Lupus: Why am I hurting?
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Lupus: Why am I hurting?

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By Stuart Green, MD

By Stuart Green, MD

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  • Arthralgias with the use of MSK US low grade inflammation present
  • 1.75-100%
  • Deforming non-erosive reversible arthropathy associated with attacks of rheumatic fever was first described by Jaccoud in 1869.Bywaters associated with SLE in 1975

Lupus: Why am I hurting? Presentation Transcript

  • 1. LupusWhy am I hurting ?Stuart Green MDChief Rheumatology TBHC
  • 2. Common Complaints in SLE• Arthralgias• Arthritis• Myalgias• Myositis• Tendonitis• Fibromyalgia• Thyroid Disease
  • 3. SLE, Joint Involvement• The most common presenting symptom• Often the initial manifestation of SLE• Arthralgia vs. Arthritis• JacoudArthropathy• Nonerosive vs. Erosive
  • 4. SLE Arthritis• Morning stiffness not as long as in RA, <60min• Pain usually > then findings• Usually < 24 hours• Migratory• Symmetrical
  • 5. Jacoud’sArthopathy• Hypermobile joints with reducible deformities• Inflammation of tissues surrounding the joint• Typically NOT erosive• USA Prevalence 3-5%
  • 6. SWAN NECK DEFORMITY
  • 7. BOUTONNIERE DEFORMITY
  • 8. Arthritis• Erosive vs. Non erosive( Xray vs. MRI vs. US)• Erosive much less common 15-50%• Rhupus! ( RA + SLE) CCP antibody• Osteonecrosis, femoral head
  • 9. Osteonecrosis• Risk 2-30%( depending on exam technique)• MRI, most sensitive.• Lupus patients at risk• Steroids increase risk• Hip most common joint
  • 10. Tendonitis• Rotator Cuff tendonitis• Achilles tendonitis• Epicondylitis• Infrapatellar tendonitis• Posterior Tibialis tendonitis• Tendon Rupture
  • 11. Myalgias/Myositis• Muscle pain• Proximal Weakness; less common (7-15%)• Elevated muscle enzymes; CPK• Other causes include steroids &antimalarials
  • 12. Myalgias/Myositis• Muscle pain• Proximal Weakness; less common (7-15%)• Elevated muscle enzymes; CPK• Other causes include steroids & antimalarials
  • 13. 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
  • 14. FIBROMYALGIA TENDER POINTS
  • 15. Fibromyalgia• Low impact aerobic exercise• Tricyclics• Tamadol• Duloxetine• Milnacipran• Pregabalin
  • 16. Treatment• Physical therapy/OT• NSAIDS• Steroids• Hydroxychloroquine• Methotrexate• Bellimumab------------------------• ? Tocilizumab
  • 17. Thyroid Disease• Common in woman• Maybe more common in AI diseases• Musculoskeletal complaints may initial complaint in AI Thyroid disease.
  • 18. Autoimunne Thyroid Disease• Hypothyroid: Hashimotos – Arthralgias – Polyarthritis – CTS – Myopathy• Hyperthyroid: Graves disease – Arthralgia, shoulders – Myopathy – Thyroid acropachy
  • 19. Autoimunne Thyroid Disease• Hypothyroid: Hashimotos – Arthralgias – Polyarthritis – CTS – Myopathy• Hyperthyroid: Graves disease – Arthralgia, shoulders – Myopathy – Thyroid acropachy