How to Tell Rheumatoid Arthritis From Lupus
Morning stiffness greater than 30 minutes everyday indicates
This is Dr. Bob Lahita and I am Chairman of Medicine at Newark Beth Israel Medical Center which is part of Barnabas Health and Professor of Medicine at UMDNJ in Newark, NJ. I am going to tell you the differences between a patient with Rheumatoid Arthritis and a patient with Lupus.First of all Lupus and Rheumatoid Arthritis are both Autoimmune diseases. Rheumatoid Arthritis is the most common autoimmune disease in the world. It is basically a disease which causes weakness and it causes many of the symptoms like joint pain and joint destruction in some cases that one sees in Lupus.But there's a big difference: The joints in Lupus are asymmetrically involve. That means you can have a knee hurt, or an elbow, or a shoulder or one hand or both hands. The symmetry of the disease is not usually the same, and there's not a lot of morning stiffness. Generally patients with Lupus have joint pain all day.In rheumatoid arthritis the joint disease is symmetrical: that means if one knee is involved, the other knee is involved, if one wrist is involved the other wrist is involved. Joints that are involved specifically in lupus but also can be involved in rheumatoid arthritis are the wrist and what we call the meta-carpal phalangeal and the proximal inter-phalangeal joints. These can be swollen and red and the patients will have difficulty bending these joints. The hand is very helpful, as is the wrist.Plain x-rays will help your doctor in the final stage of differentiating between lupus and rheumatoid arthritis. Because the key hallmark in rheumatoid arthritis is erosive changes at what are called the periarticular surfaces of the bone. Particularly those joints that I showed you: the MCP the PIP joints and the wrist joints.What we are looking for in rheumatoid arthritis are bony erosions. We don't see these erosions in patients with systemic lupus. Classically in cases of rheumatoid arthritis we would like the patients to have greater than 30 minutes of morning stiffness everyday. That is generally not seen in systemic lupus. Pain in the feet when the patient gets out of bed: this is in rheumatoid arthritis. This is Dr. Bob Lahita for About.com.