When doctors talk about lupus, the focus often lands on the kidneys. However, there’s one part of the body almost every lupus patient will face issues with: the hands. As a rheumatologist, I can tell you, the hands reveal so much and when you know what to look out for, you can alert your doc and together develop a plan.
Lupus Arthritis: Joint Pain and Beyond
It might not surprise you to know that joint pain is a part of lupus, as it is with most autoimmune conditions. More than 90% of lupus patients will experience some form of joint pain or arthritis. But when we hear “arthritis,” we tend to think of rheumatoid arthritis (RA), not lupus, and miss the nuances of lupus arthritis.
Similar to RA, the joint pain of lupus is inflammatory. It tends to be symmetrical, affecting both hands or both knees, and can appear in multiple joints at a time, sometimes even traveling to different joints. The pain, marked by swelling and stiffness, can lead to significant disability. Morning stiffness for up to an hour is common, making it difficult to grip or make a fist.
However, lupus arthritis doesn’t usually cause joint erosions and bony changes like RA. Instead, it can lead to a weakening of the supporting soft tissues around the joint, namely the tendons. This laxity can change the shape of the fingers, making them malleable. These changes, known as “reducible” deformities, can make it hard to use your hands effectively. So, despite the lack of visible bone changes, lupus arthritis can cause the hands to change over time.
Lupus Hand Symptoms: Skin Rashes
Rashes in lupus come in all shapes and sizes and can appear almost anywhere on the body. The butterfly facial rash is iconic, but one of the most specific lupus rashes occurs on the hands. This red, thick, scaly rash appears between the knuckles and is usually not painful or itchy. However, its unique location sets it apart for rheumatologists.
When evaluating a hand rash, lupus isn’t always the first autoimmune condition we think of. For example, there’s a rash called Gottron’s that occurs on top of the knuckles and is associated with conditions like dermatomyositis. So, remember: a rash on the knuckles could be Gottron’s; a rash between the knuckles could be lupus.
In addition to rashes, lupus can also affect the nails. You might develop weak, brittle nails that often split or become discolored. Swelling around the nails is another symptom to watch for.
Raynaud’s Phenomenon & Lupus Vascular Issues
Raynaud’s phenomenon is a vascular issue where the tiny blood vessels in your fingers have an exaggerated response to cold or stress, causing them to constrict and temporarily limit blood flow. This leads to color changes in your fingertips, from white to blue and then red as blood flow returns. Raynaud’s is common in lupus patients, affecting up to 50%.
Managing Raynaud’s involves wearing gloves to keep your hands warm, avoiding smoking, and minimizing stress. Alongside Raynaud’s, lupus can cause inflammation in the blood vessels, known as vasculitis. This inflammation can lead to red, tender spots or ulcers on the fingertips, requiring prompt medical attention.
Managing Lupus Hand Symptoms
The best way to handle these lupus hand symptoms is to control your lupus as effectively as possible through a combination of medication and lifestyle changes. Specific therapies can also help manage individual problems. Hand physical therapy and specialized splinting can aid joint and tendon laxity, while protecting your skin from the sun and using SPF can help manage rashes.
Remember, keeping track of your health and communicating with your doctor is key to managing lupus effectively.
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