Fibromyalgia and Systemic or Autoimmune Diseases

Fibromyalgia syndrome (FMS) has been confused with or misdiagnosed as various other “similar” diseases. These similar diseases include several systemic or autoimmune disorders such as rheumatoid arthritis, lupus and Sjogren’s Syndrome. Yet, despite similarities between these medical conditions and the existence of co-morbidities in many cases, fibromyalgia is a separate medical condition.

What is the relationship between fibromyalgia and autoimmune diseases?

There seems to be some confusion among people at times about the relationship between fibromyalgia and autoimmune disorders like Sjogren’s syndrome (SS) and rheumatoid arthritis (RA). While there may be certain crossovers, these are very distinct and separate medical issues. Fibromyalgia is not Sjogren’s syndrome or rheumatoid arthritis which are both autoimmune diseases. The major cause of autoimmune disease is the failure of the immune system to distinguish its own tissue from invasive tissue. The immune system produces a response that attacks and damages the body’s tissues.

In the case of Sjogren’s syndrome, whether primary (no comorbidities) or secondary (with comorbidities such as FMS or RA), the body part affected is the tear-glands (lacrimal glands) or the salivary glands – both responsible for producing moisture. As is the case with fibromyalgia, the cause is not specified. It could be genetic and/or environmental factors at work. Whatever the reason, the autoimmune system is responsible for the invasion and destruction of the glands.

There are other commonalities between fibromyalgia and Sjogren’s Syndrome. These include chronic fatigue which is why fibromyalgia and Sjogren’s syndrome are sometimes confused when not all of the symptoms are considered. Chronic fatigue is found in approximately 70% of all primary Sjogren’s Syndrome patients. As in the case of FMS, fatigue reduces the quality of life both physically and financially.[1]

In the case of rheumatoid arthritis, a degenerative autoimmune disease, there are various symptoms that can overlap with fibromyalgia that increase the severity of either health condition. For example, both rheumatoid arthritis and fibromyalgia may lead to depression. However, rheumatoid arthritis is characterized by deformation of the joints. Symptoms include joint swelling, a loss of appetite, limited range of motion (ROM) and overtly misshapen joints. Once again, it is the immune system causing the problem as it attacks healthy tissue. If left untreated, rheumatoid arthritis may eventually actually attack the organs.

The relationship between RA and FMS is an interesting one needing much more study. You may have fibromyalgia and rheumatoid arthritis simultaneously. Yet, which one came first? Those individuals who have rheumatoid arthritis are prone to developing fibromyalgia, yet the converse is not true.[2] There is a real lack of information right now, but researchers are studying possible connections between autoimmune diseases and fibromyalgia.

Is there any connection between fibromyalgia and systemic disorders?

It is common for those who have FMS to also display symptoms reflecting the presence of another disease or disorder. While rheumatoid arthritis and Sjogren’s Syndrome are two autoimmune diseases commonly found to be co-morbid with fibromyalgia, a systemic disease may also overlap. This is Systemic Lupus Erythematosus (SLE), usually referred to as lupus.

Lupus is similar to rheumatoid arthritis in that it may affect the joints. Yet, SLE can also be characterized by its adverse affect on various body organs including the heart, lungs, kidneys, skin, and nervous system. However, lupus is comparable to fibromyalgia in that it is more common among women than men. Also, lupus exhibits symptoms of pain, inflammation and damage to the tissue. Fibromyalgia is similar but lacks inflammation and tissue damage. Like fibromyalgia, lupus can be totally unpredictable. It may be constant. It may seem to disappear (go into remission) and then will unexpectedly flare up again.

The relationship between lupus and fibromyalgia is also similar in another fashion. Like rheumatoid arthritis and fibromyalgia, it is not those who have fibromyalgia that are prone to lupus. Rather, it is the individuals who have lupus who are at higher risk for developing fibromyalgia. In a study of patients it was noted that of those that had lupus, 21% also had FMS.[3]    

Is fibromyalgia an autoimmune disease or disorder?

The immune system attacks connective tissues in many cases. The mistaken attack on healthy tissue can impact organs, the digestive system, muscles, nerves and the endocrine system. Fibromyalgia does not appear to attack healthy tissue. Rather than attacking the body, the autoimmune system of fibromyalgia patients fails to respond or performs improperly like during the production and control of the enzyme hyaluronidase or hyaluronic acid.

Indications that fibromyalgia is not an autoimmune syndrome are clearly indicated by several factors. Prominent among these is the lack of evidence in the blood of immune biological elements. Also, inflammation is a characteristic of autoimmune disorders such rheumatoid arthritis. While FMS patients experience some inflammation and/or swelling of the body extremities like the feet and hands, this is not due to fibromyalgia but rather to overlapping or co-morbid conditions.

Another feature of autoimmune diseases is tissue degeneration. This occurs when the tissues are damaged to the point of destruction. This characteristic is totally lacking in those who have fibromyalgia. In addition, conditions such as rheumatoid arthritis, Sjogrens, and lupus all have blood tests that can verify their presence and lead doctors to the correct diagnosis. Fibromyalgia has no such blood tests available yet. That being said, it does not mean that the autoimmune system does not play a role in the onset of fibromyalgia. It may simply indicate that researchers have not yet discovered exactly what part it plays.

There are More Questions than Answers

Fibromyalgia is a complex syndrome which is separate from other medical conditions like autoimmune diseases and systemic disorders. It is common, however, for it to be co-morbid with these other medical issues. Among the more common comorbidity is rheumatoid arthritis. The resultant blend of fibromyalgia with this autoimmune disease results in serious and deleterious effects on a person’s life. The medical expenses incurred by someone with fibromyalgia are typically higher than those incurred by an individual with rheumatoid arthritis. When someone has two medical conditions, the demands made on the medical system and the economic costs are more than doubled– whether in terms of personal finances, lost work days or the cost of government disability payments.[4] It is essential to find the correct diagnosis and discover a treatment that will control symptoms as effectively as possible.

References

[1] Priori, R; Iannuccelli, C; Alessandri, C; Modesti, M; Antonazzo, B; Di Lollo, AC; Valesini, G; and Di Franco, M (2010). “Fatigue in Sjögren’s Syndrome: Relationship With Fibromyalgia, Clinical and Biological Features.” Clinical and Experimental Rheumatology, 28(6,SUP36): S82-S86.

[2] Wolfe, F; Michaud, K; Li, T; and Katz, RS (2009). “Chronic Conditions and Health Problems in Rheumatic Diseases: Comparisons with Rheumatoid Arthritis, Noninflammatory Rheumatic Disorders, Systemic Lupus Erythematosus, and Fibromyalgia.” The Journal of Rheumatology, 37(2):305-315.

[3] Wolfe, F; Petri, M; Alarcón, GS; Goldman, J; Chakravarty, EF; Katz, RS; and Karlson, EW (2011). “Fibromyalgia, Systemic Lupus Erythematosus (SLE), and Evaluation of SLE Activity.” The Journal of Rheumatology, 36(1): 82-88.

[4] Silvermana, S; Dukesb, EM; Johnstonc, SS; Brandenburgb, NA; Sadoskyb, A; and Husec DM (2009). “The Economic Burden of Fibromyalgia: Comparative Analysis with Rheumatoid Arthritis.”Current Medical Research and Opinion, 25(4):829-840.

This article was originally published on July 11, 2012 and last revision and update of it was 9/7/2015