Both lupus and rheumatoid arthritis (RA) are inflammatory, autoimmune diseases that trick the body into attacking healthy tissue. In the U.S., more than 1.3 million people are currently living with RA and about 1.5 million have lupus.
Both autoimmune diseases have similar symptoms that can make life complicated. Despite the challenges, it's essential to understand the various symptoms and treatment protocols available to best manage each condition.
Lupus is an autoimmune, inflammatory condition that affects mainly the skin, joints, and internal organs. There are several types of lupus.
|Why an early RA diagnosis can help prevent joint degeneration|
With rheumatoid arthritis, the body's infection-fighting mechanisms primarily attack the synovial membrane that lines the joints. The joints most often impacted by RA are the hands, wrists, elbows, knees, ankles, and feet.
RA-related fatigue is one of the most common symptoms myRAteam members battle with regularly. As one myRAteam member said, "I suffer from severe fatigue. It is debilitating. Some days I cannot get out of bed."
The cause of either autoimmune disease remains a mystery. Still, certain risk factors may lead to the development of both lupus and rheumatoid arthritis.
Both conditions share a hereditary aspect. These autoimmune diseases rarely pass from parent to child, however having a family member with lupus or rheumatoid arthritis boosts the chances of developing the disease. For example, having a close relative with RA increases the risk factor by three to five times.
About 1 in 2,000 people in the U.S. live with lupus. Studies show that about 10 percent of people with lupus also have a family member with the condition. An identical twin with lupus increases the likelihood of the other twin developing it by 24 percent to 35 percent.
Lupus and rheumatoid arthritis share a host of symptoms. People living with either condition may experience joint pain, low-grade fever, fatigue, swelling, and inflammation.
Among the many shared symptoms of lupus and rheumatoid arthritis are skin disorders. People with lupus can experience a malar rash — a butterfly-shaped rash that appears on both cheeks of the face. Skin disorders often seen with rheumatoid arthritis include rheumatoid nodules, which develop in 25 percent of people with RA. Another rash-like effect of rheumatoid arthritis is palmar erythema, which causes redness in the hands and is usually not painful or itchy.
Both RA and lupus flare-ups can result from stress, certain foods, and fatigue, to name a few risk factors. Some myRAteam members also report weather as a factor. As one myRAteam member puts it, "Rainy weather causes my RA to flare up!!"
Since lupus is more likely than RA to attack internal organs, there is a higher possibility of long-term heart and kidney damage with lupus. People with lupus can also develop a complication called lupus nephritis, which could lead to kidney failure.
During RA flare-ups, symptoms can sometimes become severe and trigger complications beyond joint pain and swelling. Some people with RA may experience heart or lung damage. RA increases the risk of blocked arteries or inflammation of the sac that surrounds the heart. Rheumatoid nodules may develop in the lungs and, in rare cases, may rupture causing a collapsed lung.
About 1 percent of people living with rheumatoid arthritis — usually those who have had severe RA for at least 10 years — develop rheumatoid vasculitis (RV). RV is caused when blood vessels become inflamed, leading to a red, irritated rash or skin ulcers, numbness, tingling, and pain due to a lack of blood flow. Symptoms of RV are most prominent in the fingers and toes.
A chronically low white blood cell count, an enlarged spleen, high blood levels of rheumatoid factor (RF) proteins, and rheumatoid nodules are risk factors that can signal the development of rheumatoid vasculitis. Treating RA and keeping flare-ups to a minimum is key to avoiding not only rheumatoid vasculitis, but also further RA complications like joint deformities.
It's no surprise that lupus and rheumatoid arthritis are challenging to diagnose, especially when their symptoms are similar. There is no single test that can diagnose lupus or rheumatoid arthritis. Doctors will usually take a physical exam, and then order various blood tests and imaging scans to help determine the correct diagnosis.
The most common blood tests are C-reactive protein (CRP) and a complete blood count (CBC), which check for biomarkers specific to RA or lupus.
One test used in diagnosing lupus is the antinuclear antibody (ANA). This test looks for antibodies that attack cells, a critical sign that an autoimmune disease is present. About 95 percent of people with lupus will test positive for antinuclear antibodies. However, people with RA and other autoimmune conditions may also have similar ANA levels. Even with a positive test result, a specialist may recommend additional blood tests to secure an accurate diagnosis.
Because lupus can affect the kidneys, both blood and urine may be analyzed to assess kidney function.
To check for rheumatoid arthritis, a doctor will most likely order an anti-cyclic citrullinated peptide (anti-CCP) test and a test for rheumatoid factor. Both can be used in conjunction with other blood tests to determine the level and type of inflammation in a person's body. Anti-CCP is usually present in about 50 percent of people with RA at diagnosis. People with RA who test positive for anti-CCP antibodies or rheumatoid factor — or both — are referred to as having seropositive rheumatoid arthritis. Those who test negative for both are said to have seronegative rheumatoid arthritis.
The presence of anti-CCP or RF in the blood doesn't necessarily mean a person has RA, but it is a marker doctors can use for diagnosis — in addition to a physical exam of the joints and possible imaging scans.
Imaging tests can be part of the diagnostic process for both lupus and RA. They may help indicate the degree of joint or organ damage in lupus and rheumatoid arthritis. Imaging tests for both conditions may include magnetic resonance imaging (MRI), ultrasound, and X-rays.
Tests that are especially useful for diagnosing lupus are CT scans and echocardiograms to take a closer look at the heart and lungs.
Ultrasounds and MRI scans can detect inflammation of the lining of the joints and damage to tendons. Such tests are a big help to rheumatologists for accurately diagnosing RA.
Because of the inflammatory nature of both conditions, and the overlap of symptoms, numerous tests are needed to measure inflammatory markers and get to the right diagnosis.
There is currently no cure for lupus or RA. With proper treatment, it is possible to manage symptoms and achieve long-term remission. Both conditions are typically treated by specialists in musculoskeletal diseases and autoimmune conditions called rheumatologists.
Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used to treat both RA and lupus. They reduce inflammation in the body, which can ease stiff and painful joints. Some NSAIDs, like ibuprofen and Aleve (naproxen), can be bought over the counter. Other more powerful NSAIDs, like Mobic (meloxicam), are prescribed.
Both lupus and rheumatoid arthritis can also be treated with disease-modifying antirheumatic drugs (DMARDs). This class of drugs helps slow disease progression by reducing inflammation and, as a result, joint pain and damage. Antimalarial medications like Plaquenil (hydroxychloroquine) are DMARDs used for both lupus and RA. Studies have shown antimalarials can reduce lupus flares by as much as 50 percent. Methotrexate is another DMARD commonly prescribed to treat RA or lupus, either alone or in conjunction with other medications.
In more severe or later stages of RA and lupus, more specialized treatments may become necessary to manage symptoms. For people with lupus, immunosuppressives are key when symptoms are resistant to corticosteroids. Immunosuppressant drugs can leave someone vulnerable to infection, so careful monitoring is important while taking them.
For people whose RA has not responded to conventional DMARDs, a more powerful type of DMARD called a biologic may be prescribed. Biologics, which mimic the actions of proteins in the body, are currently used to treat RA but are still being researched for lupus. In severe cases of RA, joint surgery or joint replacement may be recommended.
The short answer is yes. A person can have both lupus and rheumatoid arthritis at the same time. When a person has multiple diseases simultaneously, this is known as comorbidity. Having lupus and RA as comorbid conditions may be especially tricky. Practicing extra patience, self-care, and more involved communication with your rheumatologist may help reduce disease progression.
Have you ever experienced frustration or difficulty in understanding the difference between rheumatoid arthritis and lupus? Are you living with both conditions? Comment below or start a conversation on myRAteam or MyLupusTeam.