What Is the Difference Between Rheumatoid Arthritis and Lupus?

Lupus and rheumatoid arthritis are both autoimmune diseases that affect the joints, but lupus affects more body systems.

Both rheumatoid arthritis and lupus are autoimmune diseases, conditions in which the body’s immune system mistakenly attacks its own tissues. 

In rheumatoid arthritis, the joints are primarily affected though it can affect other parts of the body. Lupus can seem like rheumatoid arthritis because it also attacks the joints in a majority of patients, but it can affect many other body parts such as the kidneys, heart, lungs, and skin.

Symptoms of both rheumatoid arthritis and lupus that are similar include:

• Fatigue
• Fever
• Weight changes 
• Joint pain and stiffness
  • In rheumatoid arthritis, joint pain and stiffness usually begins in the small joints, such as those in the fingers or toes, or may occur in a single, large joint, such as the knee or shoulder. It usually affects the same joints on both sides of the body (symmetrical).
  • In lupus, joint pain and stiffness often moves from one part of the body to another and does not tend to affect both sides of the body in the same way. Only a few joints are affected at one time, usually the fingers, wrists, and knees. 
• Muscle pain
• Muscle weakness 
• Lung problems – shortness of breath and a dry cough
• Pericarditis – inflammation of the tissue around the heart that can cause chest pain and difficulty breathing
• Eye dryness

Other symptoms of rheumatoid arthritis that are different from lupus may include:

• Numbness and tingling in the hands
• Feeling unwell (malaise) 
• Bone loss (decreased bone density)
• Skin problems (painless lumps that beneath the skin called rhematois nodules) 
• Eye problems (eye redness, pain, and vision problems)
• Vasculitis (inflammation of the blood vessels)
• Sjögren's syndrome (causes dry eyes and dry mouth)

Other symptoms of lupus that are different from rheumatoid arthritis may include:

• Skin changes
  • A "butterfly rash" that appears as redness over the cheeks and nose after sun exposure and is in the shape of a butterfly. The rash only lasts a few days and often returns.
  • Circular patches of raised, scaly skin (called discoid lesions), which often leave a scar
  • Sensitivity to sunlight which causes a skin rash after ultraviolet (UV) exposure 
  • Hair loss 
  • Painless ulcers or sores in the mouth
• Raynaud’s phenomenon - blood vessels in the fingers and toes narrow in response to cold temperatures, emotional stress, and/or smoking which causes the fingers or toes to turn pale and then blue, purple, or red.
• Changes in kidney function 
  • Inflammation of the glomerulus, the part of the kidney that filters waste and excess fluids 
  • Damage to the glomeruli can cause proteins in the bloodstream to "leak" into urine, resulting in water retention and swelling in the feet and lower legs
  • Untreated, it can lead to permanent kidney scarring which can result in the need for dialysis or a kidney transplant. 
• Digestive symptoms 
  • Severe abdominal pain, nausea, and vomiting.
  • Inflammation of the pancreas (pancreatitis)
  • Inflammation of the lining of the abdomen (peritonitis)
  • Inflammation of the large intestine (colitis)
• Nervous system problems
  • Difficulty concentrating and thinking clearly
  • Confusion or memory loss
  • Depression and anxiety
  • Headaches
  • Burning or tingling in the hands or feet 
  • Weakness or numbness
  • Seizures
  • Stroke 

The causes of rheumatoid arthritis and lupus are unknown. Both are autoimmune diseases, where the body attacks its own healthy cells and tissues. 

Risk factors for developing rheumatoid arthritis and lupus include:

• Infection 
• Genetics/family history
• Smoking 
• Stress 
• Gender (both are more common in women)

Additional risk factors for developing rheumatoid arthritis include:

• Age between 40 and 60
• Obesity
• Exposure to toxins and industrial chemicals

Additional risk factors for developing lupus include:

• Hormones
• Ultraviolet (UV) ray exposure  
• Certain drugs that make a person more sensitive to the sun
• Exhaustion
• Age 15 to 45
• Ethnicity (it is more common in African-American, Hispanic, Asian, and Native American women than in Caucasian women)

There are no specific tests for lupus or rheumatoid arthritis but a doctor will perform a physical exam and may order some blood and imaging tests. 

Blood tests used to diagnose rheumatoid arthritis may include:

• Anti-citrullinated peptide/protein antibody
• Rheumatoid factor (RF)
• C-reactive protein 
• Erythrocyte sedimentation rate (ESR)

Lupus can be more difficult than rheumatoid arthritis to diagnose. If you have 4 or more of 11 specific symptoms, you may be diagnosed with lupus. Diagnostic criteria symptoms include:

• “Butterfly rash” across nose and cheeks
• Raised red patches on skin
• Skin rash caused by sunlight exposure
• Ulcers or open sores in the mouth or nose 
• Joint pain, tenderness, and swelling in at least two joints 
• Inflamed lining around the heart or the lungs or both
• Seizures or psychosis, such as delusions or hallucinations, or both
• Kidney problems
• Blood disorders
• Immune disorder
• Positive test for antinuclear antibodies

Medications used to treat rheumatoid arthritis include: 

• Nonsteroidal anti-inflammatory drugs (NSAIDs) for pain 
  • Ibuprofen (Advil, Motrin)
  • Naproxen (Aleve) 
• Corticosteroids, to help control inflammation
  • Prednisone 
  • Prednisolone
• Disease modifying anti-rheumatic drugs (DMARDs) which can help stop the immune system from attacking the joints
  • Methotrexate (Trexall) 
  • Sulfasalazine (Azulfidine) 
• Biologic drugs that target specific parts of the immune system
  • Adalimumab (Humira) 
  • Etanercept (Enbrel)
  • Abatacept (Orencia)
  • Tocilizumab (Actemra)
• Newer biologics called JAK inhibitors target a different part of the immune system
  • Tofacitinib (Xeljanz) 

Other treatments for rheumatoid arthritis include:

• Light exercise such as walking or yoga can help when symptoms are mild 
• Rest during a flare (worsening of RA symptoms)
• Surgery to replace a joint or to fuse joints together if there is significant joint damage

Medications used to treat lupus include: 

• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Corticosteroids 
  • Prednisone
• Antimalarial drugs 
  • Hydroxychloroquine (Plaquenil) 
  • Chloroquine
• Targeted biologics 
  • Belimumab (Benlysta)
  • Rituximab (Rituxan)
• Disease modifying anti-rheumatic drugs (DMARDs) 
  • Methotrexate (Trexall)
• Immunosuppressive medicines 
  • Mycophenolate (CellCept, Myfortic)
  • Azathioprine (Azasan, Imuran)
  • Cyclophosphamide

Other treatments for lupus include:

• Sun protection to prevent skin problems
  • Wear sunscreen
  • Avoiding direct sun exposure when possible
• Eat a well-balanced diet low in fat and high in fruits, vegetables, and whole grains
• Exercise
• Don’t smoke
• Vaccines to prevent pneumonia and the flu are recommended, as is the shingles vaccine for some patients