Lupus and the joints, muscles, and bones

Lupus affects different people in different ways. Most people with lupus have problems with their joints, muscles, or bones. Sometimes lupus itself causes these problems, and sometimes they’re side effects of lupus treatments.

How does lupus affect the joints, muscles, and bones?  

Lupus can affect each of these body parts in different ways.

Lupus and the joints

Lupus can cause joint pain (arthralgia) and inflammation in and around the joints, resulting in problems like arthritis, tendonitis, and carpal tunnel syndrome. Joint problems related to lupus usually don’t cause long-term damage. 

Arthritis

Lupus can also cause inflammation in the joints, which doctors call “inflammatory arthritis.” It can make your joints hurt and feel stiff, tender, warm, and swollen. Lupus arthritis most often affects joints that are farther from the middle of your body, like your fingers, wrists, elbows, knees, ankles, and toes.

Lupus arthritis is less likely to cause permanent joint damage than rheumatoid arthritis. 

Tendonitis

Tendonitis is inflammation in the tendons — the tissues that connect your muscles to your bones. It can cause pain, and usually affects joints like the elbows, fingers, and shoulders.  

Tendon laxity

Tendon laxity is unusual looseness in the tissues that connect muscle to bone. It can cause bones to move out of position — like making fingers bend to one side at the joints.

Carpal tunnel syndrome

Carpal tunnel syndrome happens when inflammation puts too much pressure on the central nerve in your wrist. It can cause pain, tingling, and numbness in the hand and fingers.  

Lupus and the muscles

Lupus often causes myalgia, or aches and pains in the muscles. Less often, lupus can cause myositis, or inflammation in the muscles — usually in the hips, thighs, shoulders, and upper arms. 

The most common symptom of myositis is muscle weakness. When you have lupus myositis, it can be hard to do things like stand up out of a chair or raise your arms. 

Some medicines used to treat lupus, like steroids, can also cause muscle weakness. This side effect usually goes away when you stop taking the medicine that caused it. Talk to your doctor before stopping any medications prescribed to you.

Listen: The Expert Series - Lupus and Physical Activity

Lupus and the bones

Many patients with lupus develop osteoporosis (low bone density). Other bone problems like avascular necrosis (AVN) are less common than joint and muscle problems. These problems can be serious, especially for people who take high doses of steroids to treat lupus.   

Osteoporosis 

Lupus raises your risk for osteoporosis, a bone disease that makes bones weak and more likely to break. Other things that make osteoporosis more likely include:

• Taking steroids as part of your lupus treatment
• Being less physically active when lupus causes pain and fatigue (feeling tired often) 
• Having low levels of calcium or vitamin D in your blood
• Having a family history of osteoporosis
• Lupus nephritis
• Being older

Osteoporosis has no symptoms – aside from breaking a bone – so the only way to know if you have it is to get a bone density test. This test is like an X-ray or scan of your body to measure how strong your bones are. If you have osteoporosis, your doctor can recommend a prescription medication to improve your bone density.

Avascular Necrosis

Avascular necrosis (AVN) is a condition that causes bone tissue to die. It happens when there isn’t enough blood flow in part of your bone, which causes pressure to build up. Over time, AVN can weaken the bone until its surface collapses. 

Experts can’t predict who will develop AVN, but certain conditions make AVN more likely — including injuries (like a dislocation or fracture), heavy alcohol use, and sickle cell anemia. In patients with lupus, the most common reason for AVN is taking high doses of steroids to treat your lupus, especially over a long period of time.

At first, symptoms include pain in the hips, knees, or shoulders. Later on, you may have stiffness, muscle spasms, and limited movement in the affected joints. If you have severe AVN, surgery can help with pain and loss of movement.

Listen and learn more about bone health for people with lupus

Take steps to protect your joints, muscles, and bones

While many joint, muscle, and bone problems need medical treatment, making lifestyle changes may prevent or ease some symptoms.

Protect your joints and muscles

When you have muscle or joint pain, it can be hard to be active. But when you’re less active, your muscles get weaker — and that can make your joint pain worse. 

Work with your rheumatologist to make a physical activity plan that’s right for you. If you have muscle weakness, physical therapy can help strengthen your muscles. Your rheumatologist can refer you to a physical therapist.

Protect your bones

Try making these changes to lower your risk of osteoporosis and AVN:

• If you smoke, make a plan to quit
• If you drink alcohol, drink only in moderation

You can also lower your risk of osteoporosis by:

• Eating foods with plenty of calcium and vitamin D — like milk or soymilk, leafy greens, and cereals fortified with vitamins
• Getting regular physical activity 
• Getting a bone density test every 1 to 2 years

Find the right treatment plan

Because lupus can cause a lot of different muscle, joint, and bone problems, there are many different medicines and treatments. Talk to your rheumatologist to find a treatment plan that works for you.

Learn more about medicines to treat lupus.