On November 6, Hospital for Special Surgery and the S.L.E. Lupus Foundation hosted a Facebook chat on Lupus and General Health. Participants asked many questions, but our room full of experts could only answer as much as they could during the one-hour, live event. We categorized the remaining questions, and will run a series of our experts? answers over the next month. For our second installment, rheumatologists Dr. Jane Salmon, Dr. Alana Levine, Dr. Kyriakos Kirou, and Dr. Michael Lockshin answered your questions on joint pain. You can read our previous blog about lupus and medicine here.
The information provided is for informational and educational purposes, and doesn?t constitute medical or health advice for any individual problem. Please consult with your health care providers for any health problem and/or prior to starting any new medication or changing or discontinuing any medication you have been prescribed. This chat is not intended to create a doctor-patient relationship, or any other duty, between you and any member of the HSS interdisciplinary team or the S.L.E. Lupus Foundation.
Q1. Is there a link between cold weather and increase in joint pain? Also, it seems that my lupus symptoms flare more during my monthly cycle; is there a connection?
Dr. Jane Salmon: It is common for patients with any kind of arthritis to find that cold weather aggravates their pain. We don?t know why this occurs. The relationship between the menstrual cycle and lupus flares is also unclear.
Q2. What?s good for treating joint pain and headaches?
Dr. Jane Salmon: There are many approaches to treat your pain, but it is important to understand its source. I would discuss this with your physician.
Q3. Lately, I?ve been experiencing severe cramping and body stiffness. I?ve never lived with Lupus for 15 years and I?ve never experienced this much pain associated with these symptoms. Can anybody give me some suggestions?
Dr. Jane Salmon: There are many sources of pain, some related to lupus and some not. If this is a new symptom, seek advice from your physician.
Q4. How do you deal with extreme fatigue and painful joints? What do you do when your blood work shows your lupus is stable, but you feel like you?ve been run over by a Mack truck?
Dr. Alana Levine: Joint pains and the severe fatigue you?ve described are very common among lupus patients. These symptoms could still indicate active lupus, even if a patient?s labs appear normal. However, many other conditions can cause these symptoms as well. Ask your rheumatologist or general doctor to review your symptoms in detail to determine their cause so you can receive the proper treatment.
Q5. I have knots on the bottom of both feet that are very sore to the touch and painful to walk on. Does lupus cause this sort of thing?
Dr. Alana Levine: While lupus can cause arthritis in the joints of the feet, ankles, and other parts of the body, other conditions, such as plantar fasciitis or Morton?s neuroma, can also cause foot pain. Ask your rheumatologist or general doctor to help you figure out what is going on with your feet so you can find a treatment and start feeling better.
Q6. I?m ANA positive on Plaquenil and Mobic for SLE and also have osteoarthritis. I was diagnosed in 2011 and in the morning, the bottom of my feet feel bruised when I walk. Is this lupus?
Dr. Alana Levine: Lupus can cause morning aches as well as foot pain, but these symptoms can be seen in people with osteoarthritis as well. It is often very challenging to determine which condition is causing these pains. Sometimes the presence (or absence) of other symptoms or lab abnormalities can help determine which condition is causing your pain. Ask your rheumatologist to help you determine the cause of your pain so you can find the proper treatment.
Q7. I was diagnosed with SLE in 1995. I have had 2 kidney transplants that proceeded 10 years of hemodialysis. I am now experiencing severe hip and back pain. Could this be the result of 18 years of steroid use?
Dr. Kyriakos Kirou: Steroids can cause osteonecrosis of the hips and that, when severe, causes pain and collapse of the bone that may require surgery. An x-ray will often show the problem. Steroids may also cause osteoporosis, especially in the spine. Osteoporosis will occasionally lead to fracture of the vertebrae and localized pain. Other bone problems may be due to many years of kidney failure and dialysis. Again, x-rays and tests for hyperparathyroidism will be helpful. A consultation with an endocrinologist that specializes in bone metabolic disorders may be a good idea.
Q8. I had to have surgery in my neck this year for a bone spur and crushed disc. Last week, I had to have an MRI on my lower back and was told that I have mild disc disease and the L5 disc is herniated. Is this from RA and lupus?
Dr. Michael Lockshin: Those abnormalities are very common and are almost never due to lupus or rheumatoid arthritis.
Dr. Jane Salmon is Co-Director of the Mary Kirkland Center for Lupus Research, Director of the SLE APS Center of Excellence, Director of the FOCIS Center of Excellence, and Director of the Lupus Registry and Repository. Dr. Salmon?s research has focused on elucidating mechanisms of tissue injury in lupus and other autoimmune diseases. Her basic and clinical studies have expanded our understanding of pregnancy loss and organ damage in SLE and the determinants of disease outcome in lupus patients with nephritis, pregnancy, and cardiovascular disease.
Dr. Alana B. Levine is a rheumatologist at Hospital for Special Surgery. She specializes in rheumatic autoimmune diseases including systemic lupus erythematosus, antiphospholipid syndrome, undifferentiated connective tissue disease and rheumatoid arthritis.
Dr. Kyriakos Kirou is a rheumatologist at Hospital for Special Surgery and is Clinical Co-Director at the Mary Kirkland Center for Lupus Care at Hospital for Special Surgery. He has a special interest in the research and treatment of systemic autoimmune rheumatic diseases, such as systemic lupus erythematosus.
Dr. Michael D. Lockshin, is Director of the Barbara Volcker Center for Women and Rheumatic Disease at Hospital for Special Surgery. He is the author of nearly 300 research papers, book chapters, and books, most on the topic of lupus, pregnancy, antiphospholipid syndrome and sex differences in disease.