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any very bright light. Precautionary measures may be warranted, including amber window
film or blinds, which screen out blue spectrum light. Certain types of sunblock are also
available on prescription for lupus patients [105-107]. Sunblocks which screen out visible
light as well are available by prescription, or over the counter. Clinically, it is always best to
be on the lowest possible dose of steroids; thus, avoiding UV light and wearing sunblock is
important even for patients on steroids. Hydroxychloroquine (Plaquenil) seems to be
particularly helpful for preventing rashes, arthritis and pleuritic pain; however, this theapy is
also not a replacement for sunlight avoidance. Other agents (such as azathioprine,
methotrexate and cyclophosphamide) which are often used for more serious disease or to
minimize steroid dosages may also reduce the risks of sunlight induced flares. Sunblock
should be sun protection factor (SPF) 25 or greater, and effective against both UVA and UVB
light. It should be applied in the morning and reapplied during the day (at least once or twice),
as it tends to get rubbed off or sweated away [105-107]. Sunblock should be used even on
cloudy days by light-sensitive people because UV light can penetrate the cloud layer.

Lupus and the Musculoskeletal System

Joint and muscle pain represent two of the most common symptoms of lupus. Vertebral
fractures may also occur in patients with lupus [108-112]. In lupus, the joint tissue may
become inflamed, causing pain and swelling. The joints most frequently involved are located
in the hands, wrists and knees, although any joint may be involved [108-112]. The arthritis is
often intermittent, and affects different joints at different times. The ligaments and tendons
around the joints can also become inflamed and tender. If the inflammation is not brought
under control with medication and continues for a long period of time, the tendons and
ligaments can weaken. Once this happens, the tendons and ligaments can no longer support
the joint properly. The affected joint becomes lax, or unstable, and can appear to be
deformed. The hand joints are most frequently affected by these deformities [108-112]. The
joint bones themselves are not affected by lupus arthritis, and at least initially the deformities
can be painlessly corrected by pushing the joint back into position. Painkillers such as
paracetamol may control the joint pain. If this is not adequate, then the addition of
nonsteroidal anti-inflammatory drugs (NSAIDs) may be indicated. If only one or two
troublesome joints are present, an injection of steroids into the affected joints may be
recommended; this is often an effective way of obtaining maximum benefit from the steroids,
with a minimal risk of side effects. If there are more joints affected, steroids may be
administered into nearby muscles or intravenously. Intramuscular and intravenous steroids
may result in rapid and dramatic reduction in pain and inflammation of affected joints
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[108-112]. However, the improvement is often of short duration, and the treatment usually
needs to be supplemented by oral medication. The most common oral medications utilized are
antimalarials, and specifically hydroxychloroquine is frequently employed. These
medications are effective in reducing joint pain and inflammation over a long period of time,
but can take up to three months to become maximally effective. Oral steroids are also
effective in controlling joint pain, and are commonly used. Sometimes joint pain and
inflammation can be particularly problematic and stronger agents such as azathioprine,
methotrexate and cyclosporine may be prescribed [108-112]. Surgery may be helpful for

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