systemic lupus erythematosus

Lupus is a chronic inflammatory disease that occurs when your body’s immune system attacks your own tissues and organs. Inflammation caused by lupus can affect many different body systems — including your joints, skin, kidneys, blood cells, brain, heart and lungs.

Lupus can be difficult to diagnose because its signs and symptoms often mimic those of other ailments. The most distinctive sign of lupus — a facial rash that resembles the wings of a butterfly unfolding across both cheeks — occurs in many but not all cases of lupus.

Some people are born with a tendency toward developing lupus, which may be triggered by infections, certain drugs or even sunlight. While there’s no cure for lupus, treatments can help control symptoms.


This is another thing I have to deal with daily. Because I have diabetes I can’t take cortisone shots and some of the meds to control my Lupus. I find that bed rest helps a lot. I also have Raynaud’s phenomenon.  Doylene


English: Common signs and symptoms of systemic...
English: Common signs and symptoms of systemic lupus erythematosus. (See Wikipedia:Systemic lupus erythematosus#Signs and symptoms). Model: Mikael Häggström. To discuss image, please see Template talk:Human body diagrams References MedicineNet > Systemic Lupus (cont.) Last Editorial Review: 1/30/2009 (Photo credit: Wikipedia)

Lupus is a chronic inflammatory disease that occurs when your body’s immune system attacks your own tissues and organs. Inflammation caused by lupus can affect many different body systems — including your joints, skin, kidneys, blood cells, brain, heart and lungs.Lupus can be difficult to diagnose because its signs and symptoms often mimic those of other ailments. The most distinctive sign of lupus — a facial rash that resembles the wings of a butterfly unfolding across both cheeks — occurs in many but not all cases of lupus.

Some people are born with a tendency toward developing lupus, which may be triggered by infections, certain drugs or even sunlight. While there’s no cure for lupus, treatments can help control symptoms.


No two cases of lupus are exactly alike. Signs and symptoms may come on suddenly or develop slowly, may be mild or severe, and may be temporary or permanent. Most people with lupus have mild disease characterized by episodes — called flares — when signs and symptoms get worse for a while, then improve or even disappear completely for a time.

The signs and symptoms of lupus that you experience will depend on which body systems are affected by the disease. The most common signs and symptoms include:

  • Fatigue and fever
  • Joint pain, stiffness and swelling
  • Butterfly-shaped rash on the face that covers the cheeks and bridge of the nose
  • Skin lesions that appear or worsen with sun exposure
  • Fingers and toes that turn white or blue when exposed to cold or during stressful periods (Raynaud’s phenomenon)
  • Shortness of breath
  • Chest pain
  • Dry eyes
  • Headaches, confusion, memory loss

When to see a doctor See your doctor if you develop an unexplained rash, ongoing fever, persistent aching or fatigue.


Lupus occurs when your immune system attacks healthy tissue in your body. It’s likely that lupus results from a combination of your genetics and your environment. It appears that people with an inherited predisposition for lupus may develop the disease when they come into contact with something in the environment that can trigger lupus. The cause for lupus in most cases, however, is unknown. Some potential triggers include:

  • Sunlight. Exposure to the sun may bring on lupus skin lesions or trigger an internal response in susceptible people.
  • Medications. Lupus can be triggered by certain types of anti-seizure medications, blood pressure medications and antibiotics. People who have drug-induced lupus usually see their symptoms go away when they stop taking the medication.

Risk factors

Factors that may increase your risk of lupus include:

  • Your sex. Lupus is more common in women.
  • Age. Although lupus affects people of all ages, it’s most often diagnosed between the ages of 15 and 40.
  • Race. Lupus is more common in African Americans, Hispanics and Asians.


Inflammation caused by lupus can affect many areas of your body, including your:

  • Kidneys. Lupus can cause serious kidney damage, and kidney failure is one of the leading causes of death among people with lupus. Signs and symptoms of kidney problems may include generalized itching, chest pain, nausea, vomiting and leg swelling (edema).
  • Brain. If your brain is affected by lupus, you may experience headaches, dizziness, behavior changes, hallucinations, and even strokes or seizures. Many people with lupus experience memory problems and may have difficulty expressing their thoughts.
  • Blood and blood vessels. Lupus may lead to blood problems, including anemia and increased risk of bleeding or blood clotting. It can also cause inflammation of the blood vessels (vasculitis).
  • Lungs. Having lupus increases your chances of developing an inflammation of the chest cavity lining (pleurisy), which can make breathing painful.
  • Heart. Lupus can cause inflammation of your heart muscle, your arteries or heart membrane (pericarditis). The risk of cardiovascular disease and heart attacks increases greatly as well.

Other types of complications Having lupus also increase your risk of:

  • Infection. People with lupus are more vulnerable to infection because both the disease and its treatments weaken the immune system. Infections that most commonly affect people with lupus include urinary tract infections, respiratory infections, yeast infections, salmonella, herpes and shingles.
  • Cancer. Having lupus appears to increase your risk of cancer.
  • Bone tissue death (avascular necrosis). This occurs when the blood supply to a bone diminishes, often leading to tiny breaks in the bone and eventually to the bone’s collapse. The hip joint is most commonly affected.
  • Pregnancy complications. Women with lupus have an increased risk of miscarriage. Lupus increases the risk of high blood pressure during pregnancy (preeclampsia) and preterm birth. To reduce the risk of these complications, doctors recommend delaying pregnancy until your disease has been under control for at least 6 months.

Preparing for your appointment

You’re likely to start by seeing your family doctor or primary care provider, but he or she may refer you to specialist in the diagnosis and treatment of arthritis and other inflammatory joint conditions (rheumatologist). Because the symptoms of lupus can mimic so many other health problems, you may need patience while waiting for a diagnosis. Your doctor must rule out a number of other illnesses before diagnosing lupus.

What you can do Before your appointment, you may want to write a list of answers to the following questions:

  • When did your symptoms begin? Do they come and go?
  • Does anything seem to trigger your symptoms?
  • Have your parents or siblings had lupus or other autoimmune disorders?
  • What medications and supplements do you take regularly?

You may also want to write down questions to ask your doctor, such as:

  • What are the possible causes of my symptoms or condition?
  • What tests do you recommend?
  • If these tests don’t pinpoint the cause of my symptoms, what additional tests might I need?
  • Are there any treatments or lifestyle changes that might help my symptoms now?
  • Do I need to follow any restrictions while we’re seeking a diagnosis?
  • Should I see a specialist?

In addition to the questions that you’ve prepared to ask your doctor, don’t hesitate to ask questions during your appointment at any time that you don’t understand something.

What to expect from your doctor Your doctor is likely to ask you a number of questions. Being ready to answer them may leave time to go over any points you want to spend more time on. Your doctor may ask:

  • Does sun exposure cause you to develop skin rashes?
  • Do your fingers become pale, numb or uncomfortable in the cold?
  • Do your symptoms include any problems with memory or concentration?
  • How much do your symptoms limit your ability to function at school, work or in personal relationships?
  • Have you been diagnosed with any other medical conditions?
  • Are you pregnant or do you plan to become pregnant?

Tests and diagnosis

Diagnosing lupus is difficult because signs and symptoms vary considerably from person to person. Signs and symptoms of lupus may vary over time and overlap with those of many other disorders. No one test can diagnose lupus. The combination of blood and urine tests, signs and symptoms, and physical examination findings leads to the diagnosis.

Laboratory tests Blood and urine tests may include:

  • Complete blood count. This test measures the number of red blood cells, white blood cells and platelets as well as the amount of hemoglobin, a protein in red blood cells. Results may indicate you have anemia, which commonly occurs in lupus. A low white blood cell or platelet count may occur in lupus as well.
  • Erythrocyte sedimentation rate. This blood test determines the rate at which red blood cells settle to the bottom of a tube in an hour. A faster than normal rate may indicate a systemic disease, such as lupus. The sedimentation rate isn’t specific for any one disease. It may be elevated if you have lupus, another inflammatory condition, cancer or an infection.
  • Kidney and liver assessment. Blood tests can assess how well your kidneys and liver are functioning. Lupus can affect these organs.
  • Urinalysis. An examination of a sample of your urine may show an increased protein level or red blood cells in the urine, which may occur if lupus has affected your kidneys.
  • Antinuclear antibody (ANA) test. A positive test for the presence of these antibodies — produced by your immune system — indicates a stimulated immune system. While most people with lupus have a positive ANA test, most people with a positive ANA do not have lupus. If you test positive for ANA, your doctor may advise more-specific antibody testing.

Imaging tests If your doctor suspects that lupus is affecting your lungs or heart, he or she may suggest:

  • Chest X-ray. An image of your chest may reveal abnormal shadows that suggest fluid or inflammation in your lungs.
  • Echocardiogram. This test uses sound waves to produce real-time images of your beating heart. It can check for problems with your valves and other portions of your heart.

Biopsy Lupus can harm your kidneys in many different ways and treatments can vary, depending on the type of damage that occurs. In some cases, it’s necessary to test a small sample of kidney tissue to determine what the best treatment might be. The sample can be obtained with a needle, or through a small incision.

Treatments and drugs

Treatment for lupus depends on your signs and symptoms. Determining whether your signs and symptoms should be treated and what medications to use requires a careful discussion of the benefits and risks with your doctor. As your signs and symptoms flare and subside, you and your doctor may find that you’ll need to change medications or dosages. The medications most commonly used to control lupus include:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs). Over-the-counter NSAIDs, such as naproxen (Aleve) and ibuprofen (Advil, Motrin, others), may be used to treat pain, swelling and fever associated with lupus. Stronger NSAIDs are available by prescription. Side effects of NSAIDs include stomach bleeding, kidney problems and an increased risk of heart problems.
  • Antimalarial drugs. Medications commonly used to treat malaria, such as hydroxychloroquine (Plaquenil), also can help control lupus. Side effects can include stomach upset and, very rarely, damage to the retina of the eye.
  • Corticosteroids. Prednisone and other types of corticosteroids can counter the inflammation of lupus, but often produce long-term side effects — including weight gain, easy bruising, thinning bones (osteoporosis), high blood pressure, diabetes and increased risk of infection. The risk of side effects increases with higher doses and longer term therapy.
  • Immune suppressants. Drugs that suppress the immune system may be helpful in serious cases of lupus. Examples include cyclophosphamide (Cytoxan), azathioprine (Imuran, Azasan), mycophenolate (Cellcept), leflunomide (Arava) and methotrexate (Trexall). Potential side effects may include an increased risk of infection, liver damage, decreased fertility and an increased risk of cancer. A newer medication, belimumab (Benlysta) also reduces lupus symptoms in some people. Side effects include nausea, diarrhea and fever.

Lifestyle and home remedies

Take steps to care for your body if you have lupus. Simple measures can help you prevent lupus flares and, should they occur, better cope with the signs and symptoms you experience. Try to:

  • Get adequate rest. People with lupus often experience persistent fatigue that’s different from normal tiredness and that isn’t necessarily relieved by rest. For that reason, it can be hard to judge when you need to slow down. Get plenty of sleep a night and naps or breaks during the day as needed.
  • Be sun smart. Because ultraviolet light can trigger a flare, wear protective clothing, such as a hat, long-sleeved shirt and long pants, and use sunscreens with a sun protection factor (SPF) of at least 55 every time you go outside.
  • Get regular exercise. Exercise can help you recover from a flare, reduce your risk of heart attack, help fight depression and promote general well-being.
  • Don’t smoke. Smoking increases your risk of cardiovascular disease and can worsen the effects of lupus on your heart and blood vessels.
  • Eat a healthy diet. A healthy diet emphasizes fruits, vegetables and whole grains. Sometimes you may have dietary restrictions, especially if you have high blood pressure, kidney damage or gastrointestinal problems.

Alternative medicine

Sometimes alternative or complementary medicine may benefit people with lupus. However, these therapies are usually used with conventional medications. Discuss these treatments with your doctor before initiating them on your own. He or she can help you weigh the benefits and risks and tell you if the treatments will interfere with your current lupus medications.

Complementary and alternative treatments for lupus include:

  • Dehydroepiandrosterone (DHEA). Supplements containing this hormone have been shown to reduce the dose of steroids needed to stabilize symptoms in some people who have lupus.
  • Flaxseed. Flaxseed contains a fatty acid called alpha-linolenic acid, which may decrease inflammation in the body. Some studies have found that flaxseed may improve kidney function in people who have lupus that affects the kidneys. Side effects of flaxseed include bloating and abdominal pain.
  • Fish oil. Fish oil supplements contain omega-3 fatty acids that may be beneficial for people with lupus. Preliminary studies have found some promise, though more study is needed. Side effects of fish oil supplements can include nausea, belching and a fishy taste in the mouth.
  • Vitamin D. There is some evidence to suggest that people with lupus may benefit from supplemental vitamin D.

Coping and support

If you have lupus, you’re likely to have a range of painful feelings about your condition, from fear to extreme frustration. The challenges of living with lupus increase your risk of depression and related mental health problems, such as anxiety, stress and low self-esteem. To help you cope with lupus, try to:

  • Learn all you can about lupus. Write down all the questions you have about lupus and ask them at your next appointment. Ask your doctor or nurse for reputable sources of further information. The more you know about lupus, the more confident you’ll feel in your treatment choices.
  • Gather support among your friends and family. Talk about lupus with your friends and family and explain ways they can help out when you’re having flares. Lupus can be frustrating for your loved ones because they usually can’t see it and you may not appear sick. They can’t tell if you’re having a good day or a bad day unless you tell them. Be open about what you’re feeling so that your friends and family know what to expect.
  • Take time for yourself. Cope with stress in your life by taking time for yourself. Use that time to read, meditate, listen to music or write in a journal. Find activities that calm and renew you.
  • Connect with others who have lupus. Talk to other people who have lupus. You can connect with other people who have lupus through support groups in your community or through online message boards. Other people with lupus can offer unique support because they’re facing many of the same obstacles and frustrations that you’re facing.

Polymyalgia rheumatica

Polymyalgia rheumatica is an inflammatory disorder that causes muscle pain and stiffness. The pain and stiffness often occur in your shoulders, neck, upper arms and hips. Symptoms of polymyalgia rheumatica (pol-ee-my-AL-juh roo-MA-ti-kah) usually begin quickly, within two weeks.

Most people who develop polymyalgia rheumatica are older than 65. It rarely affects people younger than 50.

Polymyalgia rheumatica
By Mayo Clinic staff
Original Article:

Polymyalgia rheumatica is an inflammatory disorder that causes muscle pain and stiffness. The pain and stiffness often occur in your shoulders, neck, upper arms and hips. Symptoms of polymyalgia rheumatica (pol-ee-my-AL-juh roo-MA-ti-kah) usually begin quickly, within two weeks.

Most people who develop polymyalgia rheumatica are older than 65. It rarely affects people younger than 50.

Anti-inflammatory drugs called corticosteroids improve the symptoms of polymyalgia rheumatica, but these drugs require careful monitoring for serious side effects.

Polymyalgia rheumatica is related to another inflammatory disorder called giant cell arteritis, which can cause headaches, vision difficulties, jaw pain and other symptoms. It’s possible to have both of these conditions together.


The signs and symptoms of polymyalgia rheumatica usually occur on both sides of the body and may include:

Aches or pain in your shoulders (often the first symptom)
Aches or pain in your neck, upper arms, buttocks, hips or thighs
Stiffness in affected areas, particularly in the morning or after being inactive for a long time, such as a long car ride
Limited range of motion in affected areas
Pain or stiffness in wrists or knees (less common)
You may also have more general signs and symptoms, including:

Mild or low-grade fever
A general feeling of not being well (malaise)
Loss of appetite
Unintended weight loss
When to see a doctor
See your doctor if you experience aches, pains or stiffness that:

Is new
Disrupts your sleep
Limits your ability to do activities of daily living, such as getting dressed or going up and down stairs

The exact cause of polymyalgia rheumatica is unknown. However, there are two factors that appear to be involved in the development of this condition, including:

Genetics. Certain genes and variations in some genes may increase your susceptibility to developing polymyalgia rheumatica.
An environmental exposure. New cases of polymyalgia tend to come in cycles and may develop seasonally, which suggests that an environmental trigger, such as a virus, might play a role. But no specific virus has been shown to cause polymyalgia rheumatica.
Giant cell arteritis
Polymyalgia rheumatica and another disease known as giant cell arteritis share many similarities. Giant cell arteritis results in inflammation in the lining of arteries, most often the arteries located in the temples. Giant cell arteritis usually causes headaches, jaw pain, vision problems and scalp tenderness. It can lead to permanent vision loss.

Polymyalgia rheumatica and giant cell arteritis may actually be the same disease but with different manifestations. The overlap between the two diseases is significant:

As many as 30 percent of people with polymyalgia rheumatica may also have giant cell arteritis.
About half of the people with giant cell arteritis may also have polymyalgia rheumatica.
Risk factors

Risk factors for polymyalgia rheumatica include:

Age. Polymyalgia rheumatica affects older adults almost exclusively. The average age at onset of the disease is 70.
Sex. Women are about two times more likely to develop the disorder.
Ethnicity. People of Northern European origin are more likely to have polymyalgia rheumatica than are people of other ethnicities. People living in Middle Eastern and Asian countries have the lowest rates of the disease.

Symptoms of polymyalgia rheumatica can greatly affect a person’s ability to perform everyday activities. The pain and stiffness may contribute to difficulties with the following tasks:

Getting out of bed, standing up from a chair or getting out of a car
Bathing, combing your hair or performing other tasks related to personal hygiene
Getting dressed or putting on a coat
These complications can affect a person’s health, social interactions, physical activity, sleep and general well-being.

Preparing for your appointment

If you’re experiencing aches, pains or stiffness in joints or muscles, you’ll probably see your primary care doctor first. You may then be referred to a specialist in inflammatory disorders of muscles and the skeletal system (rheumatologist).

Because appointments can be brief, and there’s often a lot of ground to cover, it’s a good idea to arrive well prepared. Here’s some information to help you get ready for your appointment, and what to expect from your doctor.

What you can do

Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there’s anything you need to do in advance, such as restrict your diet.
Write down any symptoms you’re experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
Write down key personal information, including any major stresses or recent life changes. It’s also helpful to bring the name and contact information of any doctor you have seen recently or see regularly.
Make a list of all medications, vitamins or supplements that you’re taking, along with the dosage for each.
Ask a family member or friend to come with you, if possible. In addition to offering support, this person can write down information from your doctor or other clinic staff during the appointment.
Write down questions to ask your doctor.
Your time with your doctor is limited, so preparing a list of questions can help you make the most of your time together. For polymyalgia rheumatica, some basic questions to ask your doctor include:

What’s the most likely cause of my symptoms?
Are there other possible causes for my symptoms?
What kinds of tests do I need? Do these tests require any special preparation?
Is this condition temporary or long-lasting?
What treatments are available, and which do you recommend?
What types of side effects can I expect from treatment?
Are there any alternatives to the primary approach that you’re suggesting?
I have other health conditions. How can I best manage these conditions together?
Are there any restrictions that I need to follow?
Is there a generic alternative to the medicine you’re prescribing me?
Are there any brochures or other printed material that I can take home with me? What websites do you recommend visiting?
In addition to the questions that you’ve prepared to ask your doctor, don’t hesitate to ask additional questions during your appointment.

What to expect from your doctor
Your doctor will likely ask you a number of questions. Be prepared to answer the following:

Where is the pain or stiffness located?
When did the symptoms begin?
How would you rate your current level of pain on a scale of 1 to 10?
Are symptoms worse at certain times of day or night?
How long does stiffness last after you wake in the morning or after a long period of inactivity?
Does the pain or stiffness limit your activities? Are you avoiding any activities because of the symptoms?
Have you experienced similar episodes of pain or stiffness in the past? Was the condition diagnosed and treated?
Have you experienced any new or severe headaches?
Have you noticed any changes in your vision?
Have you experienced any jaw pain?
Tests and diagnosis

Your answers to questions, a general physical exam and the results of tests can help your doctor determine the cause of pain and stiffness.

Your doctor will conduct an exam to get an idea of your overall health, identify possible causes or rule out certain diseases. He or she may gently move your head and limbs to judge how much your symptoms affect your range of motion.

Blood tests
A nurse or assistant will draw a sample of your blood. This sample will be used for several laboratory tests that your doctor will order. Typically, your doctor will check the complete blood counts (CBC) and for signs of inflammation, but your doctor also may recommend additional tests to rule out other conditions that have similar symptoms to polymyalgia rheumatica.

Test results helpful in making a diagnosis of polymyalgia rheumatica include the following:

Sed rate (erythrocyte sedimentation rate), measures the distance red blood cells, or erythrocytes (uh-RITH-roh-sites), fall in a test tube in one hour. The distance indirectly measures the level of inflammation — the farther the red blood cells have descended, the greater the inflammatory response of your immune system. An increased rate occurs because of certain changes to red blood cell properties in response to inflammation.
C-reactive protein test measures the concentration of C-reactive proteins in your blood. A high concentration of C-reactive protein indicates increased inflammation.
Imaging tests
Your doctor may use magnetic resonance imaging (MRI) or ultrasound imaging to find inflammation of tissues within the shoulder and hip joints that can support a diagnosis of polymyalgia rheumatica. These images may also help identify or rule out other causes of your symptoms. Ultrasound imaging uses sound waves to produce images, while MRI relies on radio waves and a magnetic field to create images. Neither procedure exposes you to radiation.

Monitoring for giant cell arteritis
Your doctor will monitor you for signs or symptoms that may indicate the onset of giant cell arteritis. Talk to your doctor immediately if you experience any of the following symptoms:

New, unusual or persistent headaches
Jaw pain or tenderness
Blurred or double vision or visual loss
Scalp tenderness
If your doctor suspects a diagnosis of giant cell arteritis, he or she will order a biopsy of the artery in one of your temples. This procedure, performed during local anesthesia, removes a tiny sample of the artery, which is then examined in a laboratory for signs of inflammation.

Treatments and drugs

Treatment can take a year or more, but most people with polymyalgia rheumatica will be better after the first course of treatment. And you’ll start to feel better within days. Some people, however, will have a relapse and need additional treatment.

Polymyalgia rheumatica is usually treated with a low dose of an oral corticosteroid, such as prednisone. A daily dose at the beginning of the treatment is usually 10 to 20 milligrams a day.

Relief from pain and stiffness should occur within the first two or three days. If you’re not feeling better in a few days, it’s likely you don’t have polymyalgia rheumatica. In fact, your response to medication is one way your doctor can confirm the diagnosis.

After the first two to three weeks of treatment, your doctor may gradually decrease your dosage depending on your symptoms and the results of sed rate and C-reactive protein tests. The goal is to keep you on as low a dose as possible without triggering a relapse in your symptoms. Most people with polymyalgia rheumatica need to continue the corticosteroid treatment for one to two years. You’ll need frequent follow-up visits to monitor how the treatment is working and whether or not you’re having any side effects.

People who taper off the medication too quickly are more likely to have a relapse. Twenty percent or more of people with polymyalgia rheumatica will have a least one relapse when tapering off the corticosteroids. About 10 percent of people who successfully finish corticosteroid treatment will have a relapse within 10 years of the initial treatment.

Monitoring side effects
Long-term use of corticosteroids can result in a number of serious side effects. Your doctor will monitor you closely for potential problems. He or she may adjust your dosage and prescribe treatments to manage these reactions to corticosteroid treatment. Side effects include:

Weight gain. This is a common side effect of corticosteroid therapy.
Osteoporosis, the loss of bone density and weakening of bones, which increases the risk of bone fractures.
High blood pressure (hypertension), which increases the risk of cardiovascular disease.
High cholesterol, which also increases the risk of cardiovascular disease.
Diabetes, chronic high levels of blood sugar that can cause tissue damage in a number of body systems.
Cataracts, a clouding of the lenses of your eyes that can cloud or dim your vision .
Calcium and vitamin D supplements
Your doctor will likely prescribe daily doses of calcium and vitamin D supplements to help prevent osteoporosis induced by corticosteroid treatment. The American Academy of Rheumatology recommends the following daily doses for anyone taking corticosteroids for more than three months:

1,000 to 1,200 milligrams (mg) of calcium supplements
400 to 1,000 international units (IU) of vitamin D supplements
Other medications
Several other medications are being studied for use in polymyalgia rheumatica, including:

Methotrexate (Trexall). This immune-suppressing medication may help lower the dose of corticosteroid that’s needed, which can help preserve bone mass. It’s often given long term, for a year or more.
Anti-TNF drugs. TNF stands for tumor necrosis factor, which is a substance that causes inflammation. These drugs block that substance and reduce inflammation. Research results have been mixed on using these medications in polymyalgia rheumatica, but they might be helpful for people who can’t take corticosteroids, such as people with diabetes or osteoporosis.
Physical therapy
Your doctor may recommend physical therapy to help you regain strength, coordination and your ability to perform everyday tasks after a long period of limited activity that polymyalgia rheumatica often causes.

Lifestyle and home remedies

Healthy lifestyle choices can help you manage the side effects that may result from corticosteroid treatment:

Eat a healthy diet. Eat a diet of fruits, vegetables, whole grains, and low-fat meat and dairy products. Limit the salt (sodium) in your diet to prevent fluid buildup and high blood pressure.
Exercise regularly. Talk to your doctor about exercise that is appropriate for you to maintain a healthy weight and to strengthen bones and muscles.
Use assistive devices. Use luggage and grocery carts, reaching aids, shower grab bars and other assistive devices to help make daily tasks easier. Wear low-heeled shoes to minimize the risk of falls. Talk to your doctor about whether the use of a cane or other walking aid is appropriate for you to prevent falls or other injury.
Coping and support

Even though you’ll start to feel better soon after you begin treatment, it can be frustrating having to take medication daily, especially one that can cause such serious side effects. Ask your health care team what steps you can take to stay healthier while you’re taking corticosteroids. Your doctor may also know if there are any local support groups in your area. Talking to others who are living with the same illness and challenges can be helpful and encouraging.

Reflex Sympathetic Dystrophy

Maintain normal daily activities as best you can.
Pace yourself and be sure to get the rest that you need.
Stay connected with friends and family.
Continue to pursue hobbies that you enjoy and are able to do.



The pictures above shows how different I look when I have good days and when I have bad days.

I have been sick a month with a bladder infection. I have taken three antibiotics and they all have made me sick. I didn’t need that on top of everything else. I’m getting appointments with specialist tomorrow. In the last two pictures you can tell I have lost some of the use of my right side. My shoulder is down. My face is lower on one side . I pray that all of you are coping better than I am. I keep praying to the Lord to help me to stop complaining. I know my husband is getting tired of it. I can’t sleep at night. I go to sleep about 2 AM and wake three hours later. When I go on trips with my sisters they make sure I get a room close to the kitchen and living room. The last trip we made a few months ago was to Ireland . I was lucky enough to get a downstairs bedroom by the kitchen and living room. It was a five star resort with a five star restaurant and all. I didn’t have the strength to do all that my sisters did. I missed half of everything. I’m still glad I could go. I hope all of you are having some good days. Doylene reprints

Original Article:

Complex regional pain syndrome is an uncommon form of chronic pain that usually affects an arm or leg. Complex regional pain syndrome typically develops after an injury, surgery, stroke or heart attack, but the pain is out of proportion to the severity of the initial injury, if any.

The cause of complex regional pain syndrome isn’t clearly understood. Treatment for complex regional pain syndrome is most effective when started early. In such cases, improvement and even remission are possible.

Signs and symptoms of complex regional pain syndrome include:

Continuous burning or throbbing pain, usually in your arm, leg, hand or foot
Sensitivity to touch or cold
Swelling of the painful area
Changes in skin temperature — at times your skin may be sweaty; at other times it may be cold
Changes in skin color, which can range from white and mottled to red or blue
Changes in skin texture, which may become tender, thin or shiny in the affected area
Changes in hair and nail growth
Joint stiffness, swelling and damage
Muscle spasms, weakness and loss (atrophy)
Decreased ability to move the affected body part

Symptoms may change over time and vary from person to person. Most commonly, pain, swelling, redness, noticeable changes in temperature and hypersensitivity (particularly to cold and touch) occur first. Over time, the affected limb can become cold and pale and undergo skin and nail changes as well as muscle spasms and tightening. Once these changes occur, the condition is often irreversible.

Complex regional pain syndrome occasionally may spread from its source to elsewhere in your body, such as the opposite limb. The pain may be worsened by emotional stress.

In some people, signs and symptoms of complex regional pain syndrome go away on their own. In others, signs and symptoms may persist for months to years. Treatment is likely to be most effective when started early in the course of the illness.

When to see a doctor
If you experience constant, severe pain that affects a limb and makes touching or moving that limb seem intolerable, see your doctor to determine the cause. It’s important to treat complex regional pain syndrome early.

Complex regional pain syndrome occurs in two types, with similar signs and symptoms, but different causes:

Type 1. Previously known as reflex sympathetic dystrophy syndrome, this type occurs after an illness or injury that didn’t directly damage the nerves in your affected limb. About 90 percent of people with complex regional pain syndrome have type 1.
Type 2. Once referred to as causalgia, this type follows a distinct nerve injury.

Many cases of complex regional pain syndrome occur after a forceful trauma to an arm or a leg, such as a crush injury, fracture or amputation. Other major and minor traumas — such as surgery, heart attacks, infections and even sprained ankles — also can lead to complex regional pain syndrome. Emotional stress may be a precipitating factor, as well.

It’s not well understood why these injuries can trigger complex regional pain syndrome, but it may be due to a dysfunctional interaction between your central and peripheral nervous systems and inappropriate inflammatory responses.

If complex regional pain syndrome isn’t diagnosed and treated early, the disease may progress to more disabling signs and symptoms. These may include:

Tissue wasting (atrophy). If you avoid moving an arm or a leg because of pain or if you have trouble moving a limb because of stiffness, your skin, bones and muscles may begin to deteriorate.
Muscle tightening (contracture). You may also experience tightening of your muscles. This may lead to a condition in which your hand and fingers or your foot and toes contract into a fixed position.

Preparing for your appointment

To get the best medical care, take time to prepare for your appointment.

What you can do
Write down any symptoms you’re experiencing — including the severity and location of your pain, stiffness or sensitivity. It’s also a good idea to write down any questions you have for your doctor.

Examples of questions you might ask your doctor include:

What’s the likely cause of the symptoms I’m experiencing?
What kinds of tests, if any, do I need?
Is my condition likely temporary or chronic?
What types of treatments are available? Which do you recommend?
What are the alternatives to the primary approach that you’re suggesting?
I have these other health conditions. How can I best manage them together?
Is there a generic alternative to the medicine you’re prescribing for me?
Are there any brochures or other printed material that I can take home? What websites do you recommend?

In addition to the questions that you’ve prepared to ask your doctor, don’t hesitate to ask questions during your appointment.

What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. For complex regional pain syndrome, your doctor may ask:

Have you had a recent accident, illness or injury, such as trauma to your limbs, a heart attack or an infection?
Have you had surgery recently?
When did you first begin experiencing pain or burning?
How long have you been experiencing your symptoms?
Is the pain occasional or continuous?
Does anything seem to improve or worsen your symptoms?
Have you experienced similar symptoms after past injuries?

Tests and diagnosis

Diagnosis of complex regional pain syndrome is based on a physical exam and your medical history. There’s no single test that can definitively diagnose complex regional pain syndrome, but the following procedures may provide important clues:

Bone scan. This procedure may help detect bone changes. A radioactive substance injected into one of your veins permits viewing of your bones with a special camera.
Sympathetic nervous system tests. These tests look for disturbances in your sympathetic nervous system. For example, thermography measures the skin temperature and blood flow of your affected and unaffected limbs. Other tests can measure the amount of sweat on both limbs. Dissimilar results can indicate complex regional pain syndrome.
X-rays. Loss of minerals from your bones may show up on an X-ray in later stages of the disease.
Magnetic resonance imaging (MRI). Images captured by an MRI device may show a number of tissue changes.

Treatments and drugs

Improvement and even remission of complex regional pain syndrome is possible if treatment begins within a few months of your first symptoms. Often, a combination of various therapies is necessary. Your doctor will tailor your treatment based on your specific case. Treatment options include:

Doctors use various medications to treat the symptoms of complex regional pain syndrome.

Pain relievers. Over-the-counter (OTC) pain relievers, such as aspirin, ibuprofen (Advil, Motrin, others) and naproxen (Aleve), may ease pain and inflammation. Your doctor may prescribe stronger pain relievers if OTC ones aren’t helpful. Opioid medications may be an option. Taken in appropriate doses, they may provide acceptable control of pain. Some pain medications, such as celecoxib (Celebrex), may increase your risk of heart attack and stroke. Be sure to discuss your individual risks with your doctor.
Antidepressants and anticonvulsants. Sometimes antidepressants, such as amitriptyline, and anticonvulsants, such as gabapentin (Neurontin), are used to treat pain that originates from a damaged nerve (neuropathic pain).
Corticosteroids. Steroid medications, such as prednisone, may reduce inflammation and improve mobility in the affected limb.
Bone-loss medications. Your doctor may suggest medications to prevent or stall bone loss, such as alendronate (Fosamax) and calcitonin (Miacalcin).
Sympathetic nerve-blocking medication. Injection of an anesthetic to block pain fibers in your affected nerves may relieve pain in some people.


Applying heat and cold. Applying cold may relieve swelling and sweating. If the affected area is cool, applying heat may offer relief.
Topical analgesics. Various creams are available that may reduce hypersensitivity, such as lidocaine or a combination of ketamine, clonidine and amitriptyline.
Physical therapy. Gentle, guided exercising of the affected limbs may help decrease pain and improve range of motion and strength. The earlier the disease is diagnosed, the more effective exercises may be.
Transcutaneous electrical nerve stimulation (TENS). Chronic pain is sometimes eased by applying electrical impulses to nerve endings.
Biofeedback. In some cases, learning biofeedback techniques may help. In biofeedback, you learn to become more aware of your body so that you can relax your body and relieve pain.
Spinal cord stimulation. Your doctor inserts tiny electrodes along your spinal cord. A small electrical current delivered to the spinal cord results in pain relief.

Recurrences of complex regional pain syndrome do occur, sometimes due to a trigger such as exposure to cold or an intense emotional stressor. Recurrences may be treated with small doses of antidepressant or other medication.
Coping and support

Living with a chronic, painful condition can be challenging, especially when — as is often the case with complex regional pain syndrome — your friends and family don’t believe you could be feeling as much pain as you describe. Share information from reliable sources about complex regional pain syndrome with those close to you to help them understand what you’re experiencing.

Take care of your physical and mental health by following these suggestions:

Maintain normal daily activities as best you can.
Pace yourself and be sure to get the rest that you need.
Stay connected with friends and family.
Continue to pursue hobbies that you enjoy and are able to do.

If complex regional pain syndrome makes it difficult for you to do things you enjoy, ask your doctor about ways to get around the obstacles.

Keep in mind that your physical health can directly affect your mental health. Denial, anger and frustration are common with chronic illnesses. At times, you may need more tools to deal with your emotions. A therapist, behavioral psychologist or other professional may be able to help you put things in perspective. They also may be able to teach you coping skills, such as relaxation or meditation techniques.

Sometimes joining a support group, where you can share experiences and feelings with other people, is a good approach. Ask your doctor what support groups are available in your community.

The following measures may help you reduce the risk of developing complex regional pain syndrome:

Taking vitamin C after a wrist fracture. Studies have shown that people who take daily vitamin C supplements after a wrist fracture have a lower risk of complex regional pain syndrome compared with those who don’t take vitamin C.
Early mobilization after a stroke. Some research suggests that people who get out of bed and walk around soon after a stroke (early mobilization) lower their risk of complex regional pain syndrome.

DS00265 March 31, 2011