Lupus and rheumatoid arthritis are two rare autoimmune diseases. These diseases have distinctive causes, but there is a great deal of overlap in both their symptoms and the way they affect a person’s health.
Some people with one of these diseases notice that they have symptoms more consistent with other autoimmune illnesses.
Is it possible to have lupus and rheumatoid arthritis at the same time? The answer is complicated.
Increased Rates of Autoimmune Illness
Autoimmune diseases are becoming more common in the developed world. Although there is a diverse range of autoimmune illness, all of them share a few commonalities.
Our immune system’s basic function is to attack invaders, such as bacteria and virus.
In autoimmune disease, the immune system instead begins to attack the body’s own tissues.
According to WebMD, this class of diseases includes a diverse range of disorders including lupus, rheumatoid arthritis, type 1 diabetes, and multiple sclerosis.
Some autoimmune diseases affect only one organ. Lupus and rheumatoid arthritis, however, can affect the entire body.
Autoimmune diseases are not contagious. This means that people who have these illnesses cannot spread them to others. You cannot catch these diseases from loved ones who have them.
What Is Lupus?
According to the National Resource Center on Lupus, lupus, also known as systemic lupus erythematosus, is a chronic autoimmune disease that can affect the skin, joints, and organs of the body. This can cause inflammation, pain, and permanent damage.
Lupus was first recognized in the 1950’s. At the time, it was believed to be a skin disorder due to a distinctive “butterfly rash” that people with lupus often get on their faces.
Doctors later realized that lupus can affect many other tissues and organs, including the liver, kidneys, heart, and lungs.
Every person with lupus has different symptoms. However, there are a few that are extremely common.
- Distinctive “butterfly” rash that worsens with exposure to sunlight
- Swelling in face, joints, and extremities
- Hair loss
- High white blood cell counts, which can lead to increased clotting
- Ulcers in the mouth
- Pain with breathing
- Fingers and toes turning white or blue in cold weather
People with lupus may have any or all of these symptoms. In severe cases, people can even develop kidney failure or heart problems from this disease.
However, most people can manage their symptoms with lifestyle choices and medications.
What Is Rheumatoid Arthritis?
Like lupus, rheumatoid arthritis (or RA for short) is an autoimmune disease that attacks tissues throughout the body.
Although it is best known for its effects on joints, the Mayo Clinic points out that it also can affect organs such as the eyes, lungs, and heart, along with effects on the skin in many cases.
Rheumatoid arthritis usually attacks the joints, causing inflammation that can cause lifelong damage if left untreated.
It begins with painful, swollen, red joints, usually beginning with the smaller joints such as the knuckles of the fingers. These symptoms are usually worse in the morning or after periods of inactivity.
As RA progresses, it can affect larger joints as well. People may notice fever, fatigue, and weight loss.
Dr. Larry Santora has made a video describing the permanent and distinctive deformities that this disease can cause.
Rheumatoid arthritis often progresses to affect more than the joints including:
- Skin and glands
- Blood vessels
- The nervous system
- Bone marrow
Like lupus, rheumatoid arthritis can sometimes be fatal due to potential effects on vital organs.
However, this is rare. Most people can effectively treat their symptoms to reduce long-term effects.
Causes of Autoimmune Disease
Doctors do not know exactly what causes the immune system to turn on the body’s own tissues, but they have identified what populations are most at risk.
Women are twice as likely to develop them as men, particularly women of childbearing age. Different autoimmune diseases are more common in different racial and ethnic groups.
In addition, some of these illnesses appear to be hereditary. In most cases, people who have a first-order relative with a particular autoimmune disease are more likely to develop the illness than the general population.
There are many hypotheses about what triggers an autoimmune illness. According to Healthline, Some doctors believe that our homes are too clean, with little exposure to bacteria.
This is called the hygiene hypothesis. Others, such as Dr. Amy Myers, blame the Western diet, environmental contamination, stress, and other causes.
Most doctors and scientists believe that people with autoimmune diseases have genes that leave them susceptible.
The diseases are then activated by an unknown environmental trigger. This would explain why these diseases can run in families but do not affect everyone in the family.
Most people with autoimmune diseases will have times when they have few symptoms and times when their symptoms are very severe.
These are known as remissions and flares. One of the goals of treatment is to reduce the severity of flares and lengthen the time of remissions.
Many people find that stress and other factors increase the prevalence of flares. The factors that cause flares also may be partial causes of the disease itself.
Many people are successful in reducing flares by reducing their triggers, especially when combined with medication and other treatments.
Ultimately we do not know why some people develop autoimmune diseases. However, we know that healthy lifestyle choices can improve symptoms and help patients to lead a longer and healthier life.
We also have developed the ability to test for specific autoimmune diseases and a wide variety of innovative new treatments.
Although lupus and rheumatoid arthritis are different diseases, there are several symptoms that they have in common.
Fatigue, fever, and weight loss are common to both. These are the same symptoms that people notice with any immune system activity, whether your body is attacking a virus or attacking its own tissues.
In addition, many people with either one of these diseases will have joint pain. Lupus does not usually cause the long-term joint damage that RA causes, but can look very similar to early RA.
There are a few differences between lupus and RA that can guide doctors in deciding which disease a patient has.
First, patients will have different antibodies in their bloodwork. Second, rheumatoid arthritis is usually worse in the morning, while the symptoms of lupus generally remain the same throughout the day. In addition, lupus usually does not cause erosions in bone or joint deformities.
It is usually easy for a rheumatologist, a doctor who specializes in autoimmune disease, to determine which a patient has.
Although it is rare, some patients can even have both diseases at the same time.
A good doctor will test for a variety of autoimmune diseases before making a diagnosis and treatment plan.
Tests for Lupus and RA
There are several blood tests that can indicate lupus. Doctors look for high ANA (anti-nuclear antibodies) as well as antibodies to double-stranded DNA and cardiolipin. There are many other rare blood markers as well.
According to health and wellness website Healthline, a person should only be diagnosed with lupus if they meet four of these criteria:
- Distinctive facial rash called a malar or butterfly rash
- Raised purple or red patches on the skin call ‘discoid lupus’
- The presence of antinuclear antibodies
- The presence of other antibodies associated with lupus
- Skin symptoms that worsen with exposure to sunlight, which is called photosensitivity
- Inflammation of the heart or lungs
- Kidney symptoms, indicated by the presence of special proteins called casts in the urine
- Anemia, abnormalities of white blood cells, or other bloodwork consistent with lupus
- Neurological symptoms such as seizure
- Arthritis that isn’t caused by other known causes of joint disease
Rheumatoid arthritis, on the other hand, is diagnosed when people get six points on a special RA scale. This scale is scored as follows:
- Rheumatoid symptoms in one or more joints (one point per joint affected, up to five points)
- The presence of antibodies associated with RA in the bloodstream, including rheumatoid factor and anti-CCP antibodies (one point per antibody present, up to three points)
- A positive erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP), both of which indicate high levels of inflammation in the body (one point)
- Presence of symptoms for more than six weeks (one point)
Although these two diseases can have similar symptoms, the diagnosis is not dependent solely on these common symptoms.
Thus, it is usually easy for doctors to tell the two apart. However, it becomes more complicated when patients have one of these diseases and believe they may have the other.
Life With Autoimmune Disease
Living with autoimmune disease can be difficult. Many of the symptoms of these diseases can keep a person from working full time or caring for their family.
This is especially true during flares when symptoms worsen immensely.
People with lupus struggle with pain, rashes, and other symptoms on a daily basis.
People with RA may have joint pain, stiffness, and inflammation that makes it difficult to perform normal activities, even ones like buttoning clothing.
Over time, they may develop permanent deformities in the joints that compromise function.
People who have either lupus or rheumatoid arthritis must be very careful to reduce risk factors for flares.
They should avoid stress, eat a healthy diet, and get plenty of rest. This balance can be difficult to manage with the demands of modern life.
In addition, patients with these diseases have to carefully track their symptoms to ensure that their treatment plan is working.
They often have to fit multiple doctor’s appointments and different therapies into their day.
Treatments for Lupus and RA
John Hopkins Medicine recommends starting lupus treatment with NSAIDs for mild flares.
Anti-malarial drugs such as Plaquenil can reduce flares as well as serious effects on vital organs.
Steroids such as cortisone as well as the hormone DHEA can reduce inflammation, pain, and other unpleasant daily effects during flares, although these can have serious side effects when used long term.
If these approaches do not work, people with lupus may be given immunosuppressive medications that suppress the immune system.
These are the last resort because they make people more prone to infectious illnesses.
Rheumatoid arthritis has a different treatment plan. Like lupus, it often begins with NSAIDs. Steroids also can be used sparingly. However, there are different drugs for more serious RA.
WebMD considers DMARDs the first line for rheumatoid arthritis that does not respond to NSAIDs, as do most rheumatologists.
This stands for disease modifying anti-rheumatic drugs. There are many medications in this category, all of which reduce flares while slowing damage to joints.
Biologic agents, which directly attack antibodies, are reserved for severe disease that does not get better with any other kind of medication.
These medications have been given by IV, which is inconvenient. In addition, they can have serious side effects such as fatigue and increased risk of infection.
It is important to develop a treatment plan and to follow it exactly. This is the only way to reduce the permanent injury and even death that can result from these diseases.
Further, it is important to know whether you have both diseases so a treatment plan can be developed that addresses both autoimmune illnesses at the same time.
Can You Have Lupus and Rheumatoid Arthritis at the Same Time? The Bottom Line
Because the symptoms of these diseases overlap, many people may suspect that they have both. Ultimately, it is possible to have both of these diseases at the same time. However, this is incredibly rare.
If a person suspects they have one or both of these diseases, it is important to see a doctor as soon as possible.
A doctor can help to sort out symptoms, give education about the disease, and develop a treatment plan to help patients live a longer, healthier life.