Managing Joint Pain in Systemic Lupus Erythematosus Patients

Issues related to systemic lupus erythematosus?

Hello, doctor.
I was diagnosed with systemic lupus erythematosus in early April this year.
I have already started taking medication, but I am currently away and do not have the English name of the medication with me, so I cannot provide detailed information.
Before I started the medication, I experienced less joint pain.
However, after starting the treatment, I have been experiencing joint pain almost every day.
I am unsure if this is due to the medication or if my body is reacting to the knowledge of my condition and starting to torment itself.

In terms of diet, I try to avoid refined foods, fried foods, and high-protein foods as much as possible, and I avoid sauces whenever I can.
I also do not consume certain foods like mushrooms and alfalfa sprouts.
However, I have been taking calcium supplements to help alleviate the pain.
Despite this, I still experience pain daily, and sometimes it gets so severe that I feel the need to take painkillers, but I am concerned about putting a strain on my body.
My diagnostic report shows no issues with protein in the urine, and my kidney function is normal with no abnormalities.

Aru, 20~29 year old female. Ask Date: 2015/04/30

Dr. Xiao Yongxun reply Internal Medicine

The diagnostic criteria for systemic lupus erythematosus (SLE) include: 1.
The presence of a fixed erythematous rash on the cheeks, known as a malar rash or butterfly rash; it typically does not involve the nasolabial folds.
2.
The appearance of discoid lupus erythematosus lesions on the skin.
3.
Photosensitive skin rashes.
4.
Oral and nasopharyngeal ulcers.
5.
Arthritis.
6.
Serositis, including pleuritis or pericarditis.
7.
Renal involvement: persistent proteinuria; more than 0.5 grams per day or urine dipstick showing three or more positive reactions, and may also show cellular casts under microscopy.
8.
Neuropsychiatric disorders: for example, seizures or psychiatric disturbances.
9.
Hematological disorders: such as hemolytic anemia, leukopenia (white blood cell count less than 4000/µL on two occasions), thrombocytopenia (platelet count less than 100,000/µL), or lymphopenia (lymphocyte count less than 1500/µL on two occasions).
10.
Immunological abnormalities: positive anti-DNA, anti-Sm, or anti-phospholipid antibodies, and a false positive result on the syphilis test (STS) persisting for more than six months.
11.
Positive antinuclear antibodies (ANA).
A diagnosis of systemic lupus erythematosus can be made if four or more of the above criteria are met.
Your physician likely diagnosed this condition quickly due to clear evidence; in some cases, patients may present with fewer than four symptoms, but if the affected organs are involved or the condition is severe, the clinician may still initiate treatment.
It is noted that your symptoms primarily involve joint pain.
Clinically, Hydroxychloroquine (200 mg, brand name Hydroquine®, manufactured by Sinphar Pharmaceutical) may be prescribed to manage skin and joint manifestations.
Generally, the response should be favorable; if the response to quinine-related medications is inadequate, various non-steroidal anti-inflammatory drugs, corticosteroids, and immunosuppressants are available.
Please be patient with your medication regimen; if the treatment response is poor, discuss with your rheumatologist whether to adjust or change your medication.
Some treatments for systemic lupus erythematosus can indeed be complex and challenging, requiring both the clinician and the patient to invest more time and effort to achieve optimal results.

Reply Date: 2015/04/30

More Info

Managing joint pain in patients with systemic lupus erythematosus (SLE) can be quite challenging due to the complex nature of the disease and its treatment. SLE is an autoimmune condition that can affect multiple organ systems, including the joints, leading to symptoms such as pain, swelling, and stiffness. Given your recent diagnosis and the issues you are experiencing, it is essential to explore both pharmacological and non-pharmacological approaches to manage your joint pain effectively.

First, it is important to understand that joint pain in SLE can be influenced by several factors, including disease activity, medication side effects, and psychological factors. The medications you are currently taking, such as hydroxychloroquine (often referred to by its brand name, Plaquenil), are commonly prescribed to help manage SLE symptoms, including joint pain. However, it is not uncommon for patients to experience increased pain or new symptoms after starting treatment. This could be due to the body adjusting to the medication or the underlying disease activity itself.

In your case, since you mentioned that your joint pain has increased after starting medication, it is crucial to discuss this with your healthcare provider. They may need to evaluate the effectiveness of your current treatment regimen and consider adjustments. Other medications that can be used to manage joint pain in SLE include nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, and immunosuppressive agents. Each of these options has its benefits and potential side effects, so a tailored approach is necessary.

In addition to pharmacological treatments, lifestyle modifications can play a significant role in managing joint pain. You mentioned that you are avoiding refined foods and high-fat or high-protein items, which is a good start. A balanced diet rich in anti-inflammatory foods, such as fruits, vegetables, whole grains, and omega-3 fatty acids (found in fish and flaxseeds), can help reduce inflammation and improve overall health. Staying hydrated and maintaining a healthy weight are also important, as excess weight can put additional strain on your joints.

Physical activity is another critical component of managing joint pain. While it may be tempting to rest when experiencing pain, gentle exercises such as stretching, swimming, or walking can help maintain joint function and reduce stiffness. Consider working with a physical therapist who can design a personalized exercise program that takes your specific limitations and pain levels into account.

Cognitive-behavioral therapy (CBT) and mindfulness practices can also be beneficial in managing pain perception and improving coping strategies. These approaches can help address any psychological factors that may be contributing to your pain experience, such as anxiety or stress related to your diagnosis.

Lastly, if you find that over-the-counter pain relievers are necessary, it is essential to use them judiciously. While medications like acetaminophen or NSAIDs can provide temporary relief, they should not be relied upon as a long-term solution without consulting your healthcare provider. They can help you weigh the benefits against potential risks, especially considering your concerns about the burden on your body.

In summary, managing joint pain in SLE requires a comprehensive approach that includes medication management, lifestyle modifications, physical activity, and psychological support. Regular follow-ups with your healthcare provider are crucial to monitor your disease activity and adjust your treatment plan as needed. By taking an active role in your care and utilizing a combination of strategies, you can work towards better managing your joint pain and improving your overall quality of life.

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