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Hi
there
For anyone working with fibromyalgia and lupus, it is increasingly evident that one often accompanies the other. For a number of reasons; however, the accuracy of differentially diagnosing one from the other is not so simple. Obviously, accurate diagnosis is an essential in good medical service.
One reason for misdiagnosis is that many medical professionals are still reluctant to use the diagnosis of fibromyalgia given that there is no single diagnostic test and that medications are not overly effective. In these circumstances, numerous doctors seeing a mildly positive antinuclear antibody test (ANA) leap to the conclusion of diagnosing lupus. Two problems lie herein: 1) fibromyalgia may be misdiagnosed as lupus and; 2) a lupus patient with fibromyalgia may not be diagnosed with the latter.
Many patients with lupus simultaneously have fibromyalgia. For instance, Morand et. al. (1994) concluded that 25% of studied lupus subjects also had fibromyalgia. Other studies report similar conclusions. G.D. Middleton (1994) reported some important facts from studying lupus patients with fibromyalgia. It was noted that this group had a greater likelihood of having the subsequent symptoms than was the comparison group of lupus patients without fibromyalgia: non-restorative sleep; abdominal pain and bloating; widespread pain; dysmenorrhea; myalgias; depression; and noise and light hypersensitivity. The former group also was less likely to be employed or able to engage in daily activities.
Other symptoms of fibromyalgia in general include cognitive dysfunction, chest and jaw pain, post exertional pain, severe fatigue, fluid retention, dizziness, unexplained bruising, parasthesiae, anxiety, cold intolerance and dyspnea. Other syndromes' symptoms which seem to have an increased presence in fibromyalgia include: Raynauds'; restless leg syndrome (occurring in approximately 60% of fibromyalgia patients); irritable bowel syndrome; migraine; and premenstrual syndrome.
Systemic lupus erythematosus (lupus or SLE) is a chronic, inflammatory autoimmune disease. Lupus can impact the joints, skin, kidneys, nervous system, lungs, heart and other bodily organs. Lupus symptoms are similar in ways to those of other arthritis conditions, making it even more difficult to diagnose accurately. While lupus can have an onset at any age, the onset is generally somewhere between the ages of 19 and 49 years of age.
The majority of fibromyalgia symptoms were presented above; however, an essential item remains to be addressed. People with fibromyalgia have areas of the body which are extremely sensitive to touch known as tender points. The diagnosis of fibromyalgia is partly dependent on the presence of a certain number of such tender points. In addition, many fibromyalgia patients have tender skin and a lower than average level of pain sensitivity (they experience pain at a lower level of stimulation than normal). Studies of somatosensory EEG responses and brain studies have suggested hyperalgesia as the essence of fibromyalgia. It is associated with long term changes in the nervous system or neural plasticity. Importantly, the nervous system is changeable and different people can respond differently subjectively when exposed to the same level of pain stimulation. Something that does not hurt one person can be experienced as severely painful in another. This explains why so many of you are bewildered as you tell me you cannot stand anybody touching you or that even wearing your clothes is painful.
The understanding of lupus and fibromyalgia is made more complex by the introduction of the gender bias. The ratio of females to males having lupus is 10 to 1 and in those having fibromyalgia is 9 to 1. This differential brings more pieces to the puzzle in comprehending lupus and fibromyalgia.
Given that a number of fibromyalgia patients show a mild elevation in their ANA tests, the question may arise as to whether this finding is associated with a greater likelihood that fibromyalgia patients will develop lupus at a point in the future. An increased likelihood of fibromyalgia patients later developing any rheumatic disease, including lupus, has not been shown in any long term studies.
Therefore, there are a number of similarities between fibromyalgia syndrome and lupus which make differential diagnosis tricky. There is a real danger in fibromyalgia patients being misdiagnosed with lupus and then being treated for it. This is because a number of lupus medications are quite powerful and have a number of adverse effects the fibromyalgia patient may be exposed to for no reason. In addition, the fibromyalgia patient may not receive appropriate treatment for their fibromyalgia. Furthermore, the similar clinical and subjective pictures of fibromyalgia and lupus interfere with data gathering and analysis for researching the conditions. Fortunately, strides are being made in diagnosing and understanding both illnesses and much research directed toward gathering further information is heartily suggested.
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Disorder below.
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