Other inflammatory conditions

Some other conditions, unrelated to spondyloarthritis, can cause inflammation associated with mild arthritis. The inflammation is more widespread and, as well as the joints, it affects tissues elsewhere in the body. The Arthritis Research Campaign (see Useful addresses) publishes free information leaflets on all these conditions.

Systemic lupus erythematosus

Systemic lupus erythematosus (SLE or lupus) is a member of a group of conditions called ‘connective tissue diseases’ (connective tissue supports and connects other body parts). SLE is similar to rheumatoid arthritis in that it is an autoimmune disease but it is much rarer and the arthritis is usually much less severe. Around 90 per cent of those affected are young women between the ages of 20 and 40, and women of African–Caribbean origin are particularly susceptible.

Most people with SLE have mild disease which comes and goes, affecting only their joints and skin and causing mild anaemia. A few develop severe inflammation of the internal organs, such as the kidneys, lungs and nervous system, and some women suffer repeated miscarriages of pregnancy. SLE responds very well to steroids but, in cases of severe disease, other drugs that suppress the immune system may also be needed.

Symptoms of SLE

• Painful, swollen joints, particularly in the hands

• Feeling generally unwell and feverish

• Rash on the face, particularly in response to sunlight

• Thinning of the hair.

Polymyositis

Polymyositis is also a connective tissue disorder, rarer than SLE. It mainly affects the muscles which become inflamed and very weak. In the related condition of dermatomyositis, the skin is also affected. Both conditions respond to steroids which may need to be used in large doses for a time.

Polymyalgia rheumatica

Polymyalgia rheumatica (PMR) is quite a common condition. It affects older people and is very rare in anyone younger than 50. It is not related to the connective tissue diseases.

‘Polymyalgia’ literally means ‘pain in many muscles’ but the condition appears to result from inflammation in the joints of the shoulder girdle and pelvic girdle, rather than in the muscles.

Symptoms of PMR

• Severe pain and stiffness around the shoulders and hips, which is noticeably much worse in the mornings

• Difficulty turning over in bed at night without help

• Feeling generally unwell and tired, sometimes feverish

• Loss of weight

• Depression.

Diagnosis of PMR

Your doctor will often be able to diagnose the condition from the symptoms that you describe and the results of a blood test to measure the erythrocyte sedimentation rate (ESR). The ESR is usually very high in polymyalgia, indicating the presence of inflammation.

Treatment of PMR

Steroids taken by mouth or by injection have a dramatic effect and within 24 hours you should feel almost back to normal. The steroids should not be stopped too quickly as you may need to stay on treatment for many months (occasionally, for several years) to allow the polymyalgia to settle down.

KEY POINT

• Some rare conditions cause inflammation in many areas of the body, including the joints; these are best treated with steroids, which are powerful anti-inflammatory drugs