Do I have lupus or fibromyalgia ?

[Guest guest]

 

Unfortunately some fibromyalgia patients are erroneously

diagnosed as having lupus, a potentially dangerous condition that affects about

2 in every 1000 people. Through your doctor and educational literature and

support groups, you have learned lupus patients can have involvement of almost

any system of the body including severe involvement of the kidneys, heart and

brain. This is scary information; even though you know that only a minority of

lupus patients have such a severe course.

The commonest problems encountered

by most lupus patients are joint pains, muscles pains, fatigue and skin rashes.

It is not unreasonable to assume an increased level of fatigue and increasing

joint pain heralds a severe flare of your lupus that may even progress to

life-threatening internal organ involvement. Such thoughts are

anxiety-provoking and depressing; they can cause sleepless nights. Both you and

your doctor may be convinced that your accelerating symptoms represent a lupus

flare. You may be put on prednisone or the dose of your steroids may be

increased. But before you and your doctor jump to conclusions, consider the

possibility that you could also have fibromyalgia.

Fibromyalgia is a common condition

of musculoskeletal pain, sleep disturbance and fatigue, which affects about 20

out of every 1000 persons. Recent studies have shown that approximately

one-third of patients with lupus also have fibromyalgia. It is important to

understand that the fibromyalgia in these patients develops after the lupus has

become well established. It is extremely rare for a fibromyalgia patient to

later develop lupus - I have only seen this in 2 patients in 30 years of practice

as a Rheumatologist. Although fibromyalgia patients have widespread body pain

which arises from their muscles, they often feel that the pain is originating

in their joints. In addition to widespread pain, other common fibromyalgia

symptoms include a decreased sense of energy, poor sleep and varying degrees of

anxiety and depression (related to a changed physical status). To complicate

matters further, other medical conditions are commonly associated with

fibromyalgia. These include irritable bowel syndrome, tensioˆò

Criteria

Definition

1

Malar rash

Fixed

erythema over cheeks but sparing nose-cheek folds

2

Discoid

rash

Raised red

patches with scarring in older lesions

3

Photosensitivity

Skin rash

as a result of unusual reaction to sunlight

4

Mouth

ulcers

Oral or

nasal ulcers - must be observed by a physician

5

Arthritis

Tenderness

and swelling in at least 2 joints observed by a physician

6

Serositis

Either: 1.

Pleurisy on examination by a physician or Xray changes

or

2. Pericarditis noted by a physician or ECG changes

7

Kidney

disease

1.

Persistent protein in the urine of 0.5 grams or more

or

2. Cellular casts (maybe red cells, white cells or hemoglobin)

8

Blood

disease

One of the

4 following:

1..

Hemolytic anemia with reticulocytosis

2..

Leukopenia with a white cell count of less than 4,000/mm2

3..

Lymphopenia with a lymphocyte count of less than 1,500/mm2

4..

Thrombocytopenia with a platelet count of less that 100,000/mm2

9

Brain

disease

Either: 1.

Psychosis or 2. Seizures. Both must be without other causes

10

Positive

ANA

An

abnormal titer of an anti-nuclear antibody (ANA) test in the absence of other

diseases or drugs known to cause a positive ANA.

11

Other

antibodies

Any one of

these 4 tests:

1..

A positive LE cell preparation

2..

A positive test for anti-DNA antibodies

3..

A positive test for the Sm nuclear antigen

4..

Antibodies to phospholipids/cardiolipin, a positive lupus anticoagulant test or

a false positive for syphilis

It is important to realize that the

symptoms of fibromyalgia do not respond to corticosteroids such as prednisone

or even immunosuppressive agents, such as azathioprine, methotrexate or

cyclophosphamide. These are powerful and important drugs in the treatment of

lupus but are often associated with undesirable side effects. Thus, making a

distinction between fibromyalgia symptomatology and lupus symptomatology is of

great practical relevance in deciding what medications to use.

In my experience, most lupus

patients are often shocked to hear that they also have fibromyalgia, and in

many cases don’t like being given that diagnosis. They somehow think that

it is not a real disease and detracts attention away from the realities of

having lupus. I can understand these thoughts. However, knowing that some of

your musculoskeletal pain is fibromyalgia-related and not lupus should also be

good news -- as who wants to have lupus flare? Lastly, there are some

" lupus " patients who have only fibromyalgia, but on testing were

found to have a weakly positive ANA. They were incorrectly diagnosed as having

lupus on the basis of the blood test. There is an increasing recognition among

lupus specialists that this false diagnosis scenario is not at all uncommon.

Get your FREE personalized email signature at My Mail Signature!