Fibromyalgia is a disorder in pain processing in the brain that causes chronic pain and fatigue as its main symptoms. Fibromyalgia is also associated with myriad of other symptoms and related conditions. For example, fibromyalgia is related to anxiety, migraine headaches, irritable bowel syndrome and depression, all conditions that exist independently of fibromyalgia but are more common in fibromyalgia sufferers than the general population. Fibromyalgia also has a link with some systemic autoimmune disorders, such as lupus and rheumatoid arthritis, in which the body’s immune system mistakenly attacks itself, causing inflammation and damage. This article will discuss the link between fibromyalgia and these autoimmune conditions.
Fibromyalgia is sometimes called an arthritis-related condition, because a large proportion of fibromyalgia patients also suffer from joint pain as well as muscle pain. Fibromyalgia is not true arthritis, however, because in fibromyalgia there is no actual inflammatory damage being done to the joints. Joint pain in fibromyalgia is still due to affected muscles, tendons and connective tissues, not damage to the joints themselves. All types of arthritis involve inflammation and structural damage to the joints, so fibromyalgia joint pain is not arthritis in itself.
Rheumatoid arthritis is a completely separate condition. It is a type of arthritis caused by autoimmune dysfunction. The immune system produces antibodies by mistake that attack its own structures instead of foreign invaders. In rheumatoid arthritis, the primary damage is done to the joints, but many organs can be affected too if the inflammation is severe and uncontrolled. Rheumatoid arthritis leads to joint pain, joint stiffness and joint deformity, especially in the hands. Rheumatoid arthritis seems to have a link with fibromyalgia; not all fibromyalgia sufferers also have comorbid (conditions related to) arthritis, but rheumatoid arthritis is more common in fibromyalgia sufferers than it is in the rest of the population.
Rheumatoid arthritis requires a completely separate treatment path than fibromyalgia. Drugs that can be used to treat the inflammation involved in rheumatoid arthritis include anti-rheumatic drugs, also called DMARDs, non-steroidal anti-inflammatory medications, COX-2 inhibitors, medications that are usually used to treat malaria and corticosteroids. The goal of treatment for rheumatoid arthritis is to decrease inflammation to keep the autoimmune damage under control. If the treatment options previously listed are not enough to accomplish this goal, drugs that directly modify the immune system can be used. These drugs are extremely potent, but they have more severe potential side effects, including increasing a person’s risk for infection and certain types of cancer, especially leukemia.
Systemic lupus erythematosus, the most common type of lupus, is a system-wide autoimmune disease. Lupus can affect pretty much any part of the body, including the skin, the digestive tract, the lungs, the heart and the nervous system. Common symptoms of lupus include a facial rash that is shaped like butterfly wings, severe fatigue, chest pain from lung involvement, fever, joint pain, swollen lymph nodes and abnormal sensitivity to sunlight. Other symptoms arise when specific organs are affected, like heart arrhythmias, difficulty breathing, nausea and vomiting, peripheral neuropathy, seizures and personality changes. Some patients with lupus will experience more symptoms than others; it all depends on which parts of the body are affected by the autoimmune inflammation.
Studies show that people with systemic lupus erythematosus are more likely to have fibromyalgia as well. Lupus is not a curable condition. Just like with rheumatoid arthritis, the goals of treating lupus are controlling the inflammation and reducing the damage to the body that it causes. When symptoms of lupus are not severe, non-steroidal anti-inflammatory drugs, anti-malarial drugs and low-dose corticosteroids can usually control the inflammation. In patients with more severe involvement, higher doses of corticosteroids and immune-modifying drugs must be used to prevent further organ damage. These treatments are used on a short-term basis, just until the inflammation is under control.
There may be other systemic inflammatory conditions, besides rheumatoid arthritis and lupus, that fibromyalgia also has a connection with. The explanation for this link is unknown. More research is required to discover why this link exists. Preliminary studies suggest that having an autoimmune condition is a risk factor for developing fibromyalgia, and not the other way around. Both fibromyalgia and the majority of systemic autoimmune diseases are more common in women than they are in men. It is thought that autoimmune diseases are more common in women because of the inherent small differences in the immune systems of men and women. Regardless of what the cause of the link between fibromyalgia and autoimmune disorders may be, patients who have both conditions require special treatment considerations, because autoimmune diseases and fibromyalgia have entirely different treatment plans. Both conditions must be treated separately, but in a way that is conscious of drug interactions, pain management and the overall health of the patient.