pain do not subside. | |
| • Use footwear designed for the sport you are playing. | |
| • Keep your feet meticulously clean and dry, especially between your toes. | |
| • Look for blisters and pressure sores. Change your shoes or get professional advice if these signs of stress develop. | |
| • Avoid chemical agents or cutting to remove calluses; they have formed for a reason. Find out what that reason is and fix it. | |
| • Cut your toenails straight across and regularly. | |
| • Plan ahead to avoid excessive walking when your feet are painful. | |
| • Run on dirt or track surfaces; avoid running on concrete or asphalt. | |
For more in-depth information on joint pains and lupus:
Read chapters 7 and 36 of The Lupus Encyclopedia, edition 2
Look up your symptoms, conditions, and medications in the Index of The Lupus Encyclopedia
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For more in-depth information on Joint Protection Advice for Lupus Arthritis:
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Look up your symptoms, conditions, and medications in the Index of The Lupus Encyclopedia
If you enjoy the information from The Lupus Encyclopedia, please click the “SUPPORT” button at the top of the page to learn how you can help.
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