Patients with local inflammation—flexor tenosynovitis, for instance—might feel more comfortable when the area is immobilized in a splint. Systemic corticosteroids are generally not used for localized, soft tissue disorders such as this. Serological measurements of disease activity may be helpful for assessing tenosynovitis and may serve as a guide in overall management.
Shared decision making. The patient and physician should discuss the risks and benefits of the available oral treatments. This includes consideration of the relative risks/ benefits of splinting versus corticosteroid injections.
MYALGIAS AND MYOSITIS
SLE may cause muscle inflammation that is associated with pain, objective weakness, and increased levels of muscle enzymes. Far less common is severe proximal muscle weakness, similar to that of polymyositis or dermatomyositis. When the patient has muscle weakness, it remains important to rule out other causes of weakness, including thyroid disease and chronic corticosteroid use.Colchicine and statin drugs also can cause myalgias, which are generally reversible on discontinuation of the drug.
Patients with low-level myalgias and no weakness may be treated with NSAIDs. When myositis is associated with weakness, high-dose corticosteroids generally are necessary. Keep in mind that corticosteroids also cause proximal muscle weakness but no increase in muscle enzyme levels. Hydroxychloroquine also may cause reversible myopathy. Immunosuppressive agents are an alternative for patients with lupus myositis needing treatment with a corticosteroid-sparing agent.
Proximal muscle–strengthening exercises may be appropriate for patients with inflammatory disease. They are critical for those with corticosteroid-induced myopathy.
Shared decision making. The patient and physician can discuss the risk-benefit profile of the different immunosuppressive agents that can be used to treat myositis and that there may not be one "best treatment."
