Zehra Özsoy, Buğu Bulat, Güllü Sandal Uzun, Mustafa Ekici, Şerife Asya Germe, Levent Kılıç, Ali İhsan Ertemli, Ali Akdoğan
Journal of Health Sciences and Medicine - 2025;8(6):953-958
Aims: Systemic lupus erythematosus (SLE) is a chronic autoimmune connective tissue disease that can affect multiple organs and systems. Arthralgia and myalgia are common symptoms in patients with SLE, and their etiology may be inflammatory or may result from joint hypermobility or fibromyalgia. This study aimed to investigate whether musculoskeletal complaints in SLE patients are attributable solely to inflammatory activity or whether they may also be associated with hypermobility or fibromyalgia. Methods: Patients who fulfilled the 2012 SLE classification criteria were included. Patients who had undergone surgical procedures affecting joint mobility within the last 6 months, or those with concomitant diseases such as rheumatoid arthritis or inflammatory myositis that may present with inflammatory arthritis, were excluded from the study. Disease activity at the time of examination was assessed using the SLE Disease Activity Index-2000 (SLEDAI-2K). Hypermobility was evaluated using the Beighton Hypermobility Score, and fibromyalgia was assessed according to the 2016 Fibromyalgia Diagnostic Criteria. Patients were divided into three groups: those with hypermobility, those with fibromyalgia, and those with neither condition. Demographic characteristics, comorbidities, medications, disease activity, and pain scores were analyzed. Results: Six patients with both fibromyalgia and hypermobility were excluded. A total of 120 patients were analyzed, of whom 104 (86.7%) were female. The median (min-max) disease duration was 12 (1-38) years. Hypermobility was detected in 25 patients (20.8%) and fibromyalgia in 28 patients (23.3%). Overall, 44.1% of the cohort had either hypermobility or fibromyalgia. No significant differences were found between groups in terms of comorbidities. Patients with fibromyalgia had higher median patient V AS and pain scores compared with the other two groups, while their SLEDAI-2K activity scores were lower. Arthritis, according to SLEDAI-2K, was more frequent in the group without hypermobility or fibromyalgia. A significant difference in pulse-steroid use was found between the hypermobility and fibromyalgia groups (p=0.01) and between the fibromyalgia and neither group (p=0.02). Conclusion: Severe musculoskeletal pain due to hypermobility may mimic arthralgia or arthritis and may be misinterpreted by clinicians as disease progression. This could lead to unnecessary immunosuppressive therapy (risk of overtreatment), which could lead to increased risk of infection and liver and kidney dysfunction. Therefore, hypermobility and fibromyalgia, which may coexist in the course of SLE, should be thoroughly evaluated. In our study, a significant frequency (almost half of the patients) of pain was due to non-inflammatory causes.
