Lupus and other rheumatological disorders

Rheumatological conditions are common and may have a severe effect on mobility and activities

• understand the condition
• be aware of the management options
• stay active

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Lupus mimics so many other conditions

Rheumatological conditions include any illness primarily affecting the joints and their surrounding structures, but they also include illnesses which often have joint problems as a smaller part of their collection of symptoms, such as systemic lupus erythematosus (SLE), often known simply as 'lupus'. There is a more localised form of lupus affecting the skin called discoid lupus.

Lupus predominantly affects women from teenage years to middle age, and is more common in people of Asian and Afro-Caribbean ancestry. It is far less common than rheumatoid arthritis or osteoarthritis but it often affects several different organs within the body simultaneously and its medical management is therefore more difficult. In lupus, the body's own defence (immune) system attacks the body's own organs, affecting their function and causing a variety of symptoms.

Together with a gradual onset, this makes early diagnosis difficult. There are characteristic blood factors found, but they are neither highly specific nor highly sensitive. Lupus can cause complications in pregnancy and you should ideally not try to get pregnant until at least six months after a flare of the disease. Treatment should be started as soon as possible after diagnosis, in order to prevent damage to vital organs. Medication may have to be taken long term.

Symptoms

• joint or muscle aches and pains
• leg or facial rashes, which may be caused by sunlight
• tiredness and malaise
• headaches and migraines
• hair loss
• depression
• recurrent early miscarriage
• kidney disease
• anæmia and blood disorders
• Raynaud's syndrome
• mouth ulcers

When you should contact a doctor

Though there are more common diagnoses causing the above symptoms, if you have a collection of symptoms involving multiple areas of the body as above, which are unexplained, you should speak to a doctor to see if lupus is possible or likely.

Available treatments

A variety of treatments may be used depending on the part of the body affected

• NSAIDs (anti-inflammatory drugs) help joint and muscle aches and pains
• steroids are powerful anti-inflammatories which may be needed in high doses initially, then reduced as symptoms come under control
• hydroxychloroquine, an anti-malarial medication, can help joint and skin symptoms
• immune suppression and immunoglobulin is used in more severe disease, such as where the kidneys are affected, and to allow a reduction in steroid dosage. Azathioprine, methotrexate, cyclophosphamide and cyclosporin all need careful blood monitoring
• other drugs such as anticoagulants, where there is a risk of increased clotting; aspirin and sometimes injected anticoagulants to prevent miscarriage; anti-depressive medication; powerful sun-protection cream; steroid ointment for skin disease; osteoporosis medication; and more

Related topics

• Rheumatoid arthritis
• Polymyalgia rheumatica
• Osteoarthritis
• Polyarteritis
• Joints
• Steroids save lives
• Fight fatigue
• Miscarriage