Joint pain swollen lymph nodes

Treating rheumatoid arthritis

Published: March, 2014

Just opening a jar can be a harsh reminder of the limitations rheumatoid arthritis places on daily life. Early and aggressive treatment can often help.

Rheumatoid arthritis (RA) is a chronic degenerative inflammatory disease of the joints. More than two million Americans have the condition; about 70% of them are women.

RA has long frustrated patients and doctors. It has widely varying effects, its course is unpredictable, its causes are unknown, and no cure is in sight. However, medical science has made striking progress in treating the condition. In some people, early and aggressive therapy can halt joint damage and reduce long-term disability.

Symptoms and causes

The affected joints feel warm, swollen, and tender. They may be stiff when you wake up and ache after you rest. Rheumatoid arthritis often strikes the wrists and the upper part of the fingers. The neck, shoulders, hips, knees, ankles, and feet may also be affected. Unlike other types of arthritis, RA tends to have a symmetrical pattern: When the right knee is affected, the left usually is as well.

Rheumatoid arthritis can also attack tissues in addition to the joints, causing further symptoms. Fatigue and fever are common. Lymph nodes may swell. Some people develop nodules (lumps of tissue) beneath the skin near the joints, or in bony areas often exposed to pressure, such as the elbow and the forearm. In about 40% of RA cases, the pericardium — the tissue sac that encircles the heart — becomes inflamed. Inflammation may also occur in the lining of the lungs (pleuritis) or in the tear ducts and salivary glands, resulting in dry eyes and mouth. Some people develop anemia (a low red blood cell count).

The course of the disease is varied and unpredictable. For some women, symptoms come and go over a few months and then disappear without producing any noticeable damage. Others have moderate symptoms for a lifetime, with acute phases during which more severe symptoms, called flares, alternate with remissions. Still others have severe, unremitting disease that continues for decades and causes debilitating joint damage.

It’s likely that many factors — genetic, environmental, and hormonal — interact to trigger the immune system’s attack on the body. Mounting evidence suggests that infectious agents, such as viruses or bacteria, may unleash the disease in genetically susceptible people. The symptoms tend to go away during pregnancy and return after the baby is born, so scientists suspect that estrogen and other sex hormones play a role.

Diagnosing rheumatoid arthritis

Diagnosis is difficult in the early stages because symptoms vary so much from person to person. It may be hard to differentiate RA from other arthritic conditions and even from common viral infections. A patient’s description of her symptoms and a thorough physical exam provide the most important clues.

The diagnostic process may involve a variety of blood tests, including erythrocyte sedimentation rate (a general measure of inflammation), a complete blood count, and a test for rheumatoid factor — an antibody found in the blood of most people who have rheumatoid arthritis. Not everyone who tests positive for rheumatoid factor develops the disease, so the test isn’t definitive.

X-rays aren’t particularly useful early on; it takes months of inflammation to cause the type of joint damage that will show up on an x-ray. Once such damage has occurred, x-rays may be used to monitor the progression of the disease or the effects of therapy.

Anatomy of rheumatoid arthritis

Joints (the places where bones meet) are surrounded by a capsule lined with a membrane called synovium. Synovium produces a fluid that fills the capsule, lubricating the joint and nourishing the cartilage and bones inside the capsule. In rheumatoid arthritis, the immune system, which normally protects the body from infection and disease, attacks tissues within the joint capsule.

White blood cells migrate to the synovium and cause inflammation. Inflamed joints become warm, swollen, red, and painful. The synovium thickens, and enzymes released by inflammatory cells destroy cartilage and bone. The joints become enlarged and lose their normal range of motion. Over time, the ligaments and tendons that hold bones in place become weak, and the bones fall out of alignment.

A combination of medications and nondrug therapies is used to relieve pain, control inflammation, slow or stop joint damage, and improve overall function. Drug treatment is important for just about everyone with rheumatoid arthritis, except possibly those in remission.

In the past, physicians prescribed medications conservatively, increasing doses and adding new drugs only gradually. But many experts are taking a more aggressive approach, treating RA early with powerful drugs and using drug combinations rather than a single medication. There are several reasons for this. Studies have shown a link between ongoing RA inflammation and an increased rate of death and illness. Also, more effective therapeutic drugs have become available, and it has been shown that drug combinations can improve long-term outcomes. For women whose joint damage is severe and a source of constant pain, surgery may be the best option. Artificial joints and procedures to reconstruct tendons can restore function and dramatically improve quality of life.

Because the course and features of the disease are so variable, it’s difficult to predict early on who will develop debilitating joint damage. But if it’s going to happen, it happens fast, usually within the first two years after the diagnosis, so clinicians must carefully weigh the benefits and risks of aggressive drug treatment in each person.

Complementary therapies

Medications and a modified exercise program are the mainstays of rheumatoid arthritis treatment. Some complementary approaches have shown promise in expanding the options, although their safety and effectiveness are not proven. Before trying any of them, consult your clinician.

Fish and plant oils. Certain essential fatty acids — eicosapentaenoic acid, found in fish oil, and gamma linolenic acid, found in some plant oils — have been shown in a number of studies to have modest effects on symptoms in some people.

Supplements. Certain vitamins, minerals, and supplements may help improve symptoms. These include B vitamins, copper and zinc, and the amino acid L-histidine. But it’s best to get an adequate intake of vitamins and minerals through food and a standard multivitamin. Some supplements can interact with rheumatoid arthritis medications.

S-adenosylmethionine (SAMe). SAMe is marketed as a supplement for improving joint mobility and pain symptoms in osteoarthritis. Preliminary studies suggest it may help relieve rheumatoid arthritis pain. People who take methotrexate should not take SAMe.

What about bee venom? There’s no scientific evidence that bee venom injected — by bee or needle — into an affected joint helps in treating rheumatoid arthritis. Likewise, copper bracelets have no proven benefit.

Treating pain and inflammation

Three classes of drugs help relieve RA symptoms, although they don’t influence the overall course of the disease.

Analgesics. Acetaminophen (Tylenol, others) and prescription analgesics relieve pain but have little or no effect on inflammation. They may help during a flare.

Anti-inflammatory drugs. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Motrin), naproxen (Aleve), and aspirin reduce inflammation and relieve pain, but they all can have side effects on the stomach, including dangerous bleeding, especially with long-term use. The NSAIDs known as COX-2 inhibitors have been widely used. Although they are no more potent for the average person than traditional NSAIDs, for some people they appear to give superior pain relief. However, the COX-2 inhibitors increase the risk of stroke and heart attack. Two of the drugs that were available in the U.S. market – Vioxx (rofecoxib) and Bextra (valdecoxib) — have been withdrawn from the market for that reason, and the one drug that remains on the market, Celebrex (celecoxib), also has been found to have some increased risk.

Steroids. Prednisone and related steroids reduce inflammation by suppressing the immune system. They provide rapid, dramatic relief, but don’t change the course of the disease. Over time, they may produce many adverse effects, so they’re usually prescribed at the lowest dose possible for the shortest period of time.

Heading off joint damage

Drugs that actually alter the course of rheumatoid arthritis show promise in reducing long-term disability.

Disease-modifying antirheumatic drugs (DMARDs). Most people with rheumatoid arthritis will take a DMARD, usually methotrexate, as early as possible to reduce or prevent joint damage. These drugs take weeks or months to begin working and must be carefully monitored to prevent serious side effects. A DMARD may be given along with a steroid, which quiets inflammation and improves symptoms while the patient is waiting for the DMARD to take effect. The steroid is then gradually withdrawn.

Biological response modifiers (BRMs). This group of injected drugs works by interfering with substances that trigger inflammation as part of the body’s normal immune response. Biological response modifiers include etanercept (Enbrel), infliximab (Remicade), adalimumab (Humira), and anakinra (Kineret). The main drawback of these drugs is that they interfere with the ability to fight infection. Their long-term effects are not fully known.

Protein-A immunoadsorption. This treatment filters the blood, trapping immune substances and removing them. The FDA has approved it for treating people with RA who don’t respond to or can’t tolerate other therapies.

Selected resources

Strong Women and Men Beat Arthritis, By Miriam E. Nelson, Ph.D. Perigee Books, 2003.

National Institute of Arthritis and Musculoskeletal and Skin Diseases”Handout on Health: Rheumatoid Arthritis”www.niams.nih.gov/hi/topics/arthritis/rahandout.pdf

National Institute on Aging, www.nih.gov/nia

The Arthritis Foundation, www.arthritis.org

Nondrug approaches

To live successfully with rheumatoid arthritis, you must learn how to manage your symptoms — especially when and how to exercise and rest. Resting an inflamed joint reduces the inflammation, but prolonged inactivity can result in muscle weakness and loss of joint motion. Knowing how to adjust your activities can help keep your joints strong and flexible without overusing them. A physical therapist can teach you exercises and recommend splints and other devices to support and immobilize joints when at rest. Exercise also helps to prevent osteoporosis — a condition that’s more likely to occur in women who have rheumatoid arthritis.

Other nondrug approaches can help. An occupational therapist can show you how to protect your joints during daily activities and recommend devices that make it easier to eat, write, lift objects, and do other chores. A podiatrist can make foot orthoses — shoe inserts that help redistribute the weight of the body and improve foot function. Techniques such as cognitive behavioral therapy, biofeedback, and stress management have been shown to reduce disability and pain resulting from rheumatoid arthritis.

FDA-approved medications to treat rheumatoid arthritis*

Medications

Side effects

Analgesics

Various over-the-counter and prescription drugs can help relieve pain. They include acetaminophen (Tylenol, others), tramadol (Ultram), and codeine.

Long-term high doses of acetaminophen (more than 4,000 mg a day) can lead to liver damage. Acetaminophen should not be taken with alcohol or with other acetaminophen-containing drugs. Prescription painkillers have various side effects and can interact with alcohol and other medications. Some are addictive.

Nonsteroidal anti-inflammatory drugs (NSAIDs)

These over-the-counter and prescription drugs reduce pain, swelling, and inflammation. They include aspirin, ibuprofen (Advil, Motrin, others), naproxen (Aleve, Anaprox, Naprelan, Naprosyn), ketoprofen (Orudis, Oruvail), diclofenac (Voltaren), diflunisal (Dolobid), and indomethacin (Indocin).

Can cause stomach and abdominal upset or pain, increased bruising and bleeding, fluid retention, and ulcers. Aspirin in high doses can cause ringing in the ears. Overuse may cause liver or kidney problems. Can interact with blood thinners such as warfarin (Coumadin). May increase the rate of miscarriage. Most side effects go away when NSAID use is stopped.

COX-2 inhibitors

This is a different class of NSAIDs that are available only by prescription.

Have a lower rate of ulcers, upset stomach, and bleeding than other NSAIDs. However, the safety of all COX-2 inhibitors is under review following reports of increased risks of stroke and heart attack.

Corticosteroids

Steroids given by mouth or injection can help reduce inflammation and pain and can slow joint damage. They include prednisone (Cortan, Deltasone, Meticorten, others) and methylprednisolone (Medrol).

Can dramatically relieve symptoms, but should not be used for months or years. Long-term use can result in osteoporosis, cataracts, weight gain, diabetes, increased susceptibility to infection, and hypertension. Other side effects include easy bruising, fragile skin, and muscle weakness.

Disease-modifying antirheumatic drugs (DMARDs)

These powerful drugs are prescribed early on to relieve pain and swelling, limit joint damage, and alter the course of the disease. They include antimalarials, such as hydroxychloroquine (Plaquenil); the antibiotics sulfasalazine (Azulfidine) and minocycline (Minocin, Dynacin); injectable and oral gold; D-penicillamine (Depen, Cuprimine); methotrexate (Amethopterin); leflunomide (Arava); and immunosuppressant drugs, such as azathioprine (Imuran), cyclophosphamide (Cytoxan), and cyclosporine (Neoral, Sandimmune).

Can take weeks or months to have an effect. Side effects vary with each medication and include increased risk of infection, hair loss, stomach upset, skin rash, and kidney or liver damage. Any of these drugs may interact with other medications. Methotrexate can suppress the immune system and may cause birth defects. Azathioprine, cyclophosphamide, and leflunomide increase the risk for cancer and birth defects. All DMARDs require close supervision and monitoring by a physician.

Biological response modifiers (BRMs)

This group of injected drugs targets specific immune chemicals and interferes with the inflammatory process. It includes tumor necrosis factor (TNF) inhibitors, such as etanercept (Enbrel), infliximab (Remicade), and adalimumab (Humira), and the interleukin-1 (IL-1) inhibitor anakinra (Kineret).

Side effects vary with the medication and include an increased risk of infection, especially tuberculosis. Side effects of TNF inhibitors include sore throat, abdominal or muscle pain, rash, headache, and nausea. Anakinra requires daily self-injection; it can cause headache, runny nose, and stomach pain. None of these drugs should be taken when an active infection is present. Their long-term safety is unknown.

* A clinician should monitor all drugs taken for rheumatoid arthritis.

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Fearing Infections When You’re Taking High-Risk Medication for RA

A support group I follow via social media asked recently for patients to share the hardest individual parts of chronic illness, the things that others don’t see in the patient struggle. This is a slam dunk answer for me – it’s fear. The constant fear that my disease is silently attacking some part of my body, the unanswered questions that may be another diagnosis lingering in the shadows, the fear that my medication (while holding back the RA) is actually leaving me open to deadly infections. Above all, the patient struggle is rich with fear of debilitation – both of physical and mental function loss and further than that, the ability to create a coping strategy fast enough to match the deterioration of the body. Hence, the crying in the hospital room… It all seems too real sometimes.

By the end of the procedure I’d found my resolve. I’ll face this challenge again, as will all chronic illness patients. The breakdown of the body is not what defines us. With that in mind, I did what I always do: wiped the tears off, wished the doctor well and thanked her for her time. Whatever the result, I have a week before results come in and I refuse to let fear take over. I have a life to live and illness or no illness, cancer or no cancer, I’m going to live that life, even if it means a little public breakdown every once in a while.

We want to hear your story. Become a Mighty contributor here.

Acute lymphoblastic leukaemia (ALL)

Many symptoms of ALL are vague and non specific. You may feel as if you have flu. These symptoms are caused by too many abnormal white blood cells and not enough normal white cells, red cells and platelets.

Most people with one or more of these symptoms don’t have leukaemia. But it’s important to get any symptoms checked out by your GP.

General weakness

You might feel weaker than normal.

Feeling tired (fatigue)

You might feel more tired than normal, even if you’re getting a good nights sleep.

High temperature (fever)

You might have a high temperature or feel feverish.

Frequent infections

You might pick up infections such as coughs and colds easily. Or you might find that the infections last a long time and are difficult to shake off.

This is because you don’t have enough healthy white blood cells to fight bacteria or viruses.

Bruising or bleeding easily

You might have:

  • nosebleeds
  • bleeding gums when you clean your teeth
  • very heavy periods
  • small dark red spots on your skin
  • blood in your wee (urine) or poo (stool)

You might find you are bruising more easily than normal.

Weight loss

You might lose weight even if you haven’t changed your diet.

Swollen lymph nodes

Your lymph nodes (glands) might feel swollen when you touch them. You have lymph nodes in lots of places in your body. They might feel swollen in:

  • your neck
  • under your armpit
  • in your groin

Pain in your bones or joints

You might feel pain in your bones or joints. This might be a dull ache or more of a stabbing pain. It might be worse at different times of the day.

Too many abnormal white blood cells collecting in the bones, joints or lymph nodes may cause pain and swelling.

Feeling short of breath (breathlessness)

You might feel breathless when doing your normal day to day activities or from climbing a short flight of stairs. This could be because you do not have enough red blood cells.

Feeling full in your tummy (abdomen)

You might have a feeling of fullness or discomfort in your tummy (abdomen). This can happen if your liver or spleen are swollen.

Pale skin

You might look paler or more ‘washed out’ than normal.

When to see your doctor

You should get any of these symptoms checked by your GP. But remember, they can all be caused by other medical conditions. Most people with these symptoms don’t have leukaemia.

Symptoms of T cell ALL

A type of leukaemia called T cell ALL can cause swollen lymph nodes in the centre of your chest. It might make the thymus gland in your upper chest bigger. The swollen nodes or thymus gland may press on the windpipe, causing breathlessness and coughing.

They can also press on the veins carrying blood from the head. This causes pressure in the blood vessels and makes the face, neck and arms swell and go red. This is called superior vena cava obstruction (SVCO).

Go to the accident and emergency (A&E) department at your nearest hospital if you have any of these symptoms. It can be a medical emergency.

Are Swollen Glands a Symptom of Rheumatoid Arthritis?

What Causes Swollen Glands?

If you’ve ever experienced this symptom and you have rheumatoid arthritis, you may have wondered whether the two are related.

According to Scott Zashin, MD, an internist and rheumatologist in Dallas, there are several common causes of lymphadenopathy, and most are not directly related to rheumatoid arthritis. But some are in the same general category of rheumatic diseases as RA.

Dr. Zashin explains some of the possible root causes of swollen glands:

  • An infection Both viral and bacterial infections can cause lymph node swelling, including strep throat, the common cold, measles, mononucleosis, an ear infection, a tooth infection, HIV, or a skin infection. If the trigger is a bacterial infection, you may need an antibiotic. If it’s a viral infection, you may just have to wait it out.
  • Sjögrens syndrome Some people who have inflammatory arthritis also develop Sjögrens syndrome. Common symptoms of this autoimmune disease include dry eyes, mouth, and skin, as well as swelling of the parotid glands, which are located in front of and below the ears. A small number of people with Sjögrens may have enlarged lymph nodes.
  • Still’s disease This form of inflammatory arthritis is rare in adults, but people with Still’s disease may develop lymphadenopathy. “In 30 years, I might have had one or two patients with this,” says Zashin. People with Still’s disease who have swollen lymph nodes may also have a fever, rash, and an enlarged liver and spleen.
  • Cancer Many kinds of cancer can cause swollen lymph nodes. People who have rheumatoid arthritis, as well as those who have Sjögrens syndrome, are at higher risk for developing lymphoma, a cancer of the lymphatic system, compared to those who don’t have these conditions. “Lymphoma is not common with rheumatoid arthritis, but it does correlate with disease activity. So the higher the disease activity, the higher the risk of lymphoma,” says Zashin. Early studies have hinted that some drugs used to treat RA, known as biologics, might increase lymphoma risk. While that can’t be excluded as a possibility — and the topic is still under debate — more recent research suggests that biologics do not increase lymphoma risk. Beyond swollen nodes, other common symptoms of lymphoma include weight loss, rash, fever, and unusual fatigue or bleeding.
  • Very active, uncontrolled rheumatoid arthritis, especially if the condition has lasted for many years “It’s rare, but you can sometimes see lymph node enlargement related to rheumatoid arthritis activity,” Zashin says. “This is usually more of a diagnosis of exclusion.” In other words, your doctor will probably want to rule out other possible causes of swollen glands first, such as infection or cancer, before blaming your rheumatoid arthritis. “I would refer a patient to an oncologist unless I saw an obvious reason for it, like if the patient has mono or another infection,” he says.

Treatment of swollen lymph nodes varies widely, depending on the cause. If you alert your doctor about your symptoms right away, you can work together to figure out next steps. You might be prescribed antibiotics, advised to watch your condition and wait to see if it gets worse, or be called into the office for a biopsy. Whether the cause is serious or not, your doctor can help steer you in the right direction and get you feeling your best again.

Swollen lymph glands

I am also happy to tell you all that the surgeon could not find the node it shrunk from 3.8cm to to small to safely do a punch biopsy. The vacation did it’s job beautifully. The oncologist does not even want me for a follow up.

Hey this thing works.

Bill, MarshallProtocol.com

I was also concerned about the growth of my lymph nodes, as were my oncologist and pulmonologist, from December 2003-February 2004. They felt sure that I had lymphoma from the PET scan and the increased size and number found from numerous CT scans. The mediastinoscopy in February revealed the sarcoidosis. I had already begun Benicar; and after the surgery, I started the minocycline. The rest is history: The Marshall Protocol saved my life!

I had scans after surgery for three 3-month periods and then 6-month periods until last summer, which then became on a yearly basis. When I questioned several times about what “normal” would be, they said that it is usually anything 1 cm or less.

Carole, MarshallProtocol.com

Lumps were one of the big reasons I went to my doc for assistance. No-one seemed to be able to figure out what they were. After I met with my current doc he told me about the MP.

My lumps I think may be a mixture of enlarged lymph glands, lipomas, fat deposits.. .maybe granulomatous fibrosis or scarring. (?) Don’t really know without a biopsy. I guess I’ve come to an uneasy acceptance that it doesn’t matter….MP will hopefully address them all.

Well, during phase I and much of Modified Phase II, which I’m on now (approx 9 months total on MP) has seen an increase in lumps/lymph etc. Often these are very tender for a while, then eventually seem to become painless, though still enlarged or swollen. In the last month I have noticed that the chain of lumps/lymph on my right leg have truly begun to decrease. I didn’t quite believe it at first as it was a very slow process. But they have absolutely become smaller….either getting softer and then fading away or getting smaller and becoming very hard, like the tip of a pin for sewing with those little knobs on top. Then, they seem to get absorbed. This has been SO reassuring to me. Even as I see that I may have more swellng/enlargement throughout MP, as I still am experiencing now in other parts of my body, I can feel reassured that there is a good chance they will eventually dissolve/be reabsorbed/melt away…whatever. Helps much with my anxiety about the whole thing, too. 🙂

SherryH, MarshallProtocol.com

In February, Hospital for Special Surgery, Molly’s Fund Fighting for Lupus, and Alliance for Lupus Research hosted a Facebook chat on Lupus and General Health. Participants asked many questions, but our room full of experts could only answer as much as they could during the one-hour live event. We categorized the remaining questions, and will run a series on our experts answers over the next month. For our first installment, rheumatologist Dr. Kyriakos Kirou, answers questions on treatment and neurology.

The information provided is for informational and educational purposes, and doesn’t constitute medical or health advice for any individual problem. Please consult with your health care providers for any health problem and/or prior to starting any new medication or changing or discontinuing any medication you have been prescribed. This chat is not intended to create a doctor-patient relationship, or any other duty, between you and any member of the HSS interdisciplinary team, Molly’s Fund Fighting Lupus, or Alliance for Lupus Research.

Treatment

Q1. What is the best treatment for severe Lymphedema?

Lymphedema is best treated by vascular surgeons and it includes compression stockings, lymphedema reduction devices, etc.

Q2. Are swollen lymph nodes with high lymphocytes and low neutrophils normal with lupus? I have lupus and they keep testing for cancer.

Swollen lymph nodes are not unusual in lupus, especially when the disease flares. However, when the swelling is localized and gets worse, most doctors would like to get a lymph node biopsy to rule out lymphoma. Low neutrophils also occur commonly in lupus. They may also be due to medications used for lupus such as cyclophosphamide, azathioprine, mycophenolate, or methotrexate. Rarely can they be due to blood cancer. High lymphocytes are less typical of lupus. The most common finding is low lymphocyte numbers.

Q3. I always seem to have unusual symptoms and diseases. For example, spinal deterioration needing major surgery, trouble with my pancreas, many skin cancers, etc. I have lupus for 40 years, fibromyalgia, Raynaud’s, Sjogren’s, and neuropathy. Is it usual for lupus patients to have so many unusual problems? Right now I’m attached to a wound vac for hernia surgery that wound up needing stomach restructuring!

Lupus and its treatment may cause problems from different body organs over time. For example, steroids (prednisone) can cause slow wound healing. Fibromyalgia, Sjogren’s syndrome, and Raynaud phenomenon are commonly associated with lupus and neuropathy may also occur. Spine disease is less likely to be related directly to lupus, but it could be related to osteoporosis form steroid use.

Q4. Through a recent CT scan, plaque buildup was found on my aorta & joint replacements (hip/knees). I have also been told that I have peripheral artery disease. Is this from SLE?

Patients with SLE often develop early atherosclerosis (earlier than other people without lupus), which is plaque buildup in the aorta and other blood vessels. Also, steroids such as prednisone can make this worse. Patients with SLE will often need tight control of their cholesterol and inflammation to delay this plaque from forming in blood vessels.

Q5. I have fibromyalgia, CFS (Chronic Fatigue Syndrome), Sjogren’s, and my ANA test came back positive for lupus. However, my rheumatologist does not think I have it. I have all the signs, symptoms, and I’ll get the rash on my face. He has me taking Plaquenil and has even sent me to another hospital for other options and treatment. I’m to the point to see another doctor, but I?ve been seeing him since 2006. I’m confused; when I have all the signs, symptoms, and lab work are positive for lupus, but during other times of the year, the blood work comes back normal. Do I have it or not is my question. I am on other meds too, but my lupus issue is bothering me.

Sometimes patients have mild lupus or lupus that does not have all the typical symptoms of the disease. This is good because these patients are less likely to get very sick from their lupus. Plaquenil is a good medication for such patients. You can definitely seek a second opinion if you are concerned about the diagnosis or management.

Q6. What is the difference between SLE and lupus arthritis? Are these two different diseases, two diseases at the same time, or a single disease?

When it is not just in the skin, lupus is the same as SLE (systemic lupus erythematosus). Lupus can affect many body organs, including the joints. So when it does affect joint, it is called lupus arthritis. So it is basically the same thing and helps distinguish lupus arthritis from other causes of arthritis such as rheumatoid arthritis, osteoarthritis, etc.

Q7. What age is best to test young children?

There is no need to test children for lupus unless they have symptoms. Children have about 5% chance of getting lupus if one of their parents has lupus or another similar disease.

Q8. I have recently been diagnosed and the only symptoms I have are joint pain and fatigue. I have been fighting colds after colds this season. My question would be what is typically next? What do I have to look forward to?

We often prescribe to people in your situation hydroxychloroquine, or Plaquenil, which can help the fatigue, joint pain, and might protect from infections. You should also check of the levels of your serum immunoglobulins. Sometimes, patients with autoimmune diseases such as lupus have low levels of immunoglobulin and that increases risk for infections.

Q9. Can lupus cause chronic pancreatitis? What can lupus do to the GI tract? Is it harder for people who have systemic lupus to fight off MRSA? I never get the flu, colds, etc. and I thought people with lupus often get sick. I did get pneumonia on Christmas Eve.

Lupus may rarely cause pancreatitis. In addition, drugs for lupus such as azathioprine and prednisone may also cause pancreatitis. Lupus may also cause enteritis, which is a severe inflammation of the bowel. Lupus makes it easier for someone to get an infection, especially when flaring. Immunosuppressive drugs used for lupus also make it easier to get an infection. Lupus patients should get vaccinated against the flu, pneumonia, and other dead (not live) vaccines to protect themselves from infection.

Neurology:

Q1. Is the prognosis for CNS lupus any different from other organs that lupus impacts?

CNS lupus may be more severe as the brain/spinal cord is a delicate and important organ. So CNS lupus, when it happens, requires early and aggressive treatment to prevent damage to the brain or spinal cord.

Q2. What kind of things can we do, take, or change in our diet that might help with the brain fog? I used to not have problems with this, but in the last year, it has been really bad for me.

If lupus is active, brain fog may increase so treating disease flares helps. However, brain fog may occur without active lupus. Unfortunately, diet does not have a major impact on this. Nevertheless, patients should eat healthy, exercise, learn to cope with this (by keeping notes, etc.), and keep a positive attitude towards the problem. If the symptoms are more severe, a consultation with a neurologist should be helpful.

Dr. Kyriakos Kirou is a rheumatologist at Hospital for Special Surgery and is Clinical Co-Director at the Mary Kirkland Center for Lupus Care at Hospital for Special Surgery. He has a special interest in the research and treatment of systemic autoimmune rheumatic diseases, such as systemic lupus erythematosus.

Swollen Lymph Nodes: Diagnosis and Tests

How are swollen lymph nodes diagnosed?

Swollen lymph nodes aren’t a disease, they’re a symptom. Usually, diagnosing them means pinpointing what’s causing the swelling.

Besides a regular physical exam and medical history, your doctor will evaluate your swollen lymph nodes for:

  • Size.
  • Pain or tenderness when touched.
  • Consistency (hard or rubbery).
  • Matting (whether they feel joined or move together).
  • Location (specific diseases can be tied to where the swollen lymph nodes are in your body).

Your doctor will make sure your swollen lymph nodes aren’t caused by any of your medications. Some drugs, like the anti-seizure medication phenytoin (Dilantin®) can cause swollen lymph nodes.

Doctors only worry about swollen lymph nodes when they enlarge for no apparent reason. So if you have a large, swollen area but you’re not feeling sick and you didn’t recently have a cold, flu, upper respiratory infection or skin infection, you’ll need further tests, like blood work, imaging scans or a biopsy.

In rare situations, swollen lymph nodes can even point to cancer ― specifically, lymphoma (cancer of the lymphatic system). Other less common causes of swollen lymph nodes include injury, AIDS and cancer that’s spread from the lymph nodes to another part of your body.

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