Swollen ankles antinuclear antibodies
by Nathan Wei, MD, FACP, FACR
Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.
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Information, in part, from the Arthritis Foundation
The joint symptoms of lupus arthritis are variable.
Attacks may last several days or weeks and then go away, only to return at a later date. The distal joints are the ones most frequently involved. Multiple joints may be affected. Stiffness and pain in the morning, which improves as the day goes on, is characteristic of lupus arthritis. As the day progresses and fatigue develops, the joint symptoms may return.
Another characteristic of lupus arthritis is that it is usually symmetrical, which means that it affects similar joints on both sides of the body. Therefore, a single,painful and swollen joint in a person with lupus, is most likely due to a reason other than their lupus.
Lupus arthritis does not usually cause deformities or destruction of the joints. This lack of damage to the joints is observed both clinically and by x ray, even after months of joint symptoms.
The pattern of joint pain is the best clue to determine if the pain is caused by SLE or not. An examination of the synovial fluid within a swollen joint may establish the presence of low grade inflammatory reaction. These studies are primarily used to rule out other possible causes for the joint pain. When arthritis is the only symptom of lupus, diagnosis can be very difficult. Careful observation and re evaluation by a physician as other symptoms of SLE begin to occur, is essential in making a diagnosis of lupus.
Many people with rheumatoid arthritis may have positive ANA tests. This can be confusing. Therefore, a patient with swollen ankles and a positive ANA does not necessarily have lupus. Swelling in the ankles from arthritis can occur in sarcoidosis. This is another autoimmune condition where a positive ANA may occur.
Swelling in the legs of a patient with lupus may not be related to arthritis. If the patient has kidney involvement, fluid retention can occur, leading to swollen ankles. Also, in patients with cardiac (heart) involvement, congestive heart failure may also lead to swelling in the ankles.
Laboratory tests such as the anti-nuclear antibody (ANA) are helpful. At least 95 percent of persons with SLE will have a positive test for anti-nuclear antibody in their blood. However,
ANA is not specific for SLE.
Lupus arthritis is usually treated with non-steroidal, anti-inflammatory medications (e.g., aspirin, ibuprofen, naproxen). These medications are effective in the majority of cases and are usually well tolerated. These drugs can also cause fluid retention and swollen ankles.
Calcium channel blockers given for Raynaud's phenomenon can also lead to fluid retention and swelling in the ankles.
When anti-inflammatory drugs is not effective, antimalarial drugs such as hydroxychloroquine (Plaquenil) may be added. Corticosteroids (Prednisone) are used rarely and only when the joints remain swollen and painful despite other treatment.
Cytotoxic medications are generally not required for lupus arthritis alone. It is also important that a person learn joint protection techniques. Occupational and physical therapy may be helpful.
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