Lupus arthritis--do we have a clinically useful classification?

Abstract

Joint disease in SLE is common and has a significant impact on patients in terms of their burden of disease and quality of life. Despite this it remains largely understudied in comparison with the other inflammatory arthropathies. Newer imaging techniques are challenging the traditional concepts of a non-erosive arthropathy that is outlined in the ACR diagnostic criteria for SLE. MRI and musculoskeletal US techniques have been applied extensively in RA to detail the underlying joint pathology, to monitor response to treatment and to guide prognosis. The advent of biological therapies has revolutionized the treatment of RA and has again been borne out of an abundance of research that exists surrounding the underlying pathobiological inflammatory pathways. Unfortunately, no such unified body of evidence exists for lupus arthritis, which has made the development of an appropriate classification system somewhat difficult as our understanding remains incomplete.

Evaluation of the Patient Acceptable Symptom State (PASS) in Italian Patients Affected by Systemic Lupus Erythematosus: Association with Disease Activity Indices

“…Joint involvement in SLE is very common, affecting up to 90% of patients at any stage of disease. The clinical presentation of joint involvement can widely vary, ranging from arthralgia, without erosions or deformity, to an erosive arthritis with severe functional disability [38]. The results of the present study confirm the impact of the musculoskeletal involvement in the acceptability of the patient’s status.…”

Efficacy of Abatacept for Arthritis in Patients with an Overlap Syndrome between Rheumatoid Arthritis and Systemic Lupus Erythematosus

“…The latter lesions may represent the pathology characteristic to SLE rather than RA according to the previous studies which showed high prevalence of tenosynovitis in lupus patients [4, 5, 21]. Although the absence of tenosynovitis did not influence the efficacy of abatacept in our small number of rhupus patients, the discrimination between intra-capsular- and extra-capsular-dominant patients using ultrasound may be informative in the prediction of effectiveness of antirheumatic and immunosuppressive agents for arthritis in RA and SLE.…”

The role of imaging in the evaluation of joint involvement in 102 consecutive patients with systemic lupus erythematosus

“…Systemic lupus erythematosus (SLE) is a complex and heterogeneous disease characterized by a wide variety of clinical and serological manifestations; among these, involvement i is common, and is reported in up to 90% of patients during the disease course [1][2][3][4][5][6]. While for decades joint involvement in SLE has been considered mild and nonerosive, many studies have recently showed that patients with SLE develop joint deformities and, in up to 10% of the cases, an erosive deforming arthritis [7][8][9].…”