Can Lupus cause pain in your feet?

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Written By Dr. Marcus Yu Bin Pai

MD, PhD. Physical Medicine & Rehabilitation Physician from São Paulo - Brazil. Pain Fellowship in University of São Paulo.

Systemic Lupus Erythematosus (SLE), commonly referred to as lupus, is a complex and multifaceted medical condition characterized as a chronic autoimmune disease. In an autoimmune context, the body’s immune system, which normally protects against pathogens and infections, mistakenly attacks the body’s own cells and tissues, leading to inflammation and tissue damage.

This pathological process can affect various organs and systems, manifesting in various ways and with fluctuating intensities.

Lupus is an autoimmune disease that can affect various parts of the body, including the joints, skin, kidneys, blood cells, brain, heart, and lungs. One of the common symptoms of lupus is joint pain, which can occur in any part of the body, including the feet.

Joint Pain in Lupus

In Systemic Lupus Erythematosus (SLE), joint pain is a prevalent symptom that can manifest in various parts of the body, including the feet. This pain is often inflammatory in nature, stemming from the autoimmune process that characterizes lupus.

The inflammation in the joints can lead to synovitis, which is the swelling of the joint lining, contributing to pain and stiffness. These symptoms are typically more pronounced in the morning or after periods of inactivity, a phenomenon known as “morning stiffness.” This stiffness usually improves with gentle activity as the day progresses.

Plantar Fasciitis in Lupus

Lupus patients may experience plantar fasciitis, a condition involving inflammation of the plantar fascia – the thick band of tissue that runs along the bottom of the foot, connecting the heel bone to the toes.

This condition can cause intense heel pain, often described as stabbing pain, and is usually most noticeable with the first steps after waking up, after long periods of standing, or when getting up after sitting for extended periods. The pathophysiology of plantar fasciitis in lupus is likely related to the overall inflammatory milieu of the disease, combined with mechanical stress on the foot.

Raynaud’s Phenomenon in Lupus

Another important aspect to consider is Raynaud’s phenomenon, which is commonly associated with lupus. This condition affects the blood flow to certain parts of the body – usually the fingers and toes – in response to cold temperatures or stress.

During a Raynaud’s attack, the toes (or fingers) may first turn white or blue and feel cold and numb. As circulation improves and the area warms up, they may turn red and throb or tingle. Raynaud’s in lupus is due to vasospasm of the small vessels in the extremities, which can be exacerbated by the autoimmune process.

More on Lupus

There are different types of lupus, with Cutaneous Lupus Erythematosus (CLE) and Systemic Lupus Erythematosus (SLE) being the most prevalent. CLE primarily affects the skin, resulting in skin lesions, commonly observed in sun-exposed areas such as the face, ears, arms, and the “V” neckline. These lesions are typically erythematous (reddish), may exhibit scaling, and are sensitive to sunlight.

SLE, on the other hand, is more severe, affecting multiple organs and systems. This type of lupus can cause systemic symptoms such as fever, fatigue, weight loss, and loss of appetite. Additionally, it can manifest with specific symptoms related to different organs, including arthritis (joint pain), skin lesions, serositis (inflammation of membranes such as the pleura), lupus nephritis (kidney inflammation), and neuropsychiatric alterations. High blood pressure can be a sign of renal involvement.

The diagnosis of lupus involves clinical and laboratory evaluation, including the detection of specific antibodies (such as antinuclear antibodies – ANA), and the analysis of signs and symptoms. Treatment is personalized according to the patient’s clinical manifestations and may include immunosuppressive drugs, corticosteroids, and antimalarial medications, aiming to control disease activity and prevent organ damage.

Arthralgias in Lupus

Arthralgias in Systemic Lupus Erythematosus are a significant clinical manifestation, frequently occurring in patients.

These joint pains are often among the first signs of SLE and can fluctuate in severity, sometimes presenting as mild discomfort and at other times as more severe pain. The occurrence of arthralgias can be sporadic, closely tied to disease activity and flare-ups.

It’s important to note that while arthralgias are common in lupus, they are also prevalent in other conditions such as rheumatoid arthritis, osteoarthritis, and fibromyalgia, which can complicate differential diagnosis.

Detailed Insights into Lupus Arthritis

Lupus arthritis is a notable feature of SLE, affecting a significant proportion of patients. It is characterized by an inflammatory process that primarily targets the synovial membrane of the joints, leading to the classic symptoms of pain, swelling, warmth, and erythema. Unlike rheumatoid arthritis, lupus arthritis is less likely to cause erosive damage to the bone. However, it can still result in significant discomfort and impact a patient’s quality of life.

The pattern of joint involvement in lupus arthritis can vary. It often affects the small joints of the hands and wrists but can also involve knees, ankles, and other joints. Morning stiffness is a common complaint, although it tends to be less severe than in rheumatoid arthritis.

Understanding Jaccoud’s Arthropathy in SLE

Jaccoud’s arthropathy is a distinct type of joint deformity observed in some lupus patients. Unlike the deformities seen in diseases like rheumatoid arthritis, those in Jaccoud’s arthropathy are typically non-erosive and reducible. This condition arises due to repeated inflammation leading to the laxity of tendons and ligaments, rather than direct bone erosion. As a result, the joint deformities in Jaccoud’s arthropathy can often be corrected manually or through physical therapy, distinguishing them from the fixed deformities seen in other rheumatic diseases.

Advanced Treatment Approaches

The management of these foot-related symptoms in lupus involves both pharmacological and non-pharmacological strategies. Pain relief and control of inflammation can be achieved through medications such as nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, and disease-modifying antirheumatic drugs (DMARDs). For plantar fasciitis, specific treatments like physical therapy, orthotic devices, and stretching exercises can be beneficial.

In cases of Raynaud’s phenomenon, keeping the feet warm, avoiding stress and cold exposure, and potentially using vasodilator medications can help manage symptoms. In severe cases, more aggressive treatments like calcium channel blockers or other vasodilators might be prescribed to improve blood flow.

Treatment of lupus-related joint symptoms primarily focuses on managing inflammation and controlling the underlying SLE activity.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used for mild symptoms, while antimalarials like hydroxychloroquine are often effective in controlling joint pain and preventing flare-ups. In cases of more severe joint involvement or systemic SLE activity, corticosteroids and immunosuppressive agents may be necessary.

Physical therapy and regular exercise are also important aspects of managing lupus arthritis and arthralgias. They help in maintaining joint flexibility, reducing stiffness, and improving overall function.

Given the complexity of lupus and its symptoms, a multidisciplinary approach involving rheumatologists, physical therapists, and other healthcare professionals is crucial for optimal patient care and management of this multifaceted disease.

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MD, PhD. Physical Medicine & Rehabilitation Physician from São Paulo - Brazil. Pain Fellowship in University of São Paulo.

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