Fibromyalgia and Lupus

Affecting approximately 6% of the world’s population, fibromyalgia is one of the most common chronic, widespread pain conditions diagnosed. What exactly is fibromyalgia and who is at risk for developing it?

Introduction

According to the National Fibromyalgia Association (NFA), fibromyalgia is a chronic pain condition that causes seemingly inexplicable, widespread pain and tenderness throughout the body including the muscles, joints and even the abdomen – individuals with fibromyalgia are often even sensitive to touch. Affecting up to ten million individuals in the U.S. alone, Fibromyalgia affects mostly women between the ages of 20 – 50 at a ratio of 3:1 to men.

Fibromyalgia not only takes its toll on an individual physically, but mentally as well. Dealing with debilitating pain, chronic fatigue, poor sleep quality and the uncertainty of what is wrong can often lead to anxiety and depression. A holistic approach that treats both the mind and body is optimal for managing the symptoms of fibromyalgia.

What causes fibromyalgia?

Fibromyalgia (also referred to as fibromyositis and fibrositis), is not a disease – it is considered a syndrome or a condition. Researchers of a 2017 study published in the Polish Archives of Internal Medicine note that it is often considered a “functional somatic syndrome, a bodily distress syndrome or [a] somatoform disorder” because it can not necessarily be attributed to a specific cause. The National Health Service (NHS) suggests that fibromyalgia may be the result of how our central nervous system and brain communicate pain – chemical changes in the nervous system could result in how feelings of discomfort are transmitted and processed throughout the body, and how our brain perceives these changes and responds.

Possible causes or triggers of fibromyalgia may include:

  • Chemical Imbalances: Individuals with fibromyalgia often have low levels of serotonin, dopamine and noradrenaline.
  • Poor Sleep Quality and Changes in Sleep Patterns: This could be both a cause and a symptom of fibromyalgia.
  • Genetics: An individual can be genetically predisposed to developing fibromyalgia. In a 2009 article published in the journal Psychological Medicine, researchers studied over 31,000 twins and discovered that twins often share the same traits for conditions such as chronic, widespread pain and impairing fatigue, two prevalent symptoms of fibromyalgia. Genetics may play up to a 50% role in contributing to these symptoms.
  • Stress or psychological trauma: Researchers of a 2014 meta-analysis published in the journal Psychosomatic Medicine found that emotional stressors such as post-traumatic stress disorder (PTSD) or combat trauma, sustained emotional or physical abuse as a child or adult, the breakup of a relationship, the illness or death of a loved one, a serious accident or any intense emotional trauma have been found to be “associated with an increased prevalence of functional somatic syndromes” such as fibromyalgia.

Several conditions are also linked to fibromyalgia and include:

There is also a strong link between fibromyalgia and autoimmune thyroid disease. In a 2014 article published in the journal Clinical Rheumatology, researchers Jowairiyya Ahmad and Clement Tagoe found that up to 40% of individuals with autoimmune thyroid disease also have fibromyalgia. Conditions such as Grave’s disease and Hashimoto thyroiditis have “significant musculoskeletal manifestations” which often result in chronic widespread pain conditions such as fibromyalgia.

Fibromyalgia’s Relationship to Systemic Lupus Erythematosus (SLE)

Fibromyalgia is extremely complex in nature and shares many similarities with SLE including its target demographic, its elusivity and the time it takes to be properly diagnosed.  Both conditions can also seem “invisible” – that is, individuals who suffer from SLE and/or fibromyalgia often look perfectly healthy to everyone else.

Though fibromyalgia is not considered an overlap disease of SLE, there is also a significant relationship between the two chronic conditions. In a 2016 study published in the journal Clinical and Experimental Rheumatology, researchers noted that the longer an individual has SLE (five years or more), the higher the prevalence of fibromyalgia. One factor that may link the two conditions together is depression.  Individuals with SLE, who also experienced depression, have an even greater likelihood of developing fibromyalgia. This incidence is greater for Caucasian women. It is not fully understood if the depression is a direct result of a chronic illness such as SLE or if it stems from something else. Clearly more research is needed to determine the specific cause, but there definitely is a connection.

Much like SLE, fibromyalgia may also flare at times and for some of the same reasons. Researchers of a small 2016 study published in the journal Pain Medicine surveyed individuals with fibromyalgia in order to get a better understanding of what a fibromyalgia flare looks like. Individuals who participated reported experiencing times of feeling flu-like aches and pains and exhaustion after pushing themselves too far, not getting enough quality sleep, stressful episodes and even changes in the weather.  Once the individuals received the proper treatment, they noted that the exacerbated symptoms subsided and were manageable.

Fibromyalgia Symptoms

The U.S. federal Food and Drug Administration (FDA) ­­lists the following symptoms of fibromyalgia:

  • Chronic, widespread pain
  • Debilitating fatigue
  • Disrupted sleep
  • Stiffness, especially in the morning upon waking
  • Headaches
  • Menstrual pain
  • Pelvic pain
  • Tingling and/or numbness in the hands and/or feet
  • Cognitive difficulties (similar to lupus brain fog) including the inability to focus or remember things
  • Restless Leg Syndrome (RLS)
  • Depression/Anxiety

The NFA also includes sensitivity to light and sound as symptoms of what are considered fibromyalgia associated conditions including irritable bowel syndrome, lupus and arthritis.

Experiencing these symptoms can gravely impact an individual’s quality of life. Not only do the symptoms cause debilitating physical discomfort, they also can disrupt an individual’s education, career, financial stability, social and family life.

How is fibromyalgia diagnosed?

An internist or general practitioner may diagnose fibromyalgia, however, because fibromyalgia has many of the same pain and fatigue characteristics of arthritis, an individual may be referred to a rheumatologist for diagnosis and treatment.

In a 2014 article published in the journal Rheumatology International, researchers Daniel Wallace et. al point out that diagnosing fibromyalgia “chiefly relies on using tests to ‘rule out’ disorders of rheumatic, neurologic, psychiatric, hematologic and endocrine origins.” While there is to date no specific diagnostic test for diagnosing fibromyalgia, the American College of Rheumatology (ACR) has not only created diagnostic criteria for lupus, but they have created the following criteria to help healthcare practitioners diagnose fibromyalgia as well:

  • Pain and symptoms over the course of a week, based on the total of number (≥ 11) of painful areas out of 19 parts of the body. This includes measuring the severity level of the following symptoms
    • Fatigue
    • Waking unrefreshed
    • Cognitive (memory or thought) problems
  • The number of other general physical symptoms.
  • Symptoms lasting at least three months at a similar level.
  • No other health problem that would explain the pain and other symptoms.

A healthcare practitioner will also discuss an individual’s health history in order to help determine whether or not they have fibromyalgia.

Much like with lupus, cytokines and chemokines may play a role in fibromyalgia. A 2014 study published in the journal Rheumatology International discovered that individuals with fibromyalgia carried a specific cytokine and chemokine profile that was unique from other conditions such as rheumatoid arthritis and SLE. This and subsequent research may lead to the development of additional diagnostic tools that can quickly diagnose fibromyalgia and distinguish it from other inflammatory conditions to prevent mistaken or delayed diagnoses.

How is fibromyalgia treated?

In the U.S., the Arthritis Foundation recommends the following FDA-approved pharmaceutical treatments for fibromyalgia:

  • Anti-epileptics, including pregabalin (Lyrica). Note: Sometimes gabapentin (Neurontin) may be prescribed, but it not FDA-approved for fibromyalgia.
  • Antidepressants, including duloxetine (Cymbalta), and milnacipran (Savella) which are both serotonin and norepinephrine reuptake inhibitors (SNRIs). Amitriptyline hydrochloride (Elavil, Endep), fluoxetine (Prozac), paroxetine (Paxil) and sertraline (Zoloft) may be prescribed, but again, these are not FDA-approved specifically for the treatment of fibromyalgia at this time.

The Arthritis Foundation also recommends the following non-pharmaceutical treatments for fibromyalgia:

Making lifestyle changes may also prove beneficial in treating fibromyalgia. The Arthritis Foundation suggests considering the following changes that may improve daily quality of life for an individual with fibromyalgia:

  • Make where you spend most of your day as comfortable as possible – Adjust your workspace or chair if you sit at a desk all day. Buy comfortable shoes if you stand a lot.
  • Adjust your sleep habits – Create a space conducive for healthy sleep. Make your bed and room temperature comfortable. Take a hot bath at night to relax. Leave distractions outside of the bedroom (televisions, computers, smart phones). Stick to a routine – go to bed and wake up at the same time each day.
  • Consider massage therapy – The power of touch can be therapeutic and relaxing.
  • Give acupuncture a try – Acupuncture can be great for relieving fatigue and anxiety.

It is important to note that according to a 2017 article published in the Pharmaceutical Journal, duloxetine, milnacipran nor pregabalin are not approved treatments for fibromyalgia in Europe. In Australia, milnacipran is the only approved drug for treating fibromyalgia, and in Canada, duloxetine and pregabalin are approved.

In 2016, the European League Against Rheumatism (EULAR) updated their fibromyalgia pharmaceutical treatment recommendations to include the following:

  • Amitriptyline (at low dose)
  • Duloxetine
  • Milnacipran
  • Tramadol
  • Pregabalin
  • Cyclobenzaprine

The EULAR strongly recommends non-drug therapy intervention as a first step in managing and treating fibromyalgia. These therapies include:

The 2017 Polish Archives of Internal Medicine study also emphasizes the importance of education in the treatment and management of fibromyalgia. An individual’s healthcare practitioner should be discussing what fibromyalgia is, what the individual’s treatment plan will look like and what the prognosis is likely to be. The intent is to alleviate any anxiety the individual may experience with their new diagnosis and to keep the individual engaged in their own health and progress. Keeping the lines of communication open between and individual and their healthcare practitioner is vital in the management of fibromyalgia. An individual with fibromyalgia should feel comfortable discussing symptom changes with their trusted healthcare practitioner and their healthcare practitioner should welcome the participation.

What is the prognosis?

To date, there is no cure for fibromyalgia. Continued research and studies, however, have resulted in the recommendation of therapies and medications proven to reduce symptoms and improve overall quality of life. The NFA suggests that an “integrative approach” to treating fibromyalgia will reap the most benefits. Taking the best of western medicine and complementary therapies and creating a treatment plan specifically targeted towards an individual’s unique symptoms will prove the best approach to manage fibromyalgia.

In Conclusion

Prompt diagnosis and treatment of fibromyalgia are imperative to maintaining an individual’s quality of life. Building a trusting, communicative relationship between an individual and their healthcare practitioner will result in more efficient symptom management and less stress and anxiety. If you or someone you know suspects a fibromyalgia diagnosis, be sure to thoroughly discuss any changes in health (physical and emotional) with a healthcare practitioner in order to start receiving the quality care that everyone deserves.

 

References
About fibromyalgia. (2018). Retrieved from: http://www.fmaware.org/about-fibromyalgia/
Afari, N., Ahumada, S., Wright, L., Mostoufi, S., Golnari, G., Reise, V., & Gundy-Cuneo, J. (2014). Psychological trauma and functional somatic syndromes: A systematic review and meta-analysis. Psychosomatic Medicine. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3894419/
Ahmad, J., & Tagoe, C. (2014). Fibromyalgia and chronic widespread pain in autoimmune thyroid disease. Clinical Rheumatology. Retrieved from: https://www.researchgate.net/publication/259770475_Fibromyalgia_and_chronic_widespread_pain_in_autoimmune_thyroid_disease
Fibromyalgia. (n.d.). Retrieved from: https://www.arthritis.org/about-arthritis/types/fibromyalgia/
Fibromyalgia. (2019). Retrieved from: https://www.nhs.uk/conditions/fibromyalgia/
Häuser, W., Ablin, J. Perrot, S., & Fitzcharles, M. (2016). Management of fibromyalgia: practical guides from recent evidence-based guidelines. Polish Archives of Internal Medicine. Retrieved from: https://www.researchgate.net/profile/Winfried_Haeuser/publication/312232818_Management_of_fibromyalgia_practical_guides_from_recent_evidence-based_guidelines/links/587c695108ae4445c06507da/Management-of-fibromyalgia-practical-guides-from-recent-evidence-based-guidelines.pdf
Kato, K., Sullivan, P., Evengard, B., & Pedersen, N. (2009). A population-based twin study of functional somatic syndromes. Psychological Medicine. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3947533/pdf/nihms-543691.pdf
Living with fibromyalgia, drugs approved to manage pain. (2014). Retrieved from: https://www.fda.gov/consumers/consumer-updates/living-fibromyalgia-drugs-approved-manage-pain
Macfarlane, G., Kronisch, C., Dean. L., Atzeni, F., Häuser, W., Fluß, E. …Jones, G. (2016). EULAR revised recommendations for the management of fibromyalgia. Annals of the Rheumatic Diseases. Retrieved from: https://ard.bmj.com/content/annrheumdis/76/2/318.full.pdf
Northcott, M., Guymer, E., & Littlejohn, G. (2017). Pharmacological treatment options for fibromyalgia. The Pharmaceutical Journal. Retrieved from: https://www.pharmaceutical-journal.com/research/review-article/pharmacological-treatment-options-for-fibromyalgia/20203533.article?firstPass=false
Torrente-Segarra, V., Salman-Monte, T., Rúa-Figueroa, I., Pérez-Vincente, S., López-Longo, F., Galindo-Izquierdo, M. …Pego-Reigosa, M. (2016). Fibromyalgia prevalence and related factors in a large registry of patients with systemic lupus erythematosus. Clinical and Experimental Rheumatology. Retrieved from: https://www.researchgate.net/profile/Blanca_Hernandez-Cruz/publication/284164203_Fibromyalgia_prevalence_and_related_factors_in_a_large_registry_of_patients_with_systemic_lupus_erythematosus/links/5df9250792851c83648542c0/Fibromyalgia-prevalence-and-related-factors-in-a-large-registry-of-patients-with-systemic-lupus-erythematosus.pdf
Wallace, D., Gavin, I., Karpenko, O., Barkhordar, F., & Gilis, B. (2014). Cykotine and chemokine profiles in fibromyalgia, rheumatoid arthritis and systemic lupus erythematosus: a potentially useful tool in differential diagnosis. Rheumatology International. Retrieved from: https://link.springer.com/content/pdf/10.1007/s00296-014-3172-2.pdf

 

Author: Liz Heintz

Liz Heintz is a technical and creative writer who received her BA in Communications, Advocacy, and Relational Communications from Marylhurst University in Lake Oswego, Oregon. She most recently worked for several years in the healthcare industry. A native of San Francisco, California, Liz now calls the beautiful Pacific Northwest home.

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