Systemic lupus erythematosus, commonly known as lupus, is a chronic autoimmune disease. The immune system mistakenly attacks healthy tissues and organs, causing inflammation and damage throughout the body, including the skin, kidneys, brain, and joints. Joint involvement is common in lupus, with nearly all individuals experiencing pain, stiffness, or swelling at some point. These symptoms are often among the first signs of the disease.
How Lupus Affects Joints
Lupus-related joint involvement typically presents as inflammatory arthritis. This arthritis often affects joints symmetrically on both sides of the body. The pain can also be migratory, moving from one joint to another. While it causes discomfort and swelling, lupus arthritis generally does not lead to permanent bone erosion or joint destruction, unlike some other forms of arthritis. However, persistent inflammation can sometimes result in deformities, such as Jaccoud’s arthropathy, caused by laxity in tendons and ligaments rather than bone damage.
Commonly Affected Joints
Lupus arthritis frequently impacts the small joints of the hands and wrists, including the knuckles (metacarpophalangeal joints) and the joints closer to the fingernails (proximal interphalangeal joints). Patients often experience swelling, tenderness, and stiffness in these areas, particularly in the morning. Stiffness can sometimes last for 30 minutes or more, with warmth and redness potentially accompanying the swelling.
Knees are another common site for lupus-related joint pain and inflammation. Involvement often occurs bilaterally, meaning both knees are affected. Inflammation in these large joints can significantly impede mobility and daily activities. Swelling and pain can make walking, climbing stairs, or standing for extended periods challenging.
The feet and ankles are also susceptible to lupus arthritis. Small joints in the toes can become painful and swollen, similar to finger joints. Ankle involvement can lead to pain and swelling, making movement difficult and affecting balance. Shoulders and elbows, while less frequently affected than hands, wrists, and knees, can still experience inflammation and pain.
Less Commonly Affected Joints and Related Musculoskeletal Issues
Lupus can involve other joints beyond the commonly affected hands, wrists, knees, and feet. The hips may experience inflammation, though hip pain can also signal avascular necrosis. The spine, including the neck and back, can be affected, though direct inflammatory arthritis is less typical than in peripheral joints. The temporomandibular joint (TMJ), connecting the jaw to the skull, can also be involved, potentially causing jaw locking, pain with movement, and visible changes on imaging.
Beyond direct joint inflammation, lupus can cause other musculoskeletal problems. Tenosynovitis, inflammation of the sheath surrounding a tendon, is common, affecting between 10% and 44% of lupus patients. This can cause pain and reduced movement near joints like the wrists, ankles, fingers, shoulders, and elbows. Many individuals with lupus also report generalized muscle pain (myalgia). Less frequently, lupus can lead to myositis, or muscle inflammation, often affecting the hips, thighs, and upper arms.
Avascular necrosis (AVN), also called osteonecrosis, is a musculoskeletal complication where bone tissue dies due to insufficient blood supply. It often affects large joints like the hips, knees, and shoulders. AVN is frequently associated with long-term high-dose corticosteroid use, a common lupus treatment, rather than direct lupus inflammation.
Managing Joint Pain in Lupus
Managing lupus joint pain often involves a multi-faceted approach guided by a rheumatologist. Medications play a significant role in controlling inflammation and pain. Nonsteroidal anti-inflammatory drugs (NSAIDs) are often used for mild symptoms. Antimalarial drugs, such as hydroxychloroquine, are commonly prescribed for their anti-inflammatory effects and to help manage joint symptoms.
For more persistent or severe joint pain, doctors may prescribe low-dose corticosteroids, disease-modifying antirheumatic drugs (DMARDs) like methotrexate, or biologic therapies. These medications suppress the overactive immune system. Physical and occupational therapy are valuable for pain management, helping improve joint mobility, strengthen muscles, reduce stiffness, and maintain overall function.
Lifestyle adjustments can also contribute to alleviating joint pain. Regular, gentle exercise can help maintain joint flexibility and muscle strength. Applying heat or cold to affected joints can provide temporary relief from pain and swelling. Adequate sleep and stress management are also beneficial, as fatigue and stress can intensify pain.