Autoimmune disorders such as lupus and rheumatoid arthritis can cause a wide array of seemingly unrelated symptoms. Lupus, also known as systemic lupus erythematosus, is a systemic illness and can affect any organ system. While rheumatoid arthritis is commonly thought to be limited to the joints, it can also affect the skin, eyes, heart and lungs. Because both disorders may cause multiple symptoms, diagnosis can sometimes be tricky. Additionally, some people have an overlap syndrome, meaning they have features of more than one autoimmune disorder. Special tests are useful when the diagnosis is not clear-cut.
Lupus can affect any organ in the body, including the brain, heart, digestive organs, kidneys, joints and skin. As a result, it can lead to any number of symptoms. Nevertheless, certain symptoms are considered classic lupus symptoms. Many people initially note skin rashes, particularly a butterfly-shaped rash over the nose and cheeks. Profound fatigue, mouth sores, hair loss and joint pain are common. Shortness of breath and chest discomfort due to inflammation and irritation of the tissues surrounding the heart and lungs may also occur. Kidney inflammation may result in blood in the urine and the urge to urinate frequently. When the brain and nervous system are affected, visual disturbances, muscle weakness and seizures may occur.
Rheumatoid Arthritis Symptoms
Joint pain and stiffness that are most intense in the morning are considered hallmark symptoms of rheumatoid arthritis. Any joint in the body can be affected by RA, but the hands and feet are most commonly involved. Bumps on the skin, known as rheumatoid nodules, may form near joints. Additionally, people with RA often experience severe fatigue due to anemia. RA can also cause complications that affect the heart and lungs. For example, fluid may accumulate around the heart and lungs due to RA-induced inflammation. People with RA are also at increased risk of premature heart disease and a condition called pulmonary hypertension. A persistent cough, difficulty breathing and chest pain may occur if heart and lung disease remain untreated.
People may experience a spectrum of symptoms that does not allow for a concrete diagnosis of lupus or rheumatoid arthritis. People with features of both disorders have an "overlap syndrome." People who have previously been diagnosed with lupus, for example, may go on to develop rheumatoid nodules and joint pain that is consistent with RA. This type of symptom overlap is most often seen in postmenopausal women with lupus. Likewise, people who initially experience joint pain and are thought to have RA can later develop neurologic or kidney problems that are typically ascribed to lupus. Blood tests can help to make a diagnosis, but when an overlap syndrome is present, even lab tests may be inconclusive.
Historically, steroids have been the mainstay of therapy for both lupus and rheumatoid arthritis. Joint pain, skin irritation and fatigue due to lupus or RA often improve with steroids. Since steroids can cause numerous side effects, especially when used over the long term, other therapies have been developed. Medications known as disease-modifying antirheumatic drugs, or DMARDs, are often used to treat RA and lupus. Like steroids, DMARDs reduce inflammation but also slow progression of the underlying disorder. Commonly used DMARDs include methotrexate (Rheumatrex, Trexall), hydroxychloroquine (Plaquenil) and azathioprine (Imuran). Biologic drugs, which are a special class of DMARDs, are also used to treat people with severe RA. Examples include rituximab (Rituxan), entanercept (Enbrel) and adalimumab (Humira). The biological medication belimumab (Benlysta) can be used to treat lupus. A combination of medications is often required to treat overlap syndromes.
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- Nature: Evolving Concepts of Rheumatoid Arthritis
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- Journal of Clinical Pathology: Autoantibodies and Overlap Syndromes in Autoimmune Rheumatic Disease