ABSTRACT: A 36-year-old woman presented with Raynaud phenomenon, arthralgia, photosensitive rash, proteinuria, dry eyes and dry mouth, and alopecia.
Late-onset systemic lupus erythematosus (SLE), often considered to have a benign disease course, actually involves greater disease activity and comorbidities than early-onset SLE. Differences in disease activity may be associated with an interaction between the SLE and age.
Women with systemic lupus erythematosus (SLE) are at increased risk for coronary artery disease (CAD) and mortality. The dominant risk factors are SLE itself, age, and high total triglyceride levels rather than the traditional Framingham risk factors.
Although many medications are used for the management of systemic lupus erythematosus (SLE) and its complications, only aspirin, corticosteroids, and the antimalarial drug hydroxychloroquine (HCQ) are specifically approved by the FDA.1 Most other medications used for SLE treatment are commercially available off label (Table 1), usually borrowed from cancer or transplant regimens. In some cases, medications have been approved for a specific clinical manifestation seen in both idiopathic disease and SLE, such as bosentan for pulmonary hypertension.
Once a diagnosis of systemic lupus erythematosus (SLE) has been made, numerous neurological and psychiatric manifestations may be found to accompany the disease.
Heel pain (calcaneodynia) is most commonly due to plantar fasciitis, but has many other causes including nerve entrapment, stress fracture, and sciatica. This review describes an overall approach to diagnosis, discusses conservative treatments and highlights the most prevalent surgical procedures.
ABSTRACT: About half of patients with systemic lupus erythematosus
experience musculoskeletal involvement: arthritis, arthralgia,myalgias,
myositis, tenosynovitis, fibromyalgia, or osteonecrosis. Patients
with arthritis often have symmetrical large- and small-joint polyarthritis
unassociated with radiographic evidence of erosive or deforming
disease.Treatment generally focuses on anti-inflammatory
agents, such as NSAIDs and corticosteroids. Antimalarials are commonly
used. When NSAIDs prove ineffective, limited use of corticosteroids
may help, but patients need to be informed of the adverse
effects. Antimalarial agents usually are recommended for all persons
with lupus arthritis. Shared decision making can allay concerns
about drug toxicity and adverse effects and encourage compliance
with treatment. (J Musculoskel Med. 2008;25:458-463)