lupus: why am i hurting?
DESCRIPTION
By Stuart Green, MDTRANSCRIPT
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Lupus
Why am I hurting ?Stuart Green MD
Chief Rheumatology TBHC
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Common Complaints in SLE
• Arthralgias• Arthritis• Myalgias• Myositis• Tendonitis• Fibromyalgia• Thyroid Disease
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SLE, Joint Involvement
• The most common presenting symptom• Often the initial manifestation of SLE• Arthralgia vs. Arthritis• Jacoud Arthropathy• Nonerosive vs. Erosive
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SLE Arthritis
• Morning stiffness not as long as in RA, <60min• Pain usually > then findings• Usually < 24 hours• Migratory• Symmetrical
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Jacoud’s Arthopathy
• Hypermobile joints with reducible deformities• Inflammation of tissues surrounding the joint• Typically NOT erosive • USA Prevalence 3-5%
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SWAN NECK DEFORMITY
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BOUTONNIERE DEFORMITY
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Arthritis
• Erosive vs. Non erosive( Xray vs. MRI vs. US)• Erosive much less common 15-50%• Rhupus! ( RA + SLE) CCP antibody • Osteonecrosis, femoral head
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Osteonecrosis
• Risk 2-30%( depending on exam technique)• MRI, most sensitive.• Lupus patients at risk• Steroids increase risk• Hip most common joint
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Tendonitis
• Rotator Cuff tendonitis• Achilles tendonitis• Epicondylitis• Infrapatellar tendonitis• Posterior Tibialis tendonitis
• Tendon Rupture
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Myalgias/Myositis
• Muscle pain• Proximal Weakness; less common (7-15%)• Elevated muscle enzymes; CPK
• Other causes include steroids & antimalarials
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Myalgias/Myositis
• Muscle pain• Proximal Weakness; less common (7-15%)• Elevated muscle enzymes; CPK
• Other causes include steroids & antimalarials
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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
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FIBROMYALGIA TENDER POINTS
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Fibromyalgia
• Low impact aerobic exercise• Tricyclics• Tamadol• Duloxetine• Milnacipran• Pregabalin
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Treatment
• Physical therapy/OT• NSAIDS• Steroids• Hydroxychloroquine• Methotrexate• Bellimumab------------------------• ? Tocilizumab
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Thyroid Disease
• Common in woman• Maybe more common in AI diseases• Musculoskeletal complaints may initial
complaint in AI Thyroid disease.
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Autoimunne Thyroid Disease
• Hypothyroid: Hashimotos– Arthralgias– Polyarthritis– CTS– Myopathy
• Hyperthyroid: Graves disease– Arthralgia, shoulders– Myopathy– Thyroid acropachy
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Autoimunne Thyroid Disease
• Hypothyroid: Hashimotos– Arthralgias– Polyarthritis– CTS– Myopathy
• Hyperthyroid: Graves disease– Arthralgia, shoulders– Myopathy– Thyroid acropachy
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