Can You Have Both Rheumatoid Arthritis and Lupus?

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Rheumatoid arthritis and lupus are both forms of arthritis which affect the autoimmune system resulting to attack of healthy body tissues. A recent study has shown that an average rheumatoid arthritis patient has 1.6 comorbidities (the existence of more than one disease in a person, usually independent of each other). The risk of having more than one disease increases with the patient’s age.

Research has also shown that people with rheumatoid arthritis are at high risk of developing comorbid disorders and that the conditions may have similar features making it difficult to diagnose

Both rheumatoid arthritis and lupus can be diagnosed by looking at the following:

  • Subcutaneous nodules in specific places
  • Morning stiffness. This can be experienced at least one hour in the morning for at least six months
  • Hand joints arthritis. This should be present for six weeks
  • Soft tissue swelling. This should be in at least in 3 of at least 14 joints and be present for at least 6 weeks
  • Symmetric arthritis. This should be present for at least six weeks
  • Joint erosion suggested by radiological changes
  • Rheumatoid factors that is above 95th percentile
Autoimmune System

For you to be diagnosed with rheumatoid arthritis at least four of the symptoms above should be met.
In lupus, the following symptoms can be used to diagnose the disorders:

  • Photosensitivity. The skin develops a rash as a reaction to sunlight.
  • Malar rash. This is a butterfly shaped rash across the nose and cheeks.
  • Non-sensitive arthritis. This form of arthritis does not destroy bones around the joints. This can affect two or more joints resulting to tenderness and swelling.
  • Kidney disorder. This happens when there is excess protein in the urine. (proteinuria).
  • Cardiopulmonary involvement. This occurs when there is inflammation of the linings around the lungs(pleuritis) or the heart (pericarditis).
  • Painful mouth and nose ulcers.
  • Discoid rash. The scars are raised and they cause scars.
  • Neurologic disorder and seizure.
  • Immunologic disorder.
  • Antinuclear antibodies (ANA) positive test in absence of drugs known to cause it.
  • Hematologic disorder. This is a blood disorder that causes low red blood cells count (hemolytic anemia), low platelet count (thrombocytopenia) and low white blood cell count (leukopenia).

Lupus foundation of America says that about 5 to 30% of people with lupus report having overlap symptoms. Overlapping is when you have symptoms of more than one disease. The likelihood of having lupus and rheumatoid arthritis is 1%

There are 1.5 million people in America living with lupus and the 1% accounts for approximately 15000 people with both lupus and rheumatoid arthritis. Rheumatoid arthritis and lupus have some similar symptoms such as joint pain, tenderness and swelling making an accurate diagnosis of the disease difficult. A study published by the Journal of Rheumatology done on 603 patients diagnosed with rheumatoid arthritis indicated that 15.5% of the patients showed at least four or more symptoms of lupus after 25 years since being diagnosed with rheumatoid arthritis. This study concluded that lupus symptoms are common in people with rheumatoid arthritis.

Lupus Symptoms

Some research has shown the possible genetic connection. A study published in New England Journal of Medicine (2007) showed genetic variations that increase the risk of rheumatoid arthritis and systemic lupus erythematous (lupus). The research showed one variant form of gene was present at high frequency in Rheumatoid Arthritis patients. It is also showed that some variants of the STATA gene were strongly linked with lupus. Individuals who carry two copies of the disease risk variant form of the STAT4 gene have 60% increased risk of developing rheumatoid arthritis and double or more risk of developing lupus compared to people who carry no copies of the variant form.

Many patients are not aware they have both diseases. This has also been contributed by the lack of definitive test and symptoms overlap. A rheumatologist can be helpful in diagnosis and overseeing the treatment.

Many medication used to treat rheumatoid arthritis are also used to treat lupus. Some of these medications include prednisone, methotrexate and plaquenil.

When you have both lupus and rheumatoid arthritis just take care of your body, be engaged in exercises, get plenty of rest, have a nutritious food, and take your medication and you will be able to manage the conditions.

References

  • Murat Icen et al. (2008). Systemic Lupus Erythematosus Features in Rheumatoid Arthritis and Their Effect on Overall Mortality. The Journal of Rheumatology, 36: 50-57. Retrieved October 13, 2013 from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3114577/
  • Systemic lupus erythematosus (2013, June 27) University of Maryland Medical Center. Retrieved October 16, 2013 from http://umm.edu/health/medical/reports/articles/systemic-lupus-erythematosus
  • Rheumatoid Arthritis (2013, July 13) Mayo Clinic. Retrieved October 16, 2013 from http://www.mayoclinic.com/health/rheumatoid-arthritis/DS00020/tab=InDepth



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36 comments

  • This pathway originates with missing enzymes called protease and DNase 1. They digest dietary proteins and DNA. A lack of these enzymes leads to unbroken down protein particles and DNA entering the bloodstream. The immune system forms neutrophil extracellular traps (NETs) in an effort to contain the “foreign invaders”. These NETs can then become lodged in organs and tissues (such as the joints) leading to organ failure and tissue damage.

  • RA OA Psoriasis now possibly PsA Eczema CAD (Coronary Artery Disease) Depression Anxiety PTSD …did I leave anything out? Oh ya high blood pressure high cholesterol etc.

  • Research has also shown that people with rheumatoid arthritis are at high risk of developing combined disorders and that the conditions may have similar features making it difficult to diagnose

  • Yes I Have Both Rheumatoid Arthritis and Lupus and have Fibromyalgia, And M.S. And I’m A Diabetic…SMDH that why I’m always in a great deal of pain.

  • our bodies can get sick with these immune conditions to include chronic fatigue, fibromyalgia, lupus, crohnes…it’s all the same disease INFLAMMATION EFFECTING DIFFERENT SYSTEMS OR ORGANS….and the cause is not genetic….we have genetics but what makes our genetics express are poor diet, mal-nutrition, stress, infection, viral and bacterial and toxicity. And the cure and management lies in addressing these root causes NOT masking the symptom and treating 1 thing at a time…but treating the whole body, because there are many things out of balance to get sick…….

  • I was first dx with RA. After 3 infusions with a specific medication, I was diagnosed with MS. Have had both now for 12 years. I treat the RA and hope the MS doesn’t get out of hand. Thank God for Xeljanz…it doesn’t cause further demyelination from MS. I would like more information about these two. Lupus and RA are “related”. What about the ones that aren’t related?

  • The fact is one autoimmune leads to another….I am diabetic, have Graves ‘ disease which was treated with radioactive iodine, psoriasis and RA, and likely PsA as well. And lest I forget the ankylosing spondylitis and inflammatory arthritis of my entire spine…isn’t autoimmune disease great!?

  • Many people including doctors don’t realize that RA can overlap with other chronic conditions. I saw a locum at my GP’s office yesterday who was not aware that one person could have both RA and Fibromyalgia yet there I was sitting in front of him with a proven diagnosis of both. He did not dispute it and was glad that I had made him aware of it. I do wonder how many other cases he may have missed though.

  • I wonder how many people here have arthritis — I, for one. I got arthritis at the same time I first had lupus symptoms, in hands and feet primarily – my hands have never been the same, with large knuckles and trigger fingers, and my feet are quite misshapen now.

  • There can be “overlap” diseases, usually with lupus as a dominant and features of RA, scleroderma, sjogrens or dermatomyositis.

  • We appreciate all the info, but when the dr keeps saying my child’s fine, even though she has pain I get frustrated. Maybe it just takes years for these symptoms to show up on blood tests.

    • @Melody Those symptoms are also symptoms of Sjogrens and even though everything you read will say only old people get that, I am 28 and I have it. Pilocarpine is the only thing that works. Also side note, to the author of the article: there is one statistic missing near the end, it is a typo that would be nice to see corrected! Additionally, I have had RA since I was two. I was in remission for 8 yrs. and it came back 3 years ago. With it, I was diagnosed with Sjogrens and tested positive for Lupus. I have symptoms of both and doc calls it Rupus. She also said I’m a complicated case so I guess I’m part of this 1%!! Good thing I like to be different!!

  • Melody, have you not gotten a diagnosis yet? I’m so sorry! I would demand a referral to a pediatric rheumatologist. It is your right. There are no definite tests that will determine JIA or Lupus, mostly it’s a process of elimination. There are a few tests that would help indicate that JIA or Lupus *might* be the culprit, but unfortunately, the best we can do is to eliminate all other possibilities, and have an evaluation from a specialist. Keep fighting, you are not alone…and you know your child better than anyone. If you don’t get productive answers/help from your dr. perhaps it’s time for a second opinion.

    • Oh, Emily Christine, we have. It’s discoid lupus. Just the skin. So, if her skin looks good all her tests come back satisfactorily. Yet, she has painful joints, dry mouth, sun sensitivity, fatigue, etc. It’s hard, but I should be grateful Dr.’s then have no reason to give her much medicine. Thanks!

      • I take it back, there is one test: a positive rheumatoid factor test IS a definite “yes” to JIA, but the negative to the test is NOT a definite “no” to it being JIA. In fact, negative test results are MUCH more common than positive results

  • I have both. I’ve had two rheumatologist (Cleveland Clinic) since being diagnosed in 1998. I liked the first and love my current doctor who I have seen for 14+ years. Both have said the opposite is true as does almost everything online including lupus.org. That said, I question the accuracy this information.