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Diagnosis and Treatment of Aches and Pain in SLE

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Presentation on theme: "Diagnosis and Treatment of Aches and Pain in SLE"— Presentation transcript:

1 Diagnosis and Treatment of Aches and Pain in SLE
H. Michael Belmont, M.D. Director Lupus Clinic Bellevue Hospital Chief Medical Officer Hospital for Joint Diseases Associate Professor of Medicine New York University School of Medicine

2 Differential Diagnosis of Aches and Pain in SLE
Arthralgia Myalgia Arthritis - Non-erosive “Jaccouds” Arthritis - Erosive “Rhupus” Myositis Osteonecrosis or Avascular Necrosis of Bone (hip, knee, shoulder, ankle) Fibromyalgia Osteoporosis with fracture (vertebral, hip, shoulder, wrist) Non-SLE (tendonitis, bursitis, gout, osteoarthritis)

3 Arthralgia and Myalgia
90% of patients with SLE will experience episodes of joint aches and muscle pains Arthralgia – joint pain and possible tenderness without other signs of inflammation (redness, swelling, and warmth) Myalgia – muscle soreness and ache without weakness or elevation of muscle enzymes Fever (viral, bacterial or atypical infection) Mild SLE flare Antipyretic: Aspirin, Acetaminophen, OTC NSAID such as ibuprofen, naproxyn and ketoprofen Treat underlying cause (antibiotic, hydroxychloroquine/plaquenil, SLE disease modifying medication) Rarely steroids and then not in excess of 10 milligrams a day

4 ARTHRITIS Jaccouds Deforming X-rays No erosions
Hydroxychloroquine (Plaquenil) NSAIDs and Cox-2 Methotrexate Azathioprine (Imuran) Leflunomide (Arava) Rhupus Deforming X-rays Erosions Hydroxychloroquine NSAIDs and Cox-2 Methotrexate Azathioprine Leflunomide

5 MYOSITIS Muscle inflammation with proximal muscle weakness
Elevated muscle enzymes (CPK, aldolase, LDH, SGOT, SGPT) Abnormal EMG and muscle biopsy Steroids Azathioprine Methotrexate Leflunomide Mycophenolate mofetil IVGG intravenous gammaglobulin

Condition affecting 5-40% of SLE patients associated with prolonged (more than 2 weeks) high dose (greater than 30 milligrams a day) prednisone treatment AVN most commonly hip, knee, shoulder and ankle Often bilateral (both sides) in lupus Loss of circulation to bone leads to bone injury, death of bone with subsequent painful collapse and arthritis Treatment: pain relievers, rest, very early sometimes surgical decompression or late total joint replacement surgery Prevention: Always use steroid (prednisone) at lowest effective dose for shortest interval to treat flare of lupus and consider use of STATIN drugs (such as lipitor) to prevent expansion of fat cells within bone that contribute to this problem

7 FIBROMYALGIA Chronic widespread non-joint focused pain associated with fatigue and tender points Primary Secondary to SLE and other autoimmune and non-autoimmune chronic disorders No deformities, No erosions, No muscle deterioration Exercise, Exercise, Exercise (increase natural pain relieving endorphins) Pain relievers (Acetaminophen, OTC NSAIDs, prescription NSAIDs and Cox-2, tramodol, cyclobenzaprine-“Flexeril”) TCA TriCylic Antidepressants SSRI Selective Serotonin Reuptake Inhibitors Cognitive therapy

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