Lupus Joint and Muscle Pain

posted in Joint pain, arthritis, musculoskeletal on April 17, 2024 by

Gavin Abson

Updated June 8, 2024

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Close to 90% of people with systemic lupus erythematosus (SLE) will have joint and muscle pain. Understanding lupus joint and muscle pain is crucial for effective management and improved quality of life. In this article we’ll look at the effects of lupus on joint and muscles as described in “The Lupus Encyclopedia” in chapters 7, 13, 24, 25, 27, 36, 38, and 39. There are so many chapters that discuss pain in lupus, because there are so many different causes of pain, and more importantly, effective treatments.

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This blog post article was edited and contributed to by Donald Thomas, MD; author of “The Lupus Encyclopedia.” Parts of this blog post come from “The Lupus Encyclopedia: A Comprehensive Guide for Patients and Health Care Providers, edition 2“

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Excerpt from chapter 7, “The Musculoskeletal System,” on joint and muscle pain:

The musculoskeletal system is comprised of the muscles (musculo-), bones (“skeletal”), joints, and adjacent structures (such as tendons). The joints are the hinges between the bones that allow movement.

Because the musculoskeletal system is the most common part of the body affected by SLE (causing aches and pains, or rheumatism), rheumatologists became the specialists dedicated to diagnosing and managing SLE patients.

Osteoporosis (fragile bones that can break) and avascular necrosis (where a section of bone dies) are also musculoskeletal prob­lems that occur in SLE. However, these are usually not due to the inflammation of lupus itself and will not be discussed in this article.

The Lupus Encyclopedia (2nd ed.), p. 126

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The Musculoskeletal System: Joint and Muscle Pain with Lupus

The musculoskeletal system encompasses muscles, bones, joints, and adjacent structures such as tendons. Joints serve as the hinges between bones, facilitating movement.

Understanding Lupus Joint and Muscle Pain

Joint and muscle pain can manifest in many ways, ranging from mild discomfort to debilitating symptoms that significantly impact daily life. Symptoms may also include stiffness, swelling, tenderness, and reduced range of motion in affected joints. Understanding the underlying causes of joint and muscle pain in lupus is essential for effective management and symptom relief.

Causes and Contributing Factors

In lupus, joint and muscle pain can arise due to inflammation, a hallmark feature of the disease. The immune system mistakenly attacks healthy tissues, including joints and muscles, leading to pain and discomfort. Other factors such as osteoporosis (fragile bones), fibromyalgia and avascular necrosis (bone death) may contribute to joint and muscle pains in lupus patients.

Overactive pain nerves cause the pain of fibromyalgia. Exercise and nerve pain medicines like gabapentin, pregabalin, and duloxetine may help. Other nerve problems, like carpal tunnel syndrome and neuropathy, can also cause pain that can feel like it is coming from the joints and muscles.

While active lupus inflammation can attack the joints, causing lupus inflammatory arthritis, it also commonly attacks the tendons, causing tendonitis and tenosynovitis.

Permanent joint and tendon damage can also cause pain. SLE patients who have permanent joint damage can find it difficult to distinguish between active inflammation pain (which is treated with anti-inflammatory drugs, hydroxychloroquine, and immunosuppressants) and joint and tendon damage pain (which is treated with pain reduction therapies). See my comments about using ultrasound to help identify inflammation below.

Figuring out the cause of the pain is very important because treatments can differ greatly depending on the cause. A thorough history, physical examination, labs to assess lupus disease activity, and sometimes imaging studies are needed. In our clinic, and many other rheumatology clinics, we use ultrasonography of the joints as we examine our patients. Ultrasound can identify if the pain is coming from active lupus inflammation or not.

If you have great trouble getting help with your lupus pain, I highly recommend that you seek out a rheumatologist who can do ultrasounds in their office.

Managing Lupus Joint and Muscle Pain: Strategies for Relief

Effective management of lupus joint and muscle pain involves a comprehensive approach that addresses both the underlying inflammation and symptom management. Here are some strategies to help alleviate pain and improve quality of life for individuals living with lupus:

Medications

Medications may be prescribed to reduce inflammation and alleviate pain. These include:

• FDA-approved lupus biologics (Benlysta and Saphnelo)
• Anti-malarial drugs like hydroxychloroquine
• nonsteroidal anti-inflammatory drugs (NSAIDs)
• corticosteroids, like prednisone and other cortisones
• disease-modifying antirheumatic drugs (DMARDs), like methotrexate

Additionally, these medications can help manage symptoms and improve joint function.

Physical Therapy

Physical therapy exercises and techniques can help improve joint flexibility, strengthen muscles, reduce pain, and protect joints. A qualified physical therapist can design a personalized exercise program tailored to the individual’s specific needs and limitations.

Lifestyle Modifications

Making lifestyle changes such as maintaining a healthy diet, managing stress, getting regular exercise, and ensuring adequate rest can help manage lupus symptoms. This includes joint and muscle pain. Avoiding triggers such as excessive sun exposure and quitting smoking can also contribute to symptom management.

Complementary (Integrative) Therapies

Complementary and alternative therapies such as acupuncture, massage therapy, and herbal supplements may offer additional relief for joint and muscle pain. However, it’s essential to consult with a healthcare professional before trying any new therapy or supplement to ensure safety and efficacy.

Supplements that may reduce lupus inflammation include turmeric (curcumin) and ginger. However, ask your doctor first. They can have interactions with some prescription medications.

Also, practicing mindfulness daily (like breathing exercises) can help reduce pain perception. People who practice mindfulness daily tend to have healthier, sleep better, and respond to stress more healthily. Read my article at Lupus Corner on the science behind mindfulness and how to start doing it yourself.

Understanding the complexities of joint and muscle pain is crucial for individuals living with the condition. By adopting a comprehensive approach to management that addresses inflammation, symptom relief, and also lifestyle modifications, individuals can effectively manage their symptoms and improve their quality of life.

For more in-depth information on joint and muscle pain:

Read chapter 7 of The Lupus Encyclopedia, edition 2

Look up your symptoms, conditions, and medications in the Index of The Lupus Encyclopedia

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