Can You Have Lupus And Rheumatoid Arthritis Together

What Is Inflammatory Arthritis

The clinical hallmarks of inflammation include redness, swelling, warmth and pain. If the patient has gout, the joint is very hot and red. In contrast, a person with osteoarthritis, which involves much less inflammation, will not tend to have warmth or redness in the joint, even if some swelling, pain and stiffness are present. For someone with lupus and joint pain, the first question the rheumatologist will consider is whether it represents the inflammatory arthritis that is commonly part of lupus.

Treatments For Lupus And Ra

John Hopkins Medicine recommends starting lupus treatment with NSAIDs for mild flares.

Anti-malarial drugs such as Plaquenil can reduce flares as well as serious effects on vital organs.

Steroids such as cortisone as well as the hormone DHEA can reduce inflammation, pain, and other unpleasant daily effects during flares, although these can have serious side effects when used long term.

If these approaches do not work, people with lupus may be given immunosuppressive medications that suppress the immune system.

These are the last resort because they make people more prone to infectious illnesses.

Rheumatoid arthritis has a different treatment plan. Like lupus, it often begins with NSAIDs. Steroids also can be used sparingly. However, there are different drugs for more serious RA.

WebMD considers DMARDs the first line for rheumatoid arthritis that does not respond to NSAIDs, as do most rheumatologists.

This stands for disease modifying anti-rheumatic drugs. There are many medications in this category, all of which reduce flares while slowing damage to joints.

Biologic agents, which directly attack antibodies, are reserved for severe disease that does not get better with any other kind of medication.

These medications have been given by IV, which is inconvenient. In addition, they can have serious side effects such as fatigue and increased risk of infection.

Effect Of Overlap On Treatment At Last Visit

At last visit, patients with SLE and a 2nd AI were less likely to receive corticosteroid and/or hydroxychloroquine than those with pure SLE . Patients with RA and a 2nd AI were more likely to receive HCQ, and patients with APS and a 2nd AI were more likely to receive corticosteroid, HCQ and immunosuppressive therapy than those with pure disease. Patients with Sjögren’s syndrome with and without overlap did not differ in treatment.

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What Is The Distribution Of Arthritis

As mentioned above, the first question a rheumatologist will ask you is whether the pain is actually in the joint or not. If it is in the joint, the distribution of pain offers more information. For example, if a person has either or both of the following, it suggests inflammatory arthritis, such as RA or lupus:

• Swelling in the joints where the bones of the fingers join with the bones of the hand
• Swelling of the entire wrist

Those joints are not usually involved in osteoarthritis. Osteoarthritis tends to occur in some joints where lupus arthritis is not common, such as the finger joints closest to the nails or at the thumb side of the wrist .

Figure 1: Swelling where the fingers meet the hand, and of the entire wrist are clues to an inflammatory type of arthritis, as in lupus or rheumatoid arthritis.Image courtesy of Theodore Fields, MD.

Are The Symptoms Of Rheumatoid Arthritis Different From Lupus

The symptoms of rheumatoid arthritis are mainly limited to the joints, particularly the small joints in the toes, fingers, hands, and feet. Although less common, RA may involve the wrists, elbows, knees, ankles, and other body parts. Joint involvement in RA is symmetric, which means that if the joints in the fingers of your left hand have pain, you will experience pain in the fingers of your right hand too. The common symptoms of RA are as follows:

• Frequent miscarriages

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Meeting Others With Lupus

Lupus is a difficult condition to live with and throws up many challenges, especially during periods of life when you may need more energy.

Meeting others with lupus doesnt necessarily remove these challenges but it can help you to cope with them by sharing your thoughts and concerns with someone who understands. You may have access to an education programme through a lupus nurse specialist or you may wish to meet others through patient support groups such as LUPUS UK.

Increased Rates Of Autoimmune Illness

Autoimmune diseases are becoming more common in the developed world. Although there is a diverse range of autoimmune illness, all of them share a few commonalities.

Our immune systems basic function is to attack invaders, such as bacteria and virus.

In autoimmune disease, the immune system instead begins to attack the bodys own tissues.

According to WebMD, this class of diseases includes a diverse range of disorders including lupus, rheumatoid arthritis, type 1 diabetes, and multiple sclerosis.

Some autoimmune diseases affect only one organ. Lupus and rheumatoid arthritis, however, can affect the entire body.

Autoimmune diseases are not contagious. This means that people who have these illnesses cannot spread them to others. You cannot catch these diseases from loved ones who have them.

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How Is Knee Arthritis Diagnosed

Your doctor may use some of the following diagnostic tests and procedures to determine if you have knee arthritis:

• Medical history and physical examination
• Blood tests for genetic markers or RA antibodies
• X-rays to determine cartilage loss in the knee
• Joint aspiration: drawing out and testing the synovial fluid inside the knee joint

Cartilage cannot be seen on X-ray, but narrowing of the joint space between the bones indicates lost cartilage. X-rays show bone spurs and cysts, which can be caused by osteoarthritis. Other tests such as MRI or CT scans are rarely needed for diagnosis.

Sensitivity To Sunlight And Cold Temperatures

Sun exposure can cause a lupus rash to develop or flare. People with lupus are also at risk of developing Raynauds, a condition in which the small blood vessels in the hands and feet suddenly constrict when exposed to cold or stress.

Other lupus symptoms include fever neuropsychiatric issues such as depression, anxiety, seizures, or psychosis brain fog fatigue headaches mouth ulcers kidney problems and chest pain.

Read more here about lupus symptoms.

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Study Finds Gene Similarities For Sjgrens Syndrome Rheumatoid Arthritis And Lupus

Researchers of the study conducted a meta-analysis of gene expression data for all three diseases to determine overlapping biological processes. The analysis uncovered that inflammatory systemic autoimmune diseases are composed of 371 differentially expressed genes 187 were underexpressed and 184 were overexpressed. Many of these genes have been previously identified as biomarkers of systemic autoimmune diseases however, many of them were new.

According to the study, overexpressed genes were involved in immune and inflammatory responses, mitotic cell cycles, cytokine-mediated signaling pathways, apoptotic processes, type I interferonmediated signaling pathways and responses to viruses. Underexpressed genes were involved in inhibition of protein synthesis.

The study revealed common genes in Sjögrens syndrome, lupus and rheumatoid arthritis, which revealed biological processes that play an important role in the formation of all three diseases.

What Questions Should I Ask My Healthcare Provider About Autoimmune Diseases

Its helpful to have some questions ready to ask before you see your provider. Examples to consider include:

• Do I have an autoimmune disease?
• What tests should I go through?
• What type of autoimmune disease do I have?
• Do I need to see a specialist?
• What specialist should I see?
• Whats the best treatment for me?
• Should I let my family members know that I have an autoimmune disease?

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Risk Factors For Knee Arthritis

• Age. Osteoarthritis is a degenerative, wear and tear condition. The older you are, the more likely you are to have worn-down knee joint cartilage.
• Heredity. Slight joint defects or double-jointedness and genetic defects may contribute to osteoarthritis in the knee.
• Excess weight. Being overweight or obese puts additional stress on the knees over time.
• Injury. Severe injury or repeated injury to the knee can lead to osteoarthritis years later.
• Overuse. Jobs and sports that require physically repetitive motions that place stress on the knee can increase risk for developing osteoarthritis.
• Gender. Postmenopausal women are more likely to have osteoarthritis than men.
• Autoimmune triggers. While the cause of rheumatoid arthritis remains unknown, triggers of autoimmune diseases are still an area of active investigation.
• Developmental abnormalities. Deformities such as knock knee and bowleg place higher than normal stress on certain parts of the knee joint and can wear away cartilage in those areas.
• Other health conditions. People with diabetes, high cholesterol, hemochromatosis and vitamin D deficiency are more likely to have osteoarthritis.

The Pain Of These Two Conditions Affects More Than Just The Joints

As an autoimmune disease, rheumatoid arthritis has side effects beyond joint pain. To start, the same underlying inflammation that damages the joints can affect organs and systems throughout the body, causing an increased risk of heart disease, lung disease, and more.

Certain medications used to treat rheumatoid arthritis can affect kidney and liver function. RA and the medications that treat it also make me immunocompromised, which makes fighting infections more difficult.

The pain and mobility limitations of OA also take a toll on people. OA can cause sleep issues, for example, and social limitations. OA can force people to give up their favorite activities or need to stop working. And while OA doesnt necessarily cause these conditions, there are a number of co-occurring health problems that are common in OA patients and could affect how it is able to be treated, such as high blood pressure, heart disease, and diabetes.

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Mixed Connective Tissue Disease

NORD gratefully acknowledges Eric L. Greidinger, MD, Staff Physician, Miami VAMC, Associate Professor of Medicine and Microbiology & Immunology, University of Miami Miller School of Medicine, for assistance in the preparation of this report.

Synonyms of Mixed Connective Tissue Disease

• MCTD
• Sharp syndrome

General Discussion

Mixed connective tissue disease is an uncommon systemic inflammatory rheumatic condition. MCTD is a specific subset of the broader category of rheumatic overlap syndromes, a term used to describe when a patient has features of more than one classic inflammatory rheumatic disease. These classic rheumatic diseases include systemic lupus erythematosus, polymyositis, scleroderma and rheumatoid arthritis. Individuals with an overlap syndrome may, but need not meet, complete diagnostic criteria for one classic rheumatic disease. MCTD is distinguished from other overlap syndromes by a laboratory result: MCTD patients have rheumatic overlap syndrome plus anti-RNP antibodies. Additionally, it has been proposed that the term MCTD be reserved for patients with clinical features that include at least one of the following common manifestations: Raynauds phenomenon, puffy fingers or swollen hands.

Signs & Symptoms

Heart involvement is less common in MCTD than lung problems, but can be serious when it occurs.

Kidney disease occurs much less often in MCTD than in lupus and is often mild in MCTD.

Causes

Affected Populations

Related Disorders

Diagnosis

Treatment

Getting Prompt Treatment For Lupus Or Ra

If youve been experiencing symptoms of lupus or RA, its crucial to see your doctor as soon as possible.

If a diagnosis of RA is delayed, a lot of joint damage can occur, Dr. Agarwal says. And if lupus goes undiagnosed, you could experience kidney failure.

The good news, he adds, is that with such a wide variety of treatment options available for both conditions, RA and lupus are becoming easier to manage. Some medications are helpful for treating the two diseases, including NSAIDs, corticosteroids, anti-malarial drugs such as Plaquenil, and immunosuppressive medications like methotrexate.

Treatment varies more when RA and lupus are more severe: A person with RA may be treated with biologics, while someone with lupus would likely be treated with stronger immunosuppressive drugs, Dr. Agarwal says.

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Why The Diseases Could Be Confused

Because these two diseases share some common characteristics, people can be misdiagnosed with RA when they actually have lupus, or vice versa, at the early stages of either disease.

Once RA is advanced, doctors can tell because the disease can cause bone erosion and deformity if appropriate therapy is not provided. Lupus, however, rarely causes bone erosions.

In the early stages of RA or lupus, doctors can usually make a diagnosis by looking at your symptoms. For example, lupus often affects the kidney, causes anemia, or leads to weight changes.

RA can also cause anemia, but may lead more frequently to pulmonary issues. A doctor might order a blood panel to check the health of your organs and to see if something else could be causing the symptoms.

Both lupus and rheumatoid arthritis can be difficult to diagnose. This is especially true early on in both diseases when there are few symptoms.

To be diagnosed with systemic lupus, you must meet at least four of the following diagnostic criteria :

• acute cutaneous lupus, which includes malar rash, a rash that appears on the cheeks and nose
• chronic cutaneous lupus, which includes discoid lupus, raised red patches on the skin
• nonscarring alopecia, or hair thinning and breaking in multiple body sites
• joint disease, which includes arthritis that doesnt cause bone erosion

Diseases that often overlap with RA include:

• Sjögren syndrome

What Are The Main Differences Between Sle And Ra

Differences between the two conditions include their effects on skin, internal organs, and joint pain:

• Effect on skin: SLE can affect the skin, whereas RA usually does not do so. An SLE rash characteristically presents with a butterfly-shaped rash on the cheeks and nose.
• Internal organs: While both conditions can cause inflammation of the heart and lungs, a person with SLE is more likely to experience these symptoms than someone with RA. In addition, SLE can affect internal organs such as the kidneys, lungs, and heart. Although RA can affect internal organs, it does not commonly affect the kidneys.
• Joint pain: The main symptom of RA is joint pain and stiffness. Stiffness is not a prominent symptom of SLE.

Although both SLE and RA have some shared symptoms, each condition also has a specific set of symptoms relating to each condition, as explained below.

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Looking After Your Mental Health

Because of the pain, fatigue and disruption to life, lupus can cause anxiety and depression.

Its important to talk to someone you trust if youre feeling down or worried. This could be a friend, relative or a healthcare professional. Versus Arthritis has a helpline if youd like to speak to one of our trained advisors. Our helpline is open Monday to Friday from 9am to 8pm. Call free from the UK on 0800 5200 520.

Even if it doesnt affect the course of the condition, emotional stress can sometimes make lupus seem worse. Its not always easy, but there are things we can all do to help manage stresses in our life. For example you might want to try relaxation techniques such as meditation or mindfulness.

Your doctor may be able to refer you to a psychologist who can help with coping strategies.

Therapies such as cognitive behavioural therapy may help. This is a talking therapy that can help you manage problems by changing the way you think and behave. Its most commonly used to treat anxiety and depression, but can be useful for other mental and physical health problems.

Regular exercise can improve feelings of stress, anxiety and depression.

The Location Of The Joint Pain

RA Most commonly these joints are affected: hands, wrists, fingers, elbows, knees, feet, and hips. However, the pain can be in any joint. The pain is usually symmetrical it effects both sides of the body at the same time.

OA There is pain wherever a joint has been injured or worn through overuse most commonly in the hands, fingers, thumb, knees, hips, lower back and neck. The pain is not symmetrical. The lifetime risk of developing OA of the knee is about 46 percent, and the lifetime risk of developing OA of the hip is 25 percent, according to the American College of Rheumatology.

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How Rheumatoid Arthritis Differs From Osteoarthritis

• Most people with arthritis have osteoarthritis, which commonly occurs with age.
• But theres another type called rheumatoid arthritis , a serious autoimmune disease. The two are often confusedwhich can be endlessly frustrating for those with RA.
• Everybody says that arthritis is one word, says Christopher Evans, DSc, PhD, the Maurice Mueller Professor of Orthopaedic Surgery at Harvard Medical School in Boston. But the conditions are quite different.
• Here are 13 ways to tell the two apart.

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Rheumatoid Arthritis Vs Lupus

Both rheumatoid arthritis vs. lupus are conditions that are medically classified as autoimmune diseases. This is when the body mistakenly attacks one or more parts of the body. They are two of the most common autoimmune disorders. They can vary in severity, yet present similar symptoms. They can also be referred to as chronic illnesses, invisible illnesses and invisible disabilities. But at the same time, signs of the disease may be present in the form of visible disability.

For both rheumatoid arthritis and lupus, there is no cure various medications and lifestyle changes can only help slow the progression or halt it altogether. When the latter occurs, this is known as clinical remission . During this time, people under the guidance of their medical provider may be able to taper off medications completely. In terms of the cause of these two diseases, it is more centered on a cause-and-effect list of triggers.

The common triggers between both are emotional or physical stress. For instance, pregnancy, giving birth, undergoing surgery or multiple invasive procedures and other types of physical trauma and harm. Other common factors are stress, exhaustion, viral or bacterial infection, traumatic injuries, medications that list one or two of these conditions as a side effect and antibiotic use.

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