Long-lasting severe knee pain in a SLE patient after renal transplantation: what is the reason? A case report and literature review

Rheumatol Int. 2022 Feb;42(2):349-358. doi: 10.1007/s00296-021-05018-8. Epub 2021 Oct 19.

Abstract

Musculo-skeletal complaints in a patient suffering from systemic lupus, with co-existing chronic renal failure, undergoing immunosuppressive treatment after kidney transplantation, can have a varied etiology. The aim of this work was to present a case based review of differential diagnosis of knee pain in such a patient. A literature search was carried out using MEDLINE/PubMed, Google Scholar and EBSCO, with no time limit. We undertook a systematic review of the literature published in English, limited to full-text publications of original articles, letters to the editor, and case reports in peer-reviewed journals, for a discussion and analysis of studies reporting arthralgia in patients with lupus after kidney transplantation. We present a case report of a 45-year-old woman with lupus nephritis, after kidney transplantation, who started to complain of increasing pain in the knees, most pronounced at night and after physical activity approximately 2 years after transplantation. Extensive causal diagnostics were carried out, which revealed bilateral extensive regions of bone infarction in the femur and tibia, chondropathy, degenerative changes of medial meniscuses in the body and posterior horn as well as chondromalacia of the patella. Establishing the right diagnosis is crucial for implementing appropriate treatment.

Keywords: Arthralgia; Bone; Kidney transplantation; Lupus nephritis.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Chronic Pain / etiology
  • Female
  • Humans
  • Immunosuppressive Agents / adverse effects*
  • Kidney Transplantation / adverse effects*
  • Knee Joint / diagnostic imaging
  • Knee Joint / physiopathology*
  • Lupus Nephritis / complications
  • Lupus Nephritis / diagnosis
  • Lupus Nephritis / drug therapy*
  • Middle Aged
  • Osteonecrosis / diagnostic imaging
  • Osteonecrosis / etiology*

Substances

  • Immunosuppressive Agents