When it comes to autoimmune diseases, understanding the nuances can make all the difference. Today, we delve into two of the most commonly diagnosed conditions: rheumatoid arthritis and lupus. With similar symptoms, it can sometimes be challenging to discern one from the other. This article seeks to clear the confusion by comparing and contrasting the two autoimmune conditions and will answer the following questions
- Is it Lupus or Rheumatoid Arthritis?
- How are Lupus and Rheumatoid Arthritis similar?
- How do Lupus and Rheumatoid Arthritis differ?
- Can Lupus and Rheumatoid Arthritis co-exist?
Is It Lupus or Rheumatoid Arthritis?
If you’re experiencing joint pain accompanied by rashes, or if your physician has recommended autoimmune blood tests, you’re probably pondering this exact question. Both of these conditions present with overlapping symptoms. But understanding their specific characteristics can help pinpoint the correct diagnosis.
Lupus: Signs and Symptoms
Lupus is an autoimmune disease, potentially affecting everything from your joints and muscles to your skin and even the brain. Here are the primary symptoms associated with lupus:
- Butterfly-shaped Facial Rash: This distinct rash spreads across the nose bridge and cheeks, notably not crossing the nasolabial folds. Other rashes like discoid lupus can also manifest.
- Photosensitivity: People with lupus may have heightened skin sensitivity, burning easily under sun exposure.
- Oral Ulcerations: Painless mouth sores are another symptom in active lupus cases.
- Joint Pain and Swelling: Lupus usually affects the small joints of the hands, but it may also affect other joints like the shoulders, knees, hips, or ankles. The joint can become red, swollen, and painful. People will describe difficulties in using their hands and significant morning stiffness that usually lasts more than 1 hour but will improve with movement.
- Fatigue and Fever: People with lupus can present with low-grade fever, usually at night, accompanied by feeling unwell, tired, or fatigued. Fever can be a sign of inflammation but also an underlying infection.
- Chest Pain and Shortness of Breath: Patients with lupus may complain of chest pain, especially when taking a deep breath. They often have to stop taking deep breaths due to chest pain. This can be a sign of inflammation of the lining of the heart or lungs, or it may be a sign that there is fluid in the lungs or around your heart. Unfortunately, patients with lupus are at high risk of heart attacks, so it is best to check your heart immediately if you experience chest pain and shortness of breath.
- Kidney Involvement: Change in the urine color, like red, frothy, or bubbly urine, can indicate lupus affecting the kidneys. Once again, this is a serious complication and requires quick evaluation and treatment because the risk is to lose your kidneys.
- Neurological Symptoms: The peripheral or central nervous system can be equally affected by lupus. That means that patients with lupus can have headaches, seizures, loss of consciousness, inflammation in the spine, and even tingling and numbness in their hands or feet.
- Hair Loss and Alopecia: Hair thinning or patchy hair loss (called alopecia) can occur.
- Blood Count Changes: Patients with lupus can present with low blood counts, from anemia to low white blood cells and even low platelets. This can indicate that certain antibodies are attacking the blood cells and actively destroying them.
REAL PATIENT STORY
| Allan was a 24-year-old, physically active Black man who, four weeks before this admission, was evaluated a few times in the Emergency Room. The first time, he presented to the Emergency Room with leg pain, and after a few tests, he was diagnosed with a blood clot; he was treated and sent home on treatment. One week later, he returned to the hospital for shortness of breath. This time, he was diagnosed with possible pneumonia, treated with antibiotics, and sent home. Then, two weeks after this episode of pneumonia, he lost consciousness and was brought to the hospital by his parents. This time, he was admitted to the Intensive Care Unit, where one of my residents thought this young gentleman might have some mysterious autoimmune disease. To everyone’s surprise, the tests came back suggesting that the patient had an autoimmune disease, and they consulted me. Based on my evaluation, I was able to diagnose the patient with lupus that was involving his brain. Luckily, with his parents’ agreement, we started treatment quickly and saved this patient’s life. Today, the patient is back to normal life and was very grateful that he received the correct diagnosis and treatment in time. This case was published, and it took the first page of one of the most respected journals for rheumatology. |
Rheumatoid Arthritis (RA): Signs and Symptoms
While both diseases involve the immune system attacking the body, Rheumatoid Arthritis predominantly affects the joints. Here are some hallmark signs and symptoms of Rheumatoid Arthritis (RA):
- Joint Pain and Swelling: Particularly in the hands and feet, with the pain often being symmetrical, joint involvement is bilateral. Other joints like elbows, knees, ankles, and hips can be affected.
- Morning Stiffness: This stiffness lasts more than one hour and generally improves with movement.
- Other Organ Involvement: Rheumatoid Arthritis (RA) can also affect the eyes, heart, lungs, skin, and even blood counts.
How are Lupus and Rheumatoid Arthritis similar?
At first glance, both Rheumatoid Arthritis (RA) and lupus share similarities, especially in terms of joint, skin, lung, and blood count effects. Yet, they have some distinguishing features.
How do Lupus and Rheumatoid Arthritis differ?
Symptoms:
Lupus tends to affect the skin more, causing the butterfly rash, and the increased sensitivity to the sun together with joints, while Rheumatoid Arthritis (RA) tends to start more with joint pain, swelling, and stiffness. The swelling of the joints in Rheumatoid Arthritis (RA) tends to be more prominent than in lupus patients.
- Aggressiveness towards joints: Lupus causes inflammation but will not destroy the joints, and does not cause erosions in the bones. Lupus may cause deformities in the joints, like Jaccoud arthropathy, but these deformities are reversible when the fingers are passively moved, which distinguishes JA from the deformities seen in conditions like rheumatoid arthritis. In the contrary, Rheumatoid Arthritis (RA) affects the joints, and left untreated will destroy the joints, and cause erosions and permanent deformities
- Laboratory tests: there are specific laboratory tests for lupus like different types of antibodies from ANA (antinuclear antibodies test), auto-antibodies like Ds-DNA (anti double stranded DNA), Anti-SMITH, SSA, SSB, and RNP antibodies along with Complement levels that may be decreased.
For Rheumatoid Arthritis (RA), the Rheumatoid Factor (RF) and anti-CCP antibodies are seen in about 60-70% of patients and they can point toward the diagnosis. Some patients can also have a positive ANA test, but usually, they do not have the other lupus autoantibodies present or positive.
- Treatment: the treatment for Rheumatoid Arthritis (RA) and lupus is different and that is why it is important to have a correct diagnosis.
Can You Have Both Rheumatoid Arthritis and Lupus?
Yes, both of these diseases can come together. Actually, there is a name for that combination called RHUPUS. There are patients who have many signs and symptoms of lupus (e.g., skin rashes, oral ulcers, chest pain, and shortness of breath), plus an aggressive form of arthritis that can cause erosions to the bones and joint deformities. These patients usually have positive Rheumatoid Factor (RF) and Anti-CCP antibodies together with other autoantibodies present in lupus. That is why, even in patients with lupus, I do recommend and order the tests for Rheumatoid Arthritis (RA).
Seeking Timely Medical Assistance for Rheumatoid Arthritis or Lupus
Early diagnosis and treatment are paramount. With the average wait time to see a specialist in the US ranging from 4-6 months, it’s crucial to seek help when needed. This is critically important, especially for patients who suffer from lupus, as 6 months is enough time to lose the battle with lupus, as you may develop severe heart and lung disease, and even lose your kidneys. So waiting is unacceptable.
That is why Rheumatologist OnCall is here to help people in need when they need it the most. We are here to help people who, for so many reasons, can’t see a specialist as they are unable to travel, or they do not have a rheumatologist in their area, or the waiting time is too long, or they just want a second opinion. Rheumatologist OnCall provides online consultations to patients in multiple US states. If you or someone that you know is struggling to find a rheumatologist, check out our website and schedule an appointment.
Conclusion
While both Rheumatoid arthritis and Lupus have overlapping symptoms, understanding their distinct characteristics is vital. If you found this post helpful, don’t forget to share it with those who might benefit and leave a comment below. Your feedback supports my mission to educate and inform.
