Lupus: Why am I hurting?

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By Stuart Green, MD

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Lupus: Why am I hurting?

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

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