Lupus and Fibromyalgia

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Systemic lupus erythematosus, or lupus, is an autoimmune disease characterized by chronic inflammation. Autoimmune diseases occur when the body’s immune system mistakenly attacks its own cells and tissues. The resulting inflammation from lupus commonly affects the joints, skin, kidneys, blood cells, brain, heart, and lungs. Much like fibromyalgia, lupus can be extremely difficult to diagnose because its presenting symptoms are frequently similar to those of other conditions. The most characteristic symptom of lupus is a facial rash that resembles the wings of a butterfly spread across both cheeks and the bridge of the nose; however, again like fibromyalgia, no two individuals experience the same constellation of signs and symptoms – lupus is a very individualistic disease. Lupus tends to be mild and then “flare up” from time to time, during which symptoms worsen. Lupus can also completely disappear for periods of time.

Individuals symptoms of lupus vary both over time in one individual, and between individuals. In general, symptoms can include fatigue and fever; joint pain, swelling, and stiffness; facial rash as described above; skin lesions that worsen in sunlight; Reynaud’s phenomenon (finger and toe sensitivity to cold stimuli); shortness of breath; chest pain; dry eyes; and headaches, confusion, or memory loss.

As can be seen, many of these symptoms overlap with those of fibromyalgia, a phenomenon that can complicate the diagnostic process for lupus (which is already hindered by the fact that no single diagnostic test specific for lupus exists – or for Fibromyalgia!). As a result, patients may be mis-diagnosed as having one disease or the other, or patients may be diagnosed with both conditions, either correctly or in error. Normally, a combination of blood and urine tests, a history of symptoms, and a detailed physical examination can result in a diagnosis of lupus. The following laboratory tests may be of use:

  • A complete blood count is a blood test that measures the numbers of red and white blood cells, platelets, and hemoglobin (a protein found in red blood cells) in the blood. Anemia, as well as low white blood cell and platelet counts, is common in patients with lupus.
  • A blood test known as the erythrocyte sedimentation rate, or ESR, can help determine if an inflammatory condition, such as lupus, is present in the body; however, it cannot specifically determine the presence of lupus.
  • Blood and urine tests to evaluate kidney and liver functioning, which can both be impaired by lupus, may also be useful.
  • Antinuclear antibody (ANA) test:  If this blood test detects the presence of these antibodies, it indicates that the body’s immune system is stimulated. Although not specific to lupus, a positive ANA test can lead doctors to order more specific types of antibody tests.

Lupus and Fibromyalgia

Fibromyalgia and lupus commonly co-exist in the same patient (Staud, 2006; Buskila et al., 2003). Fibromyalgia does not appear to be a risk factor for lupus but rather the opposite – having a diagnosis of lupus increases the likelihood of having concurrent fibromyalgia (Staud, 2006). While some studies have noted a lower prevalence of fibromyalgia (ranging from 5% to 9.5%) among lupus patients of various ethnic backgrounds, the majority of studies have found prevalence rates ranging from the mid-teens to 20th percentiles (Morand et al., 1994; Gladman et al., 1997), and upwards of 47% in other studies (Staud, 2006).  In a 2012 review by M.B. Yunus, the authors found that among patients with lupus, 16.2% also had a diagnosis of fibromyalgia (Yunus, 2012). A 2009 study by Wolfe and colleagues evaluated 23,321 patients with various rheumatic diseases. Of the 834 patients who had physician-diagnosed lupus, 22.1% also had a diagnosis of fibromyalgia (Wolfe et al., 2009).

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References

1.        Yunus MB. The prevalence of fibromyalgia in other chronic pain conditions. Pain Res Treat. 2012;v.2012:584573. doi:10.1155/2012/584573.

2.        Wolfe F, Petri M, Alarcon GS, Goldman J, Chakravarty EF, Katz RS, Karlson EW, Michaud K. Fibromyalgia, systemic lupus erythematosus (SLE) and the evaluation of SLE activity. J Rheumatol. 2009;36(1):82-88.

3.        Staud R. Are patients with systemic lupus erythematosus at increased risk for fibromyalgia? Curr Rheumatol Rep. 2006;8(6):430-435.

4.        Buskila D, Press J, Abu-Shakra M. Fibromyalgia in systemic lupus erythematosus. Clin Rev Allergy Immunol. 2003;25:25-28.

5.        Morand EF, Miller MH, Whittingham S, Littlejohn GO. Fibromyalgia syndrome and disease activity in systemic lupus erythematosus. Lupus. 1994;3(3):187-191.

6.        Gladman DD, Urowitz MB, Gough J, MacKinnon A. Fibromyalgia is a major contributor to quality of life in lupus. J Rheum. 1997;24(11):2145-2148.

7.        Handa R, Aggarawl P, Wali JP, Wig N, Dwivedi SN. Fibromyalgia in Indian patients with SLE. Lupus. 1997;7(7):475-478.

8.     Friedman AW, Tewl MB, Ahn C, McGwin G Jr, Fessler BJ, Bastian HM, Baethge BA, Reveille JD, Alarcon GS, LUMINA Study Group. Systemic lupus erythematosus in three ethnic groups: XV. Prevalence and correlates of fibromyalgia. Lupus. 2003;12(4):274-279.

9.     Valencia-Flores M, Cardiel MH, Santiago V, Resendiz M, Castano VA, Negrete O, Rosenberg C, Garcia-Ramos G, Alcocer J, Alarcon-Segovia D. Prevalence and factors associated with fibromyalgia in Mexican patients with systemic lupus erythematosus. Lupus. 2004;13(1):4-10.

Akkasilpa S, Goldman D, Magder LS, Petri M. Number of fibromyalgia tender points is associated with health status in patients with systemic lupus erythematosus. J Rheum. 2005;32(1):48-50.

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