Ruling Out Autoimmune Diseases

With the symptoms of fibromyalgia common across a range of different diseases, syndromes and conditions, it is essential to ensure that the correct diagnosis is obtained. This is because the treatment of autoimmune diseases is much different than the treatment of fibromyalgia, although the symptoms for both may initially respond positively to the medication or therapeutic interventions used for one of the conditions.

To add to the complication for many patients is the fact that an autoimmune disease and fibromyalgia can occur at the same time. The symptoms of fibromyalgia may be attributed to the diagnosis of the autoimmune condition but may not respond effectively to the treatment for the confirmed diagnosis. This can be frustrating for both the doctor and the patients as treatment seems to be unsuccessful. As the treatment options fail to work the stress level for the patient increases, often leading to further development of fibromyalgia symptoms and a greater risk of developing depression and anxiety.

What Is An Autoimmune Disease?

An autoimmune disease or disorder occurs when the body misinterprets information due to a mutation in cells that control the immune response. In other words the body is not able to accurately tell what is a foreign cell that needs to be destroyed from a healthy cell that is needed in the body. In autoimmune diseases the body literally destroys its own cells, leading to potential life threatening conditions. The United States Department of Health and uHuHuman Services Office on Women’s Health reports that over 23.5 million citizens of the US have at least one of the over 80 different recognized autoimmune disorders. 1

Autoimmune disease are not always life threatening and most can be successfully managed. Common autoimmune conditions that can be controlled or managed include type 1 diabetes, hypothyroidism, hemolytic anemia, inflammatory bowel disease, multiple sclerosis, psoriasis, rheumatoid arthritis, vitiligo, and inflammatory myopathies.

Autoimmune diseases can be present at birth, or they can develop due to an injury, viral infection or other type of trauma, disease, or exposure to specific toxins or substances in the environment. Since many are genetically based, a family history as well as a grouping of symptoms is often the first step in a diagnosis. Not all autoimmune diseases are easily diagnosed and with multiple overlapping symptoms it can take a significant amount of time to actually obtain the correct diagnosis.

There are some groups that are pressing to have fibromyalgia categorized as an autoimmune condition. This is because initial research linked the condition with the development of arthritis and related conditions, which are autoimmune in nature. Currently medical experts do not classify fibromyalgia or chronic fatigue syndrome as autoimmune conditions since the specific root cause of the symptoms has not been clearly linked to an autoimmune response.

More recent research may show a link between two specific autoantibodies, anti-68/48 kD and anti-45 kD, which are produced by the body in response to a mistakenly identified foreign body. These two autoantibodies may be useful as markers in determining fibromyalgia, as is a possible link between thyroid autoimmunity and the development of fibromyalgia and chronic fatigue syndrome.

Autoimmune Diseases and Fibromyalgia

In studies of patients that have identified autoimmune disorders, the prevalence of fibromyalgia is much higher than in the general population, which may be important in linking these types of disorders and in comprehensive diagnosis. Up to 65% of patients with lupus, 57% of patients with rheumatoid arthritis and 24% with psoriatic arthritis also have the necessary symptoms to meet the criteria for fibromyalgia as outlined by the American College of Rheumatology. 2

Other research tends to support this information with a study completed in Finland showing that patients with a wide range of different rheumatic disorders including systemic lupus erythematosus, Sjögren’s syndrome, and rheumatoid arthritis having increased rates of simultaneous fibromyalgia than in a similar population that is not diagnosed with a rheumatic disorder. 3

Many experts now believe that the levels of pain experienced by some but not all individuals with the rheumatic disorder may, in fact, be fibromyalgia occurring concurrently but that is undiagnosed. Patients that are diagnosed with these types of conditions or that have other types of autoimmune conditions need to be aware of the increasing chance of the development of fibromyalgia.

What Patients Need To Do

People that are diagnosed with an autoimmune disorder or suspect an autoimmune disorder because of family history or symptoms presented need to talk to their doctor about the possibility of a diagnosis of fibromyalgia. In addition, patients need to be proactive in their medical care and should start a pain or symptom journal to accurately track all types of pain, discomfort and symptoms. This includes symptoms that are known to be associated with any type of autoimmune disorder as well as what may appear to be unrelated symptoms.

It is very important to discuss all your symptoms with your doctor and not avoid talking about them because you may not feel they are relevant. All symptoms, including problems of the bladder, reproductive system, neurological issues or changes in pain, tenderness and mood should be accurately reported to your medical doctor. If you are working with a primary care physician and one or more specialists, provide information to each doctor and ensure that the doctors are communicating with each other.

Since fibromyalgia is not progressive but may occur in flares, this can be a key element in distinguishing it from autoimmune disorders that typically are progressive in severity and scope. When both conditions are present patients may note a continual worsening or prevalence of symptoms combined with flares of pain, stiffness, fibro fog, sleep disturbances or other symptoms. The presence of these flares can be significant in assisting in getting a concurrent diagnosis of fibromyalgia and the autoimmune disease.

References

1 Autoimmune diseases fact sheet. (n.d.). Retrieved from Womens Health. gov: www.womenshealth.gov/publications/our-publications/fact-sheet/autoimmune-diseases.cfm#f

2 Buskila, D., & Sarzi-Puttini, P. (2008). Firbromyalgia and Autoimmune Diseases: the Pain Behind Autoimmunity. Israel Medical Association Journal , 77-78.

3 Makinen, H., & Hannonen, P. (2009). How to Assess Patients with Rheumatoid Arthritis and Concomitant Fibromyalgia? The Journal of Rheumatology , 9-11

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