Does Lupus Cause Shoulder Pain? Causes and Management

Systemic Lupus Erythematosus (SLE), commonly known as lupus, is a chronic autoimmune disease where the body’s immune system mistakenly attacks its own healthy tissues and organs. This widespread attack can cause inflammation and damage in many parts of the body, including joints, skin, kidneys, and the heart. A common question for those affected or seeking to understand the condition is whether lupus can cause shoulder pain. This article will explore the connection between lupus and shoulder discomfort.

Lupus and Shoulder Pain

Lupus can cause shoulder pain due to inflammation affecting the joints, tendons, and muscles in the shoulder. Up to 95% of people with lupus experience joint pain, and it can be the first symptom for around 70% of individuals. This pain often stems from lupus arthritis, which involves inflammation of the joint lining, leading to swelling, tenderness, and stiffness. Lupus arthritis can affect both large joints, such as the shoulders, and smaller joints like those in the fingers and wrists.

Lupus arthritis often involves symmetrical pain, affecting both shoulders. The pain can also be migratory, moving from joint to joint, and is typically non-erosive, meaning it generally does not cause permanent bone damage. However, prolonged, uncontrolled inflammation can sometimes lead to joint problems. Beyond the joints, lupus can cause inflammation of the tendons (tendinitis) and the fluid-filled sacs that cushion joints (bursitis). Shoulder tendinitis, especially affecting the rotator cuff, can cause pain and stiffness.

Generalized muscle aches (myalgia) are common in people with lupus and can contribute to shoulder discomfort. In some cases, lupus can lead to myositis, a more severe inflammation of the muscles that results in weakness, often affecting the shoulders and upper arms. While joint and muscle pain are frequent in lupus, the specific cause can vary and may require professional assessment.

Distinguishing Lupus Pain from Other Shoulder Pain

Distinguishing lupus-related shoulder pain from other common causes is important for effective management. Common non-lupus causes include rotator cuff tears (damaged tendons) or impingement syndrome (pinched tendons). Other conditions include frozen shoulder (stiffness and limited movement) and osteoarthritis, a “wear-and-tear” arthritis where joint cartilage breaks down over time.

Lupus pain often has specific differentiating features. It is frequently bilateral, affecting both shoulders, and may shift between joints. Unlike acute injury pain, which is sudden and localized, lupus pain often accompanies other systemic symptoms. These can include profound fatigue, skin rashes (especially a butterfly-shaped rash on the face), unexplained fevers, and swelling in other joints. Morning stiffness from lupus arthritis may also last longer than in other conditions.

Managing Lupus-Related Shoulder Pain

Managing lupus-related shoulder pain involves medical and non-pharmacological approaches to reduce inflammation and discomfort. For mild pain, nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen are often the first treatment to reduce inflammation and pain. For severe or persistent pain, a rheumatologist may prescribe corticosteroids to quickly reduce inflammation, or disease-modifying antirheumatic drugs (DMARDs) and other lupus-specific medications to control underlying disease activity and prevent flares. These medications work by modulating the immune system’s response.

Several non-pharmacological strategies also help manage lupus-related shoulder pain. Physical therapy is often recommended to improve joint mobility, strengthen surrounding muscles, and reduce stiffness. Gentle, low-impact exercises like swimming or yoga can promote well-being and maintain flexibility without straining joints. Applying heat, such as warm towels or baths, can also relieve muscle and joint pain. During periods of increased pain or disease flares, resting the affected shoulder can be beneficial.

When to Seek Medical Advice

Seek medical advice for shoulder pain, especially if you have lupus or suspect an autoimmune condition. Contact a healthcare professional if you experience new, severe, or persistent shoulder pain that doesn’t improve with rest or over-the-counter remedies. This is especially important if the pain significantly interferes with daily activities or sleep.

Consult a doctor if your shoulder pain is accompanied by other symptoms commonly associated with lupus, such as unexplained fever, widespread skin rashes, extreme fatigue, or swelling in other joints. These symptoms can indicate an underlying lupus flare or other complications requiring prompt medical evaluation. A proper diagnosis from a healthcare professional, particularly a rheumatologist, is crucial to determine the cause and establish an effective management plan.

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