posted in Joint pain, arthritis, musculoskeletal on June 6, 2021 by
A lubricating sheath surrounds some tendons. This sheath is called the tenosynovium, and it helps tendons glide more smoothly and help them stay in their place better. A typical example is the tendons in the palm that help to bend the fingers. When these become inflamed in SLE, it is called “lupus tenosynovitis.” Ultrasound (see below) studies show that 20% to 40% of SLE patients with joint pain with no detectible joint swelling have inflammatory tenosynovitis. When this occurs with the fingers, the affected person may need to use the other hand to straighten out the finger. This problem is called “trigger finger” (see the photo above).
Damage of the tendons from lupus can cause the tendons to slip around the joints and become unstable in some people. When this occurs, it can cause deformed joints (see the 1st photo above) called “Jaccoud’s arthropathy.” Jaccoud’s arthropathy was first described in people with rheumatic fever (due to infection). However, today, the most common cause is SLE.
As with all problems in SLE, please read and abide by all my “Lupus Secrets” to keep the best control of your SLE problems like lupus tendonitis. Make sure to download all my free handouts from the Lupus Secrets page of my website. Just as with arthritis, the tendonitis of SLE is treated with nonsteroidal anti-inflammatory drugs (NSAIDs such as ibuprofen and naproxen), steroids, and hydroxychloroquine (Plaquenil), while stronger medications such as methotrexate, mycophenolate, and belimumab are used for severe cases. Resting the tendon to allow the body to heal is one of the most important things to learn. If you have tendonitis, it is crucial to abide by joint protection measures. Joint protection measures can easily be found on the internet.
Cortisone Injections for Lupus Tendinitis
An injection with a corticosteroid (a cortisone injection) is also one of the safest and quickest ways to treat lupus tendonitis and tenosynovitis. Using an ice pack as needed can also help to decrease the severity of pain from lupus tendonitis.
Cold Therapy For Lupus Tendinitis
Cold therapy (cryotherapy): Icing can be helpful for injuries, tendonitis, bursitis, and inflammation (such as lupus inflammatory arthritis pain). Ice therapy can be applied in many ways, including raw ice (like an ice cube), ice frozen in a Styrofoam cup, commercial ice or gel wraps, and packs. Do not use bare ice for more than 1-3 minutes. Follow the rule of thumb “when you’re numb, you’re done.” Cold compresses with a barrier between the ice and the skin (such as cups, wraps, and packs) may be applied longer, but when “you’re numb, you’re done.” Do not apply ice on areas of broken skin. If you have neuropathy (nerve damage), be careful as you could freeze your skin if the ice source is too cold (you may not feel it), and make sure not to use it for more than 1-3 minutes.
Joint Protection for Lupus Tendinitis
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 sports that may be aggravating your condition. For example, a person may keep getting wrist pain and then realize that this seems to occur most often the day after she crochets, one of her favorite hobbies. Repetitive tasks such as crocheting are some of the most common contributors to joint and tendon damage. Some of the most common repetitive-use tendon injuries occur from using computers and texting on cell phones. It is essential to identify activities that exacerbate your joint pain and do them less and for shorter periods. Another example would be a mother who keeps getting severe pain at the base of her thumb and then realizes that this often happens after picking up her baby. Holding the thumb back while holding a baby can put a lot of stress on the tendons that move the thumb, so severe tendonitis can result. Learning to pick up a baby while not stressing the tendons can make a big difference in relieving the inflammation and pain. Using a wrist splint to help rest those tendons can also be helpful.
Personality assessment is also essential. The person who is a compulsive worker and perfectionist may have the attitude of “I’m going to finish this job if it kills me.” This type of person needs to learn to respect their aches and pains, pay attention to what their body is telling them, and recognize this potentially self-destructive behavior. People who feel that they must do everything or are the only ones who will get something done right can be particularly guilty of this.
For example, a mother may insist that the house stay clean and organized differently (after all, this is what her husband and children expect). Even though she may have severe lupus tendonitis pain, she pushes herself to clean everything to meet her expectations, thereby causing her body more damage and pain. At the same time, her resentment toward her loved ones builds, and she ends up feeling that they do not care enough to help her. It becomes a vicious cycle where the pain, mental frustration, stress, and resentment continue to worsen over time. This damages not only the person’s tendons but also her relationships with the ones she loves. It can be important to learn how to change your expectations, how not to be a perfectionist, and realize that there is more than one way to live or work (such as cleaning the house). 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.
Personality assessment is also essential. The person who is a compulsive worker and perfectionist may have the attitude of “I’m going to finish this job if it kills me.” This type of person needs to learn to respect their aches and pains, pay attention to what their body is telling them, and recognize this potentially self-destructive behavior. People who feel that they must do everything or are the only ones who will get something done right can be particularly guilty of this. For example, a mother may insist that the house stay clean and organized differently (after all, this is what her husband and children expect). Even though she may have severe lupus tendonitis pain, she pushes herself to clean everything to meet her expectations, thereby causing her body more damage and pain. At the same time, her resentment toward her loved ones builds, and she ends up feeling that they do not care enough to help her. It becomes a vicious cycle where the pain, mental frustration, stress, and resentment continue to worsen over time. This damages not only the person’s tendons but also her relationships with the ones she loves. It can be important to learn how to change your expectations, how not to be a perfectionist, and realize that there is more than one way to live or work (such as cleaning the house). 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.
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
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.
If you have joint pains and lupus, what has your experience been? What do you recommend for other patients?
Do you have any questions to ask Dr. Thomas?
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NOTE: The above is an amended version of the Musculoskeletal section of “The Lupus Encyclopedia“, 2nd edition prior to editor review and acceptance (Johns Hopkins Press).
Don Thomas, MD, author of “The Lupus Encyclopedia” and “The Lupus Secrets”
Special thanks to Dr. Jemima Felicity L Albayda, M.D., Director, Musculoskeletal Ultrasound and Injection Clinic
Assistant Professor of Medicine, Johns Hopkins Hospital, Baltimore, Maryland who helped write this for inclusion in “The Lupus Encyclopedia”, 2nd edition.
NOTE: All opinions and interpretations of the medical literature are our own. We get no compensation from any industry for our blog posts. Our intent is to motivate patients to become knowledgeable and proactive in their health care.
Read more in The Lupus Encyclopedia, edition 2
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.
If you have lupus, what has your experience been? What do you recommend for other patients?
Do you have any questions to ask Dr. Thomas?
Please click on “Leave a Comment” above to comment.
Click on “SUPPORT” at the top of the page to learn how you can support “The Lupus Encyclopedia“
My tendons have been causing me pain for years. My doctor’s have all been calling it fibromyalgia (including all the rheumatologists I’ve seen). Sometimes they call it myifascial pain. It can be very hard to sleep, even with all of my pillows! I’d like to read your handouts in solutions, but I cannot open them. Any suggestions?
Best,
Dawn
Dear Dawn: If you are talking about the handouts at the bottom of the “Lupus Secrets” page, they do require Microsoft “Word” to open. I think you can get a Word Reader off the internet to help as well.
The best way to figure out if someone has pain in the tendons due to fibromyalgia vs inflammation from lupus is to have a doctor perform Doppler ultrasound of the joints and tendons. Many of us are able to do this these days. If you have never had this done, I’d recommend calling around to rheumatologists’ offices close to you and as the staff on the phone if the doctor does ultrasonography, and if they say, Yes, make an appointment and at the appointment mention that I stated this could be done to help figure it out. They’ll know what to do.
Good luck, I hope you do well… Donald Thomas, MD
Seeing this picture and reading this article shows and let’s me know that this has happened to my hands. They called it contractures when I saw the surgeon and the occupational therapist for my hands and wrists. I was given splints and a bulky brace and plastic rings for my fingers. I’m already on Benlysta, plaquenil, and imuran. They said there’s nothing more they can do for me
Do you have any recommendations/references for rheumatologists in the Minneapolis Minnesota area who use ultrasound??? I have severe tendon pain with Lupus but any Rheumatologist that I have seen do not believe me and think I have fibromyalgia. I found this article researching the internet.
Brooke:
Easiest thing to do is to call offices close to where you live and ask the phone staff if their rheumatologists perform ultrasound inside their office when they see patients.
Another way is to check the list of rheumatologists who are certified as RhMSUS: https://rheumatology.org/rhmsus-designees
I hope that helps.
Donald Thomas, MD
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