Arthralgia or arthritis is experienced
by 95 percent of SLE patients at
some time during the course of the
disease. Articular pain is the initial
symptom in about one-half of patients
eventually diagnosed with SLE.
Morning stiffness and joint and muscle
aching can also occur. Joint pain may
be migratory; it is typically symmetric
but is asymmetric in many patients.
Joints may become warm and swollen.
X rays of the joints usually do not
show erosion or destruction of bone.
Proliferation of the synovium in lupus
is more limited than in rheumatoid
arthritis, and joint destruction is rare.
The joints most commonly involved
are those of the fingers, wrists, and
knees; less commonly involved are the
elbows, ankles, and shoulders.
Several joint complications may
occur in SLE patients, including
reducible deformities such as Jaccoud's
arthropathy and osteonecrosis. In SLE
patients, osteonecrosis may develop as
a steroid complication, which causes
bone death in the hips or other joints.
Subcutaneous nodules are rarely seen.
Tendinitis and carpal tunnel syndrome
are seen occasionally. Tendon rupture is
2. alteration in joint function
Objective: Minimize pain from joint and
1. Assess and document joint
complaints and appearance.
Changes may be transient.
2. Assess the patient's selfmanagement
3. Teach the patient to apply heat
or cold as appropriate.
4. Instruct the patient in use of
prescription and nonprescription
5. Teach the patient to apply
splints or braces, if ordered by
- morning stiffness and aching
- joint pain
- warm, swollen joints
- rarely, ulnar deviation of
the fingers with swan neck
deformities and subluxations
Generalized myalgia and muscle
tenderness, especially over the shoulders,
is more likely to be fibromyalgia than lupus.
Objective: Maintain joint function and
increase muscle strength.
1. Suggest warm showers or baths
to lessen stiffness and pain.
2. If indicated, refer patients
with acutely inflamed joints
to a physical therapist for
passive range-of-motion (ROM)
exercises. The physical therapist
may train a family member to
assist the patient with ROM
exercises at home.
3. Teach the patient that an
inflamed joint should not bear
weight and suggest that the
patient avoid strenuous activity.
4. If needed, assist the patient in
obtaining crutches, a walker, or
Source: National Institutes of Health, U.S.Dept of Health and Human Services