Musculoskeletal features in systemic lupus erythematosus and their relationship with disability

The causes of disability in systemic lupus erythematosus (SLE) are multifactorial. We examined the frequency of musculoskeletal symptoms in patients with SLE and their role in disability. Forty-six consecutive patients with SLE completed the Stanford Health Assessment Questionnaire (HAQ), completed an additional survey of work disabilities and musculoskeletal symptoms, and underwent a complete musculoskeletal examination. Arthralgias (95%), arthritis (85%), myalgias (88%), weakness (79%), and morning stiffness (88%) were reported in our patients. Typical Jaccoud's deformities occurred in 4 (9%) patients. Fixed flexion contracture of the hands and elbows were found in 4 (9%) and 2 (4%) patients, respectively. Four (9%) patients had avascular necrosis. Two patients (4%) developed fractures resulting from osteoporosis. Twenty four (52%) patients stated they were unable to work because of SLE. Twenty of 24 patients had applied for disability benefits, but only 12 had received benefits. Neuropsychiatric symptoms, musculoskeletal symptoms, and fatigue were often listed by patients as factors in their disability. However, despite the high frequency of symptoms in work disabled SLE patients, objective measurements of musculoskeletal dysfunction could not predict work disability. The degree of organ damage evaluated by the SLICC score was significantly higher in patients who felt they were disabled than in nondisabled patients (p = 0.005). Lower education level was also a significant factor related to disability in this group of SLE patients (r < 0.04).