Abstract:Systemic lupus erythematosus is an autoimmune disease that promotes chronic inflammation, with periods of activation and remission. Pain is commonly one of the first symptoms reported by patients with lupus. It interferes with patients’ quality of life, leading to a decrease in strength and difficulty in performing daily activities. Given the chronic nature of the disease, the high prevalence of pain and its negative impact on the quality of life of patients with lupus, the present literature review study aims… Show more
“…Pain can be potentially exacerbated by comorbidities, disease sequelae and its presence in locations other than the joints (as summarized in Fig. 2 ), which further complicates its treatment [ 46 , 47 ]. Despite the availability of effective treatments for inflammation, many patients continue to experience debilitating joint pain, highlighting this unmet medical need [ 46 , 48 ].…”
Section: Resultsmentioning
confidence: 99%
“…2 ), which further complicates its treatment [ 46 , 47 ]. Despite the availability of effective treatments for inflammation, many patients continue to experience debilitating joint pain, highlighting this unmet medical need [ 46 , 48 ]. Fig.…”
Although the clinical approach to the management of musculoskeletal manifestations in systemic lupus erythematosus (SLE) is often similar to that of rheumatoid arthritis (RA), there are distinct differences in immunopathogenesis, structural and imaging phenotypes and therapeutic evidence. Additionally, there are few published comparisons of these diseases. The objective of this narrative literature review is to compare the immunopathogenesis, structural features, magnetic resonance imaging (MRI) and musculoskeletal ultrasound (MSUS) studies and management of joint manifestations in RA and SLE. We highlight the key similarities and differences between the two diseases. Overall, the literature evaluated indicates that synovitis and radiographical progression are the key features in RA, while inflammation without swelling, tendinitis and tenosynovitis are more prominent features in SLE. In addition, the importance of defining patients with RA by the presence or absence of autoantibodies and categorizing patients with SLE by synovitis detected by musculoskeletal ultrasound and by structural phenotype (non-deforming, non-erosive arthritis, Jaccoud’s arthropathy and ‘Rhupus’) with respect to joint manifestations will also be discussed. An increased understanding of the joint manifestations in RA and SLE may inform evidence-based clinical decisions for both diseases.
“…Pain can be potentially exacerbated by comorbidities, disease sequelae and its presence in locations other than the joints (as summarized in Fig. 2 ), which further complicates its treatment [ 46 , 47 ]. Despite the availability of effective treatments for inflammation, many patients continue to experience debilitating joint pain, highlighting this unmet medical need [ 46 , 48 ].…”
Section: Resultsmentioning
confidence: 99%
“…2 ), which further complicates its treatment [ 46 , 47 ]. Despite the availability of effective treatments for inflammation, many patients continue to experience debilitating joint pain, highlighting this unmet medical need [ 46 , 48 ]. Fig.…”
Although the clinical approach to the management of musculoskeletal manifestations in systemic lupus erythematosus (SLE) is often similar to that of rheumatoid arthritis (RA), there are distinct differences in immunopathogenesis, structural and imaging phenotypes and therapeutic evidence. Additionally, there are few published comparisons of these diseases. The objective of this narrative literature review is to compare the immunopathogenesis, structural features, magnetic resonance imaging (MRI) and musculoskeletal ultrasound (MSUS) studies and management of joint manifestations in RA and SLE. We highlight the key similarities and differences between the two diseases. Overall, the literature evaluated indicates that synovitis and radiographical progression are the key features in RA, while inflammation without swelling, tendinitis and tenosynovitis are more prominent features in SLE. In addition, the importance of defining patients with RA by the presence or absence of autoantibodies and categorizing patients with SLE by synovitis detected by musculoskeletal ultrasound and by structural phenotype (non-deforming, non-erosive arthritis, Jaccoud’s arthropathy and ‘Rhupus’) with respect to joint manifestations will also be discussed. An increased understanding of the joint manifestations in RA and SLE may inform evidence-based clinical decisions for both diseases.
“…7 8 Multiple factors have been found to cause, exacerbate or mitigate pain and fatigue in patients with SLE. [9][10][11][12][13] While comorbidities and psychological distress play important roles in the occurrence of these symptoms, [14][15][16] there is also variation by sociodemographic factors. 17 Racial disparities have been described in pain outcomes, with greater pain severity and pain-related physical and psychosocial disability among black compared with white individuals.…”
Section: Lupus Science and Medicinementioning
confidence: 99%
“…Multiple factors have been found to cause, exacerbate or mitigate pain and fatigue in patients with SLE 9–13. While comorbidities and psychological distress play important roles in the occurrence of these symptoms,14–16 there is also variation by sociodemographic factors 17.…”
ObjectiveWhile fatigue and pain are pervasive symptoms in SLE, self-efficacy can mitigate their intensity and impact on patients’ daily activity. We examined the relationships of these domains and their interactions with demographics and depression in black women with SLE.MethodsThis is a cross-sectional analysis of data collected among 699 black women with SLE. We used validated, self-reported measures of fatigue, pain interference, symptom self-efficacy, treatment self-efficacy and depression. Linear regression analyses were conducted to examine the relationships between each outcome (fatigue and pain interference) and each predictor (symptom self-efficacy and treatment self-efficacy), and the interaction of demographics and depression.ResultsWe found inverse associations between fatigue and each of symptom self-efficacy (slope −0.556, p<0.001) and treatment self-efficacy (slope −0.282, p<0.001), as well as between pain interference and each of symptom self-efficacy (slope −0.394, p<0.001) and treatment self-efficacy (slope −0.152, p<0.001). After adjusting for confounders, symptom self-efficacy remained significantly associated with each outcome (adjusted slope −0.241 (p<0.001) and −0.103 (p=0.008) for fatigue and pain, respectively). The amount of decrease in fatigue and pain interference differed by depression severity (p<0.05 for the interaction of symptom self-efficacy and depression). The difference in fatigue by depression widened as symptom self-efficacy increased; the adjusted fatigue scores for moderate/severe depression compared with no depression were 6.8 and 8.7 points higher at mean and high symptom self-efficacy, respectively (p<0.001). Age and education significantly changed the relationship between outcomes and self-efficacy.ConclusionsSymptom self-efficacy and treatment self-efficacy were inversely related to fatigue and pain interference in black women with SLE. Depression disproportionately increased the intensity of these outcomes. While older women with low symptom self-efficacy reported disproportionately higher pain interference, those with higher education and mean or high levels of symptom self-efficacy reported lower pain interference. These findings may help predict who might benefit most from self-efficacy-enhancing interventions.
“…Patients with inflammatory rheumatic diseases are often afflicted with acute and chronic pain. Chronic noncancer pain can be due to a variety of factors including active inflammatory disease, accumulated damage from disease or treatment, injury, neurologic or neuropathic disease, central pain disorder, or other conditions [1][2][3][4]. The Centers for Disease Control and Prevention (CDC) have developed guidelines for chronic pain treatment, and appropriate opioid use in the general population [2].…”
Purpose of reviewThis article discusses publications assessing the prevalence, efficacy, and safety of opioid analgesics in patients with rheumatic diseases, including rheumatoid arthritis, systemic lupus erythematosus, psoriatic arthritis, ankylosing spondylitis, and systemic sclerosis.
Recent findingsRecent studies show long-term opioid use is common in patients with inflammatory rheumatic disease. We did not find any studies demonstrating improved function or pain control with long-term opioid use in people with rheumatic diseases. Some data shows potential adverse effects including increased risk for fractures and opioid poisoning hospitalizations. There is evidence demonstrating an association of opioid use with mental health disorders, fibromyalgia, obesity, and disability, although causative links have not been established. Only minimal reductions in opioid use were observed after initiation of biologic disease modifying antirheumatic drugs (DMARDs). Studies have shown delayed DMARD initiation and reduced DMARD use in patients on opioids, raising concerns that these analgesics may delay care or initially mask symptoms of active disease.
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