Lupus is a chronic autoimmune disease where the body’s immune system mistakenly attacks its own healthy tissues and organs, leading to inflammation and potential damage throughout the body. This systemic inflammation can affect various parts of the body, including the skin, joints, blood, and internal organs. Tendonitis, on the other hand, involves the inflammation or irritation of a tendon, which are the tough, fibrous cords connecting muscles to bones. Tendonitis typically results in pain and tenderness just outside a joint. Yes, lupus can indeed cause tendonitis.
Lupus and Tendonitis Connection
The systemic inflammation characteristic of lupus can extend its effects to connective tissues throughout the body, including the tendons. In lupus, the immune system, which normally defends against foreign invaders, becomes misdirected and attacks healthy structures like tendons. This misdirected immune response contributes to widespread inflammation that can manifest in various musculoskeletal issues. Tendonitis is a recognized musculoskeletal manifestation of lupus.
While not all individuals with lupus will develop tendonitis, it is a common symptom. Approximately 10% of lupus cases are estimated to lead to tendonitis, causing pain and stiffness around joints. Studies have indicated that joint pain experienced by individuals with systemic lupus erythematosus (SLE) is frequently due to tendon involvement rather than solely arthritis.
How Lupus Affects Tendons
Lupus contributes to tendonitis through chronic inflammation, where immune cells and inflammatory mediators target tendon tissue. This sustained inflammatory environment can lead to damage and irritation within the tendons. The body’s immune response in lupus may also involve the deposition of immune complexes, clusters of antibodies and antigens, in the tendons. This process can result in pain, stiffness, and a reduction in the tendon’s normal function.
Lupus-related tendonitis can occur in various locations throughout the body. Common sites include the Achilles tendon at the back of the ankle, the rotator cuff in the shoulder, and the patellar tendon below the kneecap. It can also affect tendons in the fingers, elbows, wrists, and other ankle regions. Beyond simple tendon inflammation, lupus can also cause tenosynovitis (inflammation of the lubricating sheath surrounding some tendons) and enthesitis (inflammation where tendons or ligaments attach to bone).
Recognizing Tendonitis in Lupus
Recognizing tendonitis in the context of lupus involves observing specific symptoms and undergoing diagnostic evaluations. Individuals commonly report localized pain, often described as a dull ache, which typically worsens with movement of the affected limb or joint. Other signs include tenderness when pressure is applied to the tendon, mild swelling, and sometimes a grating or popping sensation during movement. The affected joint may also feel stiff, limiting its range of motion.
Diagnosis usually begins with a thorough physical examination and a review of the patient’s medical history. Healthcare providers, particularly rheumatologists, specialize in conditions affecting joints, muscles, and connective tissues like lupus. Imaging studies, such as ultrasound or magnetic resonance imaging (MRI), play an important role in confirming tendon inflammation and distinguishing it from other conditions.
Managing Tendonitis with Lupus
Management strategies for tendonitis associated with lupus aim to address both the local tendon inflammation and the underlying systemic lupus activity. Initial approaches often include rest for the affected tendon, application of ice to reduce swelling and pain, and participation in physical therapy to restore function and strength. Nonsteroidal anti-inflammatory drugs (NSAIDs) can help alleviate pain and reduce inflammation. In some cases, healthcare providers may consider corticosteroid injections directly into the affected tendon area for more targeted relief.
Controlling the underlying lupus activity is important for long-term management of tendonitis. This often involves lupus-specific medications that modulate the immune system. Immunosuppressants such as methotrexate, mycophenolate mofetil, azathioprine, and cyclosporine reduce the immune system’s overactivity. Biologic therapies, such as belimumab and anifrolumab, represent newer treatment options that target specific components of the immune response contributing to lupus. Lifestyle adjustments, including sufficient sleep, activity pacing, and regular communication with the medical team, also play a role in managing symptoms and improving overall well-being.