Lupus Symptoms: Differentiating Between Disease and Injury

Systemic lupus erythematosus (SLE)

Hello Doctor, I was diagnosed with lupus at the age of 18, and until this year, I was taking two quinine tablets a day.
However, this year my doctor informed me that my urine protein UPCR increased from below 200 to 500, and my CRP was 0.19.
As a result, I started taking one steroid tablet a day and one mycophenolate mofetil tablet every two days.
After a month, my UPCR decreased to 250, and the dosage was adjusted to one steroid and one mycophenolate mofetil every two days.

Recently, I have been experiencing morning stiffness in my fingers, discomfort in my knees when going up and down stairs, soreness in my knees when exposed to wind, and a sensation of tightness in my hip joints while walking.
I also feel pain near my hip joints and discomfort at the base of my spine near the sciatic area.
Taking Celebrex provides relief.
When I consulted my doctor, they mentioned that if Celebrex alleviates the symptoms, it is likely not caused by lupus.

I am confused as to why lupus patients commonly take Celebrex.
Additionally, I have not been exercising recently, so I do not understand the origin of these symptoms.
I would like to ask how to differentiate whether these issues are caused by lupus or by exercise-related injuries.
Thank you very much, Doctor.

Ms. Chen, 30~39 year old female. Ask Date: 2023/06/07

Dr. Gao Jiankai reply Internal Medicine

Hello, thank you for your question.
Most immune system issues, including lupus, often present with joint symptoms, which is why patients are monitored in rheumatology.
For mild joint symptoms, we manage them with anti-inflammatory pain relievers, including Celecoxib.
Celecoxib is a relatively new anti-inflammatory medication that is less harsh on the stomach, making it a common choice for rheumatology patients.
Since rheumatology patients often take many medications, we prefer anti-inflammatory pain relievers that are less irritating to the stomach, such as Celecoxib.

The joint pain caused by lupus is a type of pain resulting from inflammation, which worsens with rest and improves with movement.
For example, morning stiffness is a manifestation of inflammatory joint pain.
In contrast, pain resulting from sports injuries is due to structural damage and requires rest for healing; thus, the symptoms are opposite: pain from sports injuries improves with rest and worsens with activity.
This symptom differentiation can help in initial assessment.

The Allergy, Immunology, and Rheumatology Department of Changhua Hospital, Ministry of Health and Welfare, is here to support you.

Reply Date: 2023/06/07

More Info

Understanding the symptoms of lupus, particularly systemic lupus erythematosus (SLE), can be quite complex, especially when differentiating between symptoms caused by the disease itself and those resulting from other factors such as physical injuries or overuse.
Lupus is an autoimmune disease that can affect multiple systems in the body, leading to a wide range of symptoms. Common manifestations include joint pain, fatigue, skin rashes, and organ involvement. In your case, you have been experiencing symptoms such as morning stiffness in your fingers, discomfort in your knees when climbing stairs, and pain in your hips and lower back. These symptoms can indeed be associated with lupus, particularly when considering the inflammatory nature of the disease.

However, it is essential to differentiate between lupus-related symptoms and those resulting from physical activity or injuries. The key lies in understanding the nature of the pain and the circumstances surrounding its onset.
1. Lupus-Related Pain: Pain associated with lupus is often inflammatory in nature. It tends to be worse after periods of inactivity (like overnight), which is why you might experience morning stiffness. This type of pain typically improves with movement and activity. In contrast, lupus-related joint pain may also be accompanied by swelling, warmth, and tenderness in the affected areas.

2. Injury-Related Pain: On the other hand, pain resulting from an injury or overuse usually has a different pattern. It often worsens with activity and improves with rest. If you have engaged in any physical activity that could have led to strain or injury, this could explain the discomfort you are feeling in your knees and hips.
In your case, the fact that you have not been engaging in physical activity recently makes it less likely that your symptoms are due to an injury. However, the response to medications like Celecoxib (希樂葆) can provide clues. If your symptoms improve with this medication, it suggests an inflammatory process, which could be related to lupus.
It is also important to consider that lupus can cause flares, where symptoms worsen due to various triggers, including stress, infections, or changes in medication. The increase in your urine protein levels (UPCR) and the need for steroids indicate that your lupus may be active, which could explain the new or worsening symptoms.

In conclusion, while lupus can cause a variety of symptoms, including joint pain and stiffness, it is crucial to assess the context and nature of these symptoms. Keeping a symptom diary that tracks when the pain occurs, its intensity, and any activities that may have contributed can be helpful for discussions with your healthcare provider. Regular follow-ups and communication with your doctor are essential to manage your condition effectively and adjust treatment as necessary. If you continue to experience confusion about your symptoms, consider seeking a second opinion or further evaluation from a rheumatologist who specializes in autoimmune diseases.

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