Lupus and Fibromyalgia

• Can you have lupus and fibromyalgia at the same time?
• How can you tell the difference between lupus and fibromyalgia?
• What is fibromyalgia?
• Is fibromyalgia considered an autoimmune disorder?
• What causes fibromyalgia?
• What are the treatments for fibromyalgia?
• How can fibromyalgia symptoms be differentiated from lupus activity?

Can you have lupus and fibromyalgia at the same time?

Fibromyalgia is a disorder that can occur alone or secondary to connective tissue disorders such as lupus. Studies suggest that about 25% of people who have lupus also have fibromyalgia.

How can you tell the difference between lupus and fibromyalgia?

It is important for people who have lupus to learn about fibromyalgia because symptoms of both conditions can be similar, but the treatments are different.

People who have lupus or fibromyalgia may experience any or all of the following:

• fatigue
• joint and muscle pain
• stiffness
• numbness
• headaches

However, there are separate treatments for lupus and fibromyalgia. If you are being treated with immunosuppressive medications for your lupus, but have continued pain and fatigue, then it is important for you and your doctor to be able to differentiate symptoms of fibromyalgia from ongoing lupus activity. If your doctor believes that some of your symptoms may be related to fibromyalgia, rather than lupus, then higher doses of immunosuppressive medications, which do not help fibromyalgia, may not be needed at that time for your lupus. Among people with lupus, fatigue has been shown to be correlated with presence of fibromyalgia more so than with lupus disease activity.

A correct diagnosis can alleviate anxiety. For example, if you experience numbness that can be attributed to fibromyalgia rather than lupus, then this can be reassuring. Fibromyalgia does not have the same internal organ manifestations and potential for damage that lupus-mediated problems can have. If some of your symptoms are caused by fibromyalgia instead of lupus, then you may have a better prognosis (outlook).

Distinguishing between lupus and fibromyalgia is also important for research. The presence of fibromyalgia can affect the measurement of lupus disease activity. This may have important implications for studies on medications and other treatments for lupus.

What is fibromyalgia?

Fibromyalgia is a syndrome (a cluster of symptoms and signs) of chronic widespread or multisite musculoskeletal pain. The syndrome typically includes multiple areas of increased pain, as well as fatigue, a sense of waking unrefreshed, and cognitive symptoms. Fibromyalgia is often associated with one or more other symptoms, including sleep problems, stiffness, skin and soft tissue tenderness, headaches, lightheadedness, or tingling sensation.

Diagnosing fibromyalgia can be difficult because there are no definitive routinely available laboratory or imaging tests to confirm the diagnosis and because the symptoms can be similar to so many other disorders. Fibromyalgia is a clinical diagnosis made by your doctor after ruling out other possible causes of your symptoms, including lupus or other connective tissue diseases and thyroid dysfunction.

People with fibromyalgia have ups and downs, just as people with lupus do. They may not experience pain all the time. Stress, anxiety, and other emotional or physical stressors may make symptoms worse.

Is fibromyalgia considered an autoimmune disorder?

Although fibromyalgia may be treated by your rheumatologist, it is not believed to be an autoimmune disorder. Further, while pain is a hallmark of fibromyalgia, the muscles do not show signs of inflammation.

What causes fibromyalgia?

The most widely accepted theory of the cause of fibromyalgia is called central sensitization, in which the central nervous system becomes hypersensitive to sensations. Different nerves carry different kinds of messages to the brain. Some carry pain messages, and others carry other messages, such as pressure sensations. In people with fibromyalgia, it is believed that sensitivity is increased such that the brain experiences a range of messages as representing pain.

Is fibromyalgia linked to mental health conditions or depression?

Fibromyalgia is commonly associated with depression and other mental health conditions. Because depression can cause symptoms similar to those of fibromyalgia, it can be difficult to distinguish between depression and fibromyalgia. Depression itself may affect how people respond to pain, and further research is needed to clarify the association between depression and fibromyalgia.

What are the treatments for fibromyalgia?

There are multiple medications used for treatment of fibromyalgia, including pregabalin (Lyrica) and duloxetine (Cymbalta). Various nonpharmacological treatments, such as cognitive behavioral therapy and different forms of exercise, also have been shown to help some patients.

Pharmacological treatments

Pregabalin (Lyrica), approved by the FDA for treatment of fibromyalgia in June 2007, was originally developed as an antiseizure medication. It is generally well tolerated, with possible side effects that include drowsiness, ankle swelling, and weight gain.

Duloxetine (Cymbalta) and milnacipran (Savella) are antidepressant medications that were approved for treatment of fibromyalgia in June 2008 and January 2009, respectively. They may be associated with nausea, constipation, dizziness, or drowsiness as possible side effects.

Other common treatments include amitriptyline (Elavil), which was originally developed as an antidepressant medication, but is also prescribed for certain types of pain relief. Amitriptyline has potential side effects such as sleepiness, dry eyes and mouth, and weight gain. In addition, gabapentin is an antiseizure medication similar to pregabalin (Lyrica) with a similar spectrum of side effects. Your doctor also may suggest other medications for fibromyalgia, such as cyclobenzaprine (Flexeril), or combinations of medications. Ongoing clinical trials may broaden the range of FDA-approved medications for people with fibromyalgia.

Corticosteroids, such as prednisone and methylprednisolone (Medrol), have not been found to be helpful for fibromyalgia. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin), may help some people with fibromyalgia by providing pain relief, but not due to its anti-inflammatory action.

Nonpharmacological treatments

A number of behavioral approaches have been shown to be useful for fibromyalgia, including aerobic exercise and cognitive behavioral therapy.

Aerobic exercise – such as brisk walking, low-impact aerobics, and swimming – has been found to decrease pain and improve health-related quality of life over time. While it can be challenging to maintain an exercise regimen, many people with fibromyalgia may find this helpful.

Cognitive behavioral therapy (CBT) also has been shown to improve health-related quality of life in people with fibromyalgia. CBT is a directed kind of behavioral modification that involves education and can help people with fibromyalgia approach and cope with pain.

Other complementary approaches have been shown to be effective in some studies, including yoga, tai chi, and acupuncture.

A useful approach may be to combine medication, aerobic exercise, and therapeutic support. Some studies have demonstrated that these combined approaches can be particularly effective.

How can fibromyalgia symptoms be differentiated from lupus activity?

Generally, in people with fibromyalgia and no other underlying condition, tests for inflammatory markers show normal results. Any of the following scenarios also may suggest that fibromyalgia, rather than lupus, is the underlying cause:

• symptoms that do not respond to corticosteroids
• widespread pain despite otherwise successful control of lupus symptoms or flares
• absence of previously positive laboratory tests suggestive of lupus activity

Because fibromyalgia can cause so many different types of symptoms, patients may seek care from a wide variety of specialists. This may contribute to the difficulty of getting a correct diagnosis and in determining whether lupus or fibromyalgia is the cause of any particular symptom. Communication among your doctors (for example, your primary care doctor and your rheumatologist) can help them make an agreed-upon diagnosis. It is also helpful for people with lupus to keep track of all of their symptoms to help their doctors discern any new patterns that may suggest a different diagnosis – and different treatment.

(Find a specialist at HSS who treats fibromyalgia.)