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Lupus or Rheumatoid Arthritis?

Lupus or Rheumatoid Arthritis?

Q: About a year ago my RA count was very high. My family doctor thought I had rheumatoid arthritis while an arthritis clinic physician thinks I have lupus. I show very little signs of either disease but am taking Plaquenil for lupus. Is there a way to definitely tell which one I have?

A: Sorry to hear that you are having these problems, but I am very glad that you are doing some investigative work to educate yourself.

It can be very difficult to diagnose these disorders because the blood markers that we have for them are non-specific. For instance, rheumatoid factor can be elevated in both conditions or can be elevated as a result of some other infection in the body that has nothing to do with either.

Both lupus and rheumatoid arthritis are autoimmune disorders which the body starts to attack its own connective tissue. Other closely related disorders are: Polymyositis-dermatomyositis (PM-DM), systemic sclerosis (SSc or scleroderma), Sjogren’s syndrome (SS) and various forms of vasculitis.

These diseases have a number of common features:

1. They affect women much more frequently than men.
2. They are “multisystem” diseases, capable of affecting the function of many organs.
3. They “overlap” with one another, sharing certain clinical symptoms, signs and laboratory abnormalities.
4. Blood vessels are the most common target of injury in all of these diseases.
5. The immune system is abnormal and accounts, at least in part, for the observed tissue damage.

Although lupus most often occurs alone, many people with lupus also have symptoms characteristic of one or more of the other connective tissue diseases. In this circumstance, a physician may use the term “overlap” to describe the illness. There are several well-recognized overlaps that may affect people with lupus.

In lupus, joint pain is common. Joint swelling may be present in some cases, but the majority of those with lupus experience joint pain without swelling or only intermittent swelling. In rheumatoid arthritis (RA), joint swelling is always present and pain is common but less prominent. If a person with lupus develops severe arthritis with joint deformities, he/she should be considered to have rheumatoid-like arthritis. In some instances, the physician might have reason to believe that both diseases–SLE and RA–have occurred in the same person. When arthritis develops in the course of lupus, treatment with non-steroidal anti-inflammatory drugs (NSAIDs), low doses of cortisone, and the antimalarial drug hydroxychloroquine (Plaquenil) are usually helpful. People with lupus who have typical rheumatoid arthritis are prescribed the standard forms of RA treatment. These include methotrexate, sulfasalazine and in some cases, more potent drugs to suppress joint inflammation.

Although we don’t have the definitive diagnosis in your case, the treatment for your joints would be the same regardless. It is important to continue to follow up with your doctors so that any potential damage to other organ systems can be caught early.

Learn more:
Immunity boosting first-aid kit
Ginger for RA?

Dr. Brent Ridge is the health expert for Martha Stewart Living Omnimedia. You can call and ask him a question live every Tuesday at 2 p.m. Eastern on Sirius Satellite Radio, Channel 112 (1.866.675.6675). You can also follow along as he learns to grow his own food and raise goats on his farm in upstate New York by visiting www.beekman1802.com.

Got a health question for Dr. Brent? E-mail him at drbrent@care2.com.

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Dr. Brent

As an undergraduate, Dr. Brent Ridge majored in public health and environmental science, studying the way the state of the natural environment impacts our health choices. As a physician, he specializes in the field of aging. Send your health questions to Dr. Brent at drbrent@care2.com

14 comments

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5:31AM PDT on Apr 11, 2013

Thank you so much for sharing this information. My grandmother had RA so severely that she could not open her hands up. Her fingers were locked in a fist position, and she could barely stand to get up out of her wheelchair. I have been getting episodes of joint pain in my ankles, wrists, and knees that come and go. I have been scared to go to the doctor as I feared that he would tell me I have RA and would be in for a lifetime of pain and suffering. I do feel more hopeful now that I know there are treatments and might get the courage to go to the doctor now. I do hope a cure is found someday. It hurts (emotionally) to know that so many suffer such physical pain.

4:34AM PST on Feb 14, 2013

Thank you Dr. Brent, for Sharing this!

11:04AM PST on Jan 4, 2013

Thanks.

5:42PM PDT on Jul 21, 2012

thank you... I still don't understand all the variables spoken of here but I appreciate learning more about this.

3:06AM PST on Jan 26, 2012

Great article. Thanks.

9:26PM PST on Jan 30, 2011

Its very informative. Lupus disease affects the men and women both. Few common and painful lupus symptoms include swollen and painful joints along with fatigue and unexplained fever.

2:56AM PST on Feb 23, 2010

Very informative post on lupus and rheumatoid. I was looking for similar stuff and glad to have found it here.

http://arthritis-joint-pain.info/

5:15PM PST on Jan 15, 2010

I am 47 years old and have had RA since I was 16. I have been on Gold's, prednisone, plaquenil, methotrexate, sulfaselazine and have lost track of the many anti-inflammatories over the years. I decided to go off these drugs due to their many debilitating and harmful side effects and for five years was basically in a remission like state. Suddenly, without warning, all my symptoms came back with a vengeance, attacking me as they did when I was young and had to be wheelchair bound. I am now back on metho, plaquenil and so on and after three months of treatment the pain is so bad that 5 out of 7 days a week I cannot handle stairs, undressing, handling objects, opening containers and most of the things most people, including myself, take for granted. This is affecting me very negatively mentally, going from a very strong woman both emotionally and physically to a ball of pain that finds it hard to maintain a positive attitude when I can't even manage to open a margarine container or fold my children's laundry. My doctor will only prescribe Tylenol 3, 2 per day, to manage this pain, along with the anti-inflammitories. This does next to nothing. Does anyone out there have any advice or suggestions to help manage this and still live a reasonably normal life?

5:45PM PST on Jan 11, 2010

Even diagnosing which version of RA you have can be tricky. All I know is that I have sero negative RA and it took another 3 years to diagnose fybromyalgia. I have been told that it is a nothing illness and not to worry about it. I met a lupus sufferer at the clinic who has also been told the same thing. I suggested a second opinion and she has had her drugs changed and her life has become easier.

The major problem is, I think, a struggle to be taken seriously or as a person and to have a proper diagnosis (I appreciate that it is not always easy) but certainly to be kept informed is to make the patient aware that the consultant is trying. I had a real setback when I doscovered that several diagnoses had been made for me none of which I knew about. It is insulting and tends to make you feel like an illness and not a person.

7:24AM PST on Nov 1, 2009

AS of the last several weeks, they have a definite new medication that just passed its last clinical trial to help stave off the symptoms of Lupus! It is a huge landmark breakthrough, for it is truly the first medication specifically designed to help fight Lupus. There is another one also being developed in Europe that is showing great promise, along with a couple of others that have just began the early stages of clinical trials. After 5 decades this is very welcome news for those like myself that suffer from Lupus, plus several other autoimmune diseases. Lupus is extremely difficult to diagnose. Some of us going for 10 years or more before doctors are able to put it all together and say it is Lupus. It mimics so many other diseases, and each person seems to suffer symptoms that could definitely be completely different from another with Lupus. They also over lap many times. More and more I am hearing people like myself, that have Sjogren's, Raynaud's, and even Fibromyalgia and Chronic Fatigue Syndrome, along with Lupus and/or other autoimmune diseases such as Multiple Sclerosis and hundreds more.

I am hoping the news on the latest medication means that it will go in for FDA approval by next year! Hopefully we will see it in the hands of our doctors before the end of 2010!

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Disclaimer: The views expressed above are solely those of the author and may not reflect those of
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