03 May Arthritis in Lupus. What does it look like?
Lupus is an autoimmune disease which can affect many different organs in the body. When we say here ‘lupus’ we mean ‘systemic’ lupus, which is different to cutaneous lupus which affects only the skin. The word ‘systemic’ means that multiple parts of the body can be involved.
The joints are a common place to be affected in Lupus.
Often the joints in Lupus can hurt, but they are not inflamed.
If the joints are not inflamed, medically we call this ‘arthralgia’, which means joint pains.
People with lupus can often get widespread pains, which we refer to as fibromyalgia, but the joints can be directly inflamed as part of the systemic lupus inflammation.
95% of people with lupus have either arthritis OR arthralgias
What does the Arthritis of lupus look like?
Usually there is swelling of the joints, and it is symmetrical, meaning both right and left side of the body is involved.
The main joints affected are the large joints such as the knees and the hand joints, in particular the proximal interphalangeal joints. In medical terms we know these as ‘PIPJs’ for short, and they are the first set of knuckles in the fingers themselves.
A common feature of lupus arthritis is pain greater than the swelling. Swelling and fluid in the joints is a big feature of Rheumatoid Arthritis, but not such a big feature in lupus arthritis.
Lupus arthritis rarely causes erosions in the bones, whereas this is more common in Rheumatoid Arthritis.
Lupus arthritis is usually non deforming. Sometimes there can be a deforming arthritis but this occurs without any damage to the bones. This is known as a “Jaccouds’ arthritis.
What is a Jaccoud’s arthritis?
It is an arthritis where the hands are deformed with the fingers not in their usual alignment, but if a person is to move the fingers passively, they can be moved back into normal alignment. This is different to say for example deforming Rheumatoid arthritis where the bones are more fixed in position because they have been damaged.
Its interesting to note that the joint symptoms can be there for many years before other features of Lupus arise.
People more likely to get deforming arthritis are those who have had disease for many years, been on ‘steroids’ (ie prednisolone and not the anabolic type!) and have specific antibodies to what we medically call anti ‘Ro and La’. (and no they are not musical antibodies!)
A characteristic of lupus arthritis is a positive ANA, an auto-antibody. If you have a positive ANA and joint symptoms, its important to get checked by a Rheumatologist in case there are treatments available for you.