Aches and pains in systemic lupus erythematosus

Musculoskeletal (MSK) involvement in systemic lupus erythematosus (SLE) causing aches and pains are common. They have been described in 53% to 95% of patients. MSK manifestations can affect joints, muscle, bone and supporting structures. These include arthritis and arthralgia, tenosynovitis, myositis, osteoporosis, fibromyalgia and osteonecrosis. Fibromyalgia (FM) can be seen in up to 25% of patients with lupus and adverse impact on quality of life. It is important FM is identified and treated appropriately to minimize its effects on quality of life. The involvement ranges from active disease (arthralgia/arthritis, myalgia/myositis) to conditions associated progressive organ damage (joint deformities, muscle atrophy, osteoporosis and osteonecrosis) as a consequence of long-term disease or as a complication of treatment. It is associated with significant morbidity, has adverse impact on quality of life and increases the risk of work loss and workplace impairment. MSK damage is a poor prognostic factor and associated with increased risk of mortality. Early recognition and adequate control of lupus disease activity are essential in prevention of the long-term sequelae associated with these conditions. Glucocorticoids (GCs) are associated with damage accrual in the MSK system. Adequate bone protection measures, minimizing exposure to GCs whenever possible are essential to reduce long term risks associated with GCs usage. There is a need for treatment regimens wherein exposure to GCs can be avoided or minimized.