90% to 95% of people with lupus will experience muscle and/or joint pain. Arthralgias are pains in the joints, and myalgias are pains in the muscles. The ending “-algia” comes from the Greek word for “pain”. These pains will often be termed “polyarthralgias” and “polymyalgias” as well (“poly-“ means “many”). Experiencing arthralgias and myalgias does not necessarily mean that there is actual arthritis (actual inflammation or damage in the joints) or muscle inflammation. The doctor may not see any evidence of inflammation on examination. If a patient just has achy joints (arthralgias) without having actual inflammation of the joints (arthritis), doctors usually prescribe pain relievers for treatment. These include Paracetamol, non-steroidal anti-inflammatory drugs (NSAIDs; such as ibuprofen and naproxen), or other analgesics such as tramadol.
About 50% of people who have SLE will develop actual inflammation of the joints – the medical term for this is arthritis. Fortunately, the arthritis of lupus is usually not crippling or deforming (with the exception of Jaccoud’s arthropathy). Rheumatologists treat lupus arthritis with NSAIDs, steroids, and hydroxychloroquine. Sometimes doctors may need to prescribe stronger immunosuppressant medicines. The goal of treatment is usually to decrease the pain, stiffness, and swelling to acceptable levels.
Just as lupus can cause inflammation of the joints, it can also cause inflammation of the tendons (tendonitis). Tendonitis usually causes pain around and between the joints of the body, sometimes causing swelling as well. Some examples of tendonitis that can occur in lupus include;
Just as in arthritis, the tendonitis of SLE is treated with NSAIDs, steroids, and hydroxychloroquine, while stronger medications such as methotrexate are used for difficult cases. Resting the tendon to allow the body to heal is one of the most important things to learn to do. An injection with a corticosteroid is also one of the safest and quickest ways to treat tendonitis. Using an ice pack as needed can also help to decrease the severity of the pain from tendonitis.
Myositis refers to inflammation of the muscles caused by a direct attack of the immune system; it can occur in 10% of people who have SLE. Although there may be some achiness in the muscles (myalgias), actual muscle weakness is the more common symptom. If myositis occurs in people who have lupus, doctors usually treat it with steroids but they sometimes use immunosuppressant drugs. If a person just has achy muscles (myalgias) without having actual inflammation of the muscles (myositis), they are treated with pain relievers, such as Paracetamol, NSAIDs, or other analgesics such as tramadol.
Not all joint and muscle pain is due to the inflammation of lupus. About 20% of all people who have lupus will develop a condition called fibromyalgia. Fibromyalgia is due to a chemical imbalance problem of the pain nerves of the body. The treatment of fibromyalgia is completely different from the treatment of lupus arthritis. Instead of using anti-inflammatory medicines, doctors use medicines that reverse the chemical imbalances (such as antidepressants and anti-seizure medicines). Exercise and improving sleep are also important in the treatment of fibromyalgia. Some common symptoms that can point to the possibility of having fibromyalgia include having pain “all over”; having tenderness of the muscles, bones, and skin; headaches; waking in the morning feeling like you did not get much sleep; and feeling tired and fatigued. It is extremely important to identify it as a cause of pain when it occurs to ensure that it is treated appropriately. You can learn more about fibromyalgia from Fibromyalgia Action UK, HERE.
It can be difficult to convince someone that depression and anxiety disorders can cause pain. People can be resistant to the notion of taking an antidepressant or an anti-anxiety medicine to treat their joint or muscle pain. However, in depression and anxiety disorders, body pain is a very common problem. The treatment of choice is to use medicines that reverse the chemical imbalances that are causing the depression, anxiety, and pain. Pain medicines, anti-inflammatory medicines and steroids should not be used in these cases.
Viral infections can also cause joint and muscle pain. If you get a fever and have a lot of achiness, it could be due to lupus but you need to see a doctor right away and be evaluated to make sure it is not an infection as well.
A very important part of the treatment of joint and muscle pains is exercise. Due to the discomfort that may occur in lupus, many people are not able to be as active as they were before; they can lose muscle mass, strength, and joint flexibility, preventing them from doing certain activities. This can lead to deconditioning of the muscles of the body and cause even more aches and pains to develop. This becomes a vicious cycle where the pain leads to less activity, less activity causes loss of function and more pain, and so on. Numerous studies show that people who have arthritis who force themselves to exercise regularly actually have less pain overall, develop more muscle mass, are able to do more activities, and have a better quality of life. Not only does exercise help with pain and function, but it has other benefits such as keeping weight under better control, decreasing the chances of developing strokes and heart attacks, and helping with mood in people who have problems with depression.
Heat and ice are commonly used to treat pain and to reduce swelling, and many people have found them effective. In general, when used sensibly, they are safe treatments which make people feel better and have some effect on pain levels and there are few harmful effects associated with their use. Heat treatments, such as heating pads or warm baths, tend to work best for soothing stiff joints and tired muscles. Heat enhances circulation, delivering nutrients to joints and muscles. It’s good for getting your body ready for exercise or activity. Cold is best for acute pain; it restricts blood vessels, slowing circulation and reducing swelling. It also numbs nerve endings, dulling pain.
The power of prayer has not been formally studied in lupus, but it has been studied in other medical conditions. A review of prayer studies in 2000 showed that 57% of the studies had a positive treatment effect. Therefore, prayer should be encouraged in people who use prayer in their religious beliefs.
Meditation refers to a large group of practices used in religion as well as for secular (non-religious) purposes to change a person’s inward mode of consciousness. It often involves resting quietly, often with eyes closed, concentrating on breathing, and sometimes involves saying words repeatedly (called a mantra). In complementary medicine, it is used to increase calmness and physical relaxation, to improve psychological balance, to cope with illness, or to enhance overall health and well-being. Studies have shown its usefulness for the pain and tenderness of rheumatoid arthritis.
One form of meditation which is now widely practiced and recognised for various benefits to health and wellbeing is mindfulness. You can learn more about this practice HERE.
Hypnotherapy (hypnosis) is a type of relaxation therapy where the hypnotherapist guides the individual into a heightened state of relaxation along with an increased focus in attention. It has been used for anxiety, smoking cessation, weight control, and to help decrease pain.
Reiki is a Japanese healing art developed in the 1920s by a Japanese Buddhist. Its proponents believe that an invisible healing energy can be transmitted from the healer to the patient through intuition by placing the hands on certain parts of the patient’s body. It can also be practiced at a distance from the patient as well. There are no studies of its use in lupus. A 2011 study in cancer patients suggested that it may be helpful for pain, sleep, relaxation, anxiety and improving one’s sense of overall well-being.
Pain management programmes are a series of sessions, for groups of 6-8 people, aimed at teaching you how to live with your pain. Instead of treating your pain, you learn to cope with it and, research shows, can expect to enjoy a better quality of life, sleep and mobility afterwards. It should be noted that the techniques practiced in pain management programmes may not be effective for everyone.
Some hospital pain clinics offer pain management programmes, and some are held within GP surgeries.
As with pain clinics, you will need a referral to join a pain management programme from a GP or hospital specialist.
Occupational therapy provides support to people whose health prevents them doing the activities that matter to them. An occupational therapist can identify strengths and difficulties you may have in everyday life and will help you work out practical solutions.
They can work with you to identify goals that can help you maintain, regain, or improve your independence by using different techniques, changing your environment, and using new equipment.
“I have an orthopaedic office chair. I have changed my car to an automatic and a 4×4 so it is easier to step in and out of. We are considering a walk-in shower rather than a step into the bath/shower which we currently have. I also have a cleaner and ironing lady.”
***Please note that this article is written for informational purposes only and should not be a substitute for professional medical advice or treatment. Do not delay seeking or disregard medical advice based on information here. Always seek the advice of your local family physician or other qualified health professional before starting any new treatment or making any changes to existing treatment. It is also advisable to consult a medical professional before making any changes to diet or starting alternative remedies, which may interact with other medications.***