Joint pain very common in lupus, affects patients’ life quality: Study
SLE marked by ache, discomfort, numbness in hands, wrists and knees
Patricia Inacio, PhD
The vast majority of people with systemic lupus erythematosus (SLE) experience musculoskeletal symptoms, marked by pain, ache, discomfort, and numbness, often in the joints, primarily the hands, wrists, and knees.
That’s according to a study from researchers in Egypt, which also found that musculoskeletal symptoms were associated with a significant detrimental impact across several domains of a patient’s health-related quality of life (HRQoL), including physical health and emotional well-being.
“One of the most frequent and incapacitating clinical manifestations that patients frequently describe is joint pain,” the researchers wrote, noting that “the wrists and hands appear to be the most afflicted parts of the body.”
People with SLE with more widespread pain also had worse scores on measures of life quality, the team noted.
“The [quality of life] scores of patients with more than 5 body sites of MSK [musculoskeletal] symptoms were significantly lower than those of patients with fewer than 5 sites of MSK symptoms,” the team wrote.
The study, “Musculoskeletal symptoms in systemic lupus erythematosus patients and their impact on health-related quality of life,” was published in the journal BMC Musculoskeletal Disorders.
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Investigating the impact of musculoskeletal symptoms in SLE
SLE, the most common and serious form of lupus, is a chronic autoimmune disease that affects several organs and has a wide range of symptoms. Common symptoms include joint pain and stiffness, which are generally described as musculoskeletal symptoms.
Despite their frequency, the impact of these symptoms on patients’ HRQoL remains poorly known.
To address this gap, a team of researchers analyzed data from 103 adults with SLE who had been followed at the rheumatology and immunology unit in the Mansoura University Hospital in Egypt between April and September 2022.
The patients had a mean age of 30.8 and 86 (83%) were women. They had been diagnosed at a mean age of 24.8, and had been living with SLE for a median of four years.
A little more than a third of the patients (35.9%) had mild disease activity, according to the SLE Disease Activity Index (SLEDAI), while closer to 4 in 10 (37.9%) had moderate disease activity on that scale.
Corticosteroids were the most commonly prescribed medication, used by 80.6%. That was followed by antimalarial agents and the immunosuppressant azathioprine, both used by slightly more than half of patients. Other immunosuppressants also were used, including mycophenolate mofetil, by 22.3%, and methotrexate, by 20.4%. Biologic therapies were used by 8.7%.
Pain in wrist and hand reported by over 40% of lupus patients
Almost all patients (96.1%) reported musculoskeletal symptoms, according to the Nordic Musculoskeletal questionnaire.
Pain in the right hand and wrist was reported by 64.1% of the patients, and in the left hand and wrist by 63.1%. More than half of patients also experienced pain in the right (62.1%), left knee (53.4%), and lower back (57.3%). Slight more than half had pain in the left or right shoulder.
Such musculoskeletal symptoms lasted longer than three months for approximately half of the patients, and 71% of individuals experienced symptoms in more than five different parts of the body.
Most patients described their pain as discomforting (40.8%), while 3.9% reported it to be excruciating. Pain was intermittent in most cases (61.2%), rather than continuous (13.6%).
SLE patients struggle with a variety of symptoms that may influence their perception of their position in life and impede their physical, intimate, and emotional health.
The 73 patients who had musculoskeletal symptoms in more than five different parts of the body had significantly worse scores across all domains of a lupus HRQoL questionnaire when compared with the 26 patients who had fewer body parts affected. These domains included physical health, pain, planning, intimate relationships, burden to others, emotional health, body image, and fatigue.
Overall, these findings indicate “that SLE patients struggle with a variety of symptoms that may influence their perception of their position in life and impede their physical, intimate, and emotional health,” the researchers wrote.
The team noted that, for as many as half of SLE patients, musculoskeletal symptoms can be the first sign of lupus, and that they “can impact up to 95% of patients” over the course of the disease.
As such, “longitudinal studies are required to investigate, identify, and treat [musculoskeletal] manifestations in SLE patients,” the team wrote.
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