General Arthritis vs. Lupus Arthritis

Elaine K. Howley

For anyone with creaky joints or painful, swollen fingers, you likely know the pain of arthritis. This very common condition typically afflicts older adults, but there are actually many different types of arthritis that can impact people at various stages of life.

In total, the Arthritis Foundation reports there are more than 100 distinct types of arthritis, and the Centers for Disease Control and Prevention reports that more than 54 million U.S. adults -- that's about 1 in 4 -- have some type of arthritis.

General Arthritis

Generally speaking, "arthritis is inflammation of a joint," says Dr. Travis Scudday, an orthopedic surgeon with Hoag Orthopedic Institute in Irvine, California. The most common type of arthritis is a condition called osteoarthritis. This is the form of arthritis that's associated with aging.

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Dr. David Pugliese, a rheumatologist at Geisinger in Danville, Pennsylvania, says that "osteoarthrosis is essentially a wear-and-tear phenomenon" that gets worse over time. As you age, the cartilage that sits between the bones that meet in the joints and acts as a cushion to those bones starts to wear thin. Eventually, this cartilage becomes so thin that the bones rub against each other. This can create pain from the direct contact of bone on bone, and the more you use the joint, the more painful it becomes.

Virtually everyone will eventually develop osteoarthritis if you live long enough, it's just a simple matter of the body's protection systems breaking down with use. Osteoarthritis is "a disease of old age, basically," says Dr. Esther Lipstein-Kresch, chief of rheumatology at ProHEALTH Care in New York. "Unless you've had some kind of trauma to a joint," or there's another abnormality in the structure of the joint, "you wouldn't expect someone who is 30 or 40 to develop osteoarthritis," she says.

Osteoarthritis affects "nearly half of all people over age 65," Scudday adds. It's typically diagnosed with a clinical exam, and "there is often radiographic evidence in simple X-rays" of damage to the cartilage.

Osteoarthritis can usually be treated non-operatively with physical therapy and anti-inflammatory medications, such as over-the-counter pain killers. Some people may find relief with steroid injections into the painful joint to ease the inflammation there. "If all non-operative treatments have failed, often a joint replacement is necessary," Scudday says.

Lupus Arthritis

By comparison, another type of arthritis is related to an autoimmune disease called lupus. About 1.5 million Americans are estimated to have lupus, according to the CDC, and the disease causes a variety of symptoms including:

-- Chronic pain.

-- A signature, red butterfly rash across the face and the bridge of the nose.

-- Other rashes and skin problems.

-- Joint pain and swelling.

-- Chest pain.

-- An overall feeling of malaise.

-- Mouth sores.

-- Inflammation of blood vessels.

-- Fever.

-- Strokes.

-- Cardiovascular disease.

-- Extreme fatigue.

-- Hair loss.

-- Weight loss.

-- Arthritis.

Although there are a few different types of lupus, systemic lupus is the most common, accounting for about 70% of all cases of lupus, the Lupus Foundation of America reports. When someone says "lupus," they're usually referring to this systemic type, which is also called lupus erythematosus.

Why exactly lupus happens to some people and not others isn't entirely clear, but may be related to:

-- Genetics. The LFA reports that about 20% of people with lupus have a close relative (parent or sibling) who has or will develop lupus.

-- Hormones. About 90% of people with lupus are women, but men and children can develop it too.

-- Environmental triggers. Infection with certain viruses, such as the Epstein-Barr virus, or exposure to chemicals, such as silica dust, could play a role in the development of lupus by some individuals. Other stressors on the body are also believed to be potential triggers for the disease.

-- Medications. Certain medications, including some antibiotics or sulfa drugs that increase sun sensitivity, are thought to be potential triggers of lupus.

Lupus occurs when the immune system goes haywire and begins attacking your own cells erroneously. This causes widespread inflammation, and when this occurs in the joints, it causes a type of arthritis called lupus arthritis.

Lupus arthritis is caused by inflammation in the joints that develops because of the immune system processes that cause the disease. People with lupus may experience "flares" or periods when their joints are more inflamed, followed by periods where there's less pain, swelling and redness.

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Lupus can be very challenging to diagnose, but joint pain is often one of the first signs of the disease. "We usually see swelling of the hands and wrists but can also see knee and hip involvement," Scudday says. Unlike with osteoarthritis, lupus arthritis doesn't usually show obvious signs on X-rays.

Because it might not be clear straight away what's causing the problem, lupus is sometimes missed or misdiagnosed as a different disorder. Scudday says a blood test looking for certain blood markers associated with the autoimmune condition can help make the diagnosis, "but not all lupus patients have positive blood markers."

If you have been diagnosed with lupus, you'll likely need medication to keep your immune system in check. This can help relieve symptoms of the disease, including arthritis.

"Lupus can be treated with medication that alters the immune system to decrease the amount of inflammation," Scudday says. "Injections can be effective in the large joints such as the knee or hip." In the most advanced cases where there's irreparable damage to the joint, a total replacement might become necessary -- partial joint replacement isn't an option because of the extensive, system-wide inflammation associated with lupus.

It's important to note that while lupus is not curable, it is a disease that can be effectively managed and treated. Early detection of lupus or any other inflammatory or autoimmune disease is critical to starting treatment before the damage progresses. "Treating with medication will often stop the progression of any lupus-related arthritis," Scudday says.

Stopping or slowing progression is the name of the game in treating rheumatological consequences of autoimmune disease because once the damage occurs, it can't be reversed. "It's important to diagnose and treat lupus as early as possible," Scudday says, because in such cases, "the joint issues may be completely avoided."

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Similar Pain From Different Diseases

Though the pain you feel in the joints caused by either osteoarthritis or lupus-related arthritis might feel similar, the two diseases are quite different. And lupus isn't the only autoimmune disease that can cause arthritis; if you have any kind of autoimmune disease, you may well have rheumatological involvement because of the extensive inflammation caused by these conditions.

But, if your autoimmune disease is well-managed, then you may be able to avoid some of the worst arthritis symptoms. In such cases, it's possible that you may "develop age-related osteoarthritis, just like the rest of the population," rather than lupus arthritis, Scudday says.

Regardless of whether your joint pain is caused by osteoarthritis or another form of arthritis, it's important to get it checked out. Arthritis symptoms can be vastly improved with careful management of lifestyle factors and the addition of medication or physical therapy. The key is to not suffer in silence.