published by nonprofit Johns Hopkins Press
posted in Joint pain, arthritis, musculoskeletal on June 6, 2021 by
Updated October 12, 2025
NOTE: Johns Hopkins University Press, publisher of The Lupus Encyclopedia, is a nonprofit publisher. If you purchase JHUP books, like The Lupus Encyclopedia, you support projects like Project MUSE.
Just as lupus can cause inflammation of the joints, it can also cause inflammation of the tendons (lupus tendonitis or lupus tendonitis). Tendonitis usually causes pain around and between the joints of the body. The joint pains seen in SLE are commonly due to lupus tendonitis (lupus tendonitis) rather than arthritis. A 2017 Japanese study on SLE patients with joint pain reported 94% with tendon involvement and 80% with joint involvement. Many patients had a combination of both. The photo above shows the hands of Dr. Thomas’ patients with severe damage to her tendons from lupus tendinitis and lupus tenosynovitis. We call this “Jaccoud’s arthropathy.” Jaccoud’s arthropathy was first seen in people affected by rheumatic fever. Today, SLE is the most common cause. Make sure to read my “Lupus Secrets” to learn to take care of and prevent problems such as lupus tendinitis.
A lubricating sheath surrounds some tendons. This sheath is called the tenosynovium, and it helps tendons glide more smoothly and help them stay in their place better. A typical example is the tendons in the palm that help to bend the fingers. When these become inflamed in SLE, it is called “lupus tenosynovitis.” Ultrasound (see below) studies show that 20% to 40% of SLE patients with joint pain with no detectible joint swelling have inflammatory tenosynovitis. When this occurs with the fingers, the affected person may need to use the other hand to straighten out the finger. This problem is called “trigger finger” (see the photo above).
Damage of the tendons from lupus can cause the tendons to slip around the joints and become unstable in some people. When this occurs, it can cause deformed joints (see the 1st photo above) called “Jaccoud’s arthropathy.” Jaccoud’s arthropathy was first described in people with rheumatic fever (due to infection). However, today, the most common cause is SLE.
The photo above shows what the ultrasound can look like from lupus tenosynovitis. This is an ultrasound of the tendon that bends the woman’s index finger that you see in the previous photo (Jaccoud’s arthropathy is mainly due to tendon inflammation and damage). This ultrasound image uses Doppler technology to identify areas of inflammation. The red and blue dots are areas of inflammation occurring around the tendon. The thin parallel lines you see under the dots (they look like strands of white hair) are the actual tendons. Note that the two dots of inflammation sit within a dark gray cavity. This is swelling around the tendon, and the white line above the dots is the tendon sheath. When there is inflammation such as this, bending the finger becomes painful. Also, note that the tendon towards the left of the two dots is quite a bit more swollen than the part of the tendon towards the right. This is an example of damage to the tendon due to many years of uncontrolled inflammation.
As with all problems in SLE, please read and abide by all my “Lupus Secrets” to keep the best control of your SLE problems like lupus tendonitis. Make sure to download all my free handouts from the Lupus Secrets page of my website.
Just as with arthritis, the tendonitis of SLE is treated with nonsteroidal anti-inflammatory drugs (NSAIDs such as ibuprofen and naproxen), steroids, and hydroxychloroquine (Plaquenil), while stronger medications such as methotrexate, mycophenolate, and belimumab are used for severe cases. Resting the tendon to allow the body to heal is one of the most important things to learn. If you have tendonitis, it is crucial to abide by joint protection measures. Joint protection measures can easily be found on the internet.
An injection with a corticosteroid (a cortisone injection) is also one of the safest and quickest ways to treat lupus tendonitis and tenosynovitis. Using an ice pack as needed can also help to decrease the severity of pain from lupus tendonitis.
Cold therapy (cryotherapy): Icing can be helpful for injuries, tendonitis, bursitis, and inflammation (such as lupus inflammatory arthritis pain). Ice therapy can be applied in many ways, including raw ice (like an ice cube), ice frozen in a Styrofoam cup, commercial ice or gel wraps, and packs. Do not use bare ice for more than 1-3 minutes. Follow the rule of thumb “when you’re numb, you’re done.” Cold compresses with a barrier between the ice and the skin (such as cups, wraps, and packs) may be applied longer, but when “you’re numb, you’re done.” Do not apply ice on areas of broken skin. If you have neuropathy (nerve damage), be careful as you could freeze your skin if the ice source is too cold (you may not feel it), and make sure not to use it for more than 1-3 minutes.
If your pain persists, you must consider whether you are overstressing your joints and tendons. Carefully evaluate your activities at work, home, and during sports, as repetitive movements are common culprits. For instance, a favorite hobby like crocheting might be the source of recurring wrist pain, as repetitive tasks often contribute to joint and tendon damage. Even common activities like using a computer or texting on a cell phone can lead to overuse tendon injuries. It’s essential to identify and modify these aggravating activities by doing them less and for shorter durations. Another example is a new mother experiencing severe pain at the base of her thumb after picking up her baby. Holding the thumb in certain positions puts significant stress on the tendons. Learning an alternative way to lift the baby and using a wrist splint can help rest the tendons, reduce inflammation, and relieve the pain.
Personality assessment is also essential. The person who is a compulsive worker and perfectionist may have the attitude of “I’m going to finish this job if it kills me.” This type of person needs to learn to respect their aches and pains, pay attention to what their body is telling them, and recognize this potentially self-destructive behavior. People who feel that they must do everything or are the only ones who will get something done right can be particularly guilty of this.
With lupus tendonitis, a person often pushes through pain to meet high expectations, like a mother who must keep a perfect house. Despite severe pain, she sacrifices her physical well-being to achieve this standard, causing more damage and worsening her pain. This can create a vicious cycle. The physical strain leads to emotional distress, frustration, and resentment toward loved ones she feels aren’t helping. This damages not only her tendons but also her relationships. To break the cycle, change expectations, drop perfectionism, and learn to avoid or modify tasks to reduce stress on your joints and tendons.
Addressing the role of personality is crucial for managing chronic conditions like lupus tendonitis. Individuals with compulsive or perfectionistic tendencies often adopt the harmful “I’m going to finish this job if it kills me” mindset, ignoring their body’s pain signals. For example, a mother with severe pain may relentlessly clean to meet her own or perceived family expectations. This self-destructive drive increases her physical damage and pain, creating a vicious cycle where pain, stress, and resentment toward loved ones worsen over time. This not only harms her tendons but also damages her relationships. A vital step in management is learning to change expectations, let go of perfectionism, and accept alternative ways of performing tasks. Recognizing this self-destructive behavior is key. Learning to delegate or avoid certain tasks can be as important as finding less strenuous ways to perform them.
Read chapters 7 and 36 of The Lupus Encyclopedia, edition 2
Look up your symptoms, conditions, and medications in the Index of The Lupus Encyclopedia
If you enjoy the information from The Lupus Encyclopedia, please click the “SUPPORT” button at the top of the page to learn how you can help.
If you have joint pains and lupus, what has your experience been? What do you recommend for other patients?
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NOTE: The above is an amended version of the Musculoskeletal section of “The Lupus Encyclopedia“, 2nd edition prior to editor review and acceptance (Johns Hopkins Press).
Don Thomas, MD, author of “The Lupus Encyclopedia” and “The Lupus Secrets”
Special thanks to Dr. Jemima Felicity L Albayda, M.D., Director, Musculoskeletal Ultrasound and Injection Clinic
Assistant Professor of Medicine, Johns Hopkins Hospital, Baltimore, Maryland who helped write this for inclusion in “The Lupus Encyclopedia”, 2nd edition.
NOTE: All opinions and interpretations of the medical literature are our own. We get no compensation from any industry for our blog posts. Our intent is to motivate patients to become knowledgeable and proactive in their health care.
Read more in The Lupus Encyclopedia, edition 2
Look up your symptoms, conditions, and medications in the Index of The Lupus Encyclopedia
If you enjoy the information from The Lupus Encyclopedia, please click the “SUPPORT” button at the top of the page to learn how you can help.
If you have lupus, what has your experience been? What do you recommend for other patients?
Do you have any questions to ask Dr. Thomas?
Please click on “Leave a Comment” above to comment.
Click on “SUPPORT” at the top of the page to learn how you can support “The Lupus Encyclopedia“
My tendons have been causing me pain for years. My doctor’s have all been calling it fibromyalgia (including all the rheumatologists I’ve seen). Sometimes they call it myifascial pain. It can be very hard to sleep, even with all of my pillows! I’d like to read your handouts in solutions, but I cannot open them. Any suggestions?
Best,
Dawn
Dear Dawn: If you are talking about the handouts at the bottom of the “Lupus Secrets” page, they do require Microsoft “Word” to open. I think you can get a Word Reader off the internet to help as well.
The best way to figure out if someone has pain in the tendons due to fibromyalgia vs inflammation from lupus is to have a doctor perform Doppler ultrasound of the joints and tendons. Many of us are able to do this these days. If you have never had this done, I’d recommend calling around to rheumatologists’ offices close to you and as the staff on the phone if the doctor does ultrasonography, and if they say, Yes, make an appointment and at the appointment mention that I stated this could be done to help figure it out. They’ll know what to do.
Good luck, I hope you do well… Donald Thomas, MD
Seeing this picture and reading this article shows and let’s me know that this has happened to my hands. They called it contractures when I saw the surgeon and the occupational therapist for my hands and wrists. I was given splints and a bulky brace and plastic rings for my fingers. I’m already on Benlysta, plaquenil, and imuran. They said there’s nothing more they can do for me
Do you have any recommendations/references for rheumatologists in the Minneapolis Minnesota area who use ultrasound??? I have severe tendon pain with Lupus but any Rheumatologist that I have seen do not believe me and think I have fibromyalgia. I found this article researching the internet.
Brooke:
Easiest thing to do is to call offices close to where you live and ask the phone staff if their rheumatologists perform ultrasound inside their office when they see patients.
Another way is to check the list of rheumatologists who are certified as RhMSUS: https://rheumatology.org/rhmsus-designees
I hope that helps.
Donald Thomas, MD
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