Diagnosis Dilemma: Fibromyalgia or Lupus?
One of the most frustrating aspects of having any chronic, incurable disease is the diagnosis process.
Patients don’t want to hear words like “may” or “could be.” Most patients find that knowing the exact diagnosis is preferable to uncertainty.
Begin the Diagnosis Process.
According to the Arthritis Foundation, distinguishing fibromyalgia from lupus usually requires the services of a rheumatologist.
The diagnosis process consists of a comprehensive medical history, a physical examination and laboratory tests.
Both fibromyalgia and lupus share several symptoms in common. Shared symptoms include muscle pain, joint pain or stiffness, and fatigue.
This is where the similarity begins to disappear. Lupus patients may have a facial rash, kidney problems, shortness of breath or a blood clot.
The physical exam reveals a definitive difference. Fibromyalgia produces tenderness above muscles.
However, the fibromyalgia patient does not have swollen joints or stiffness. Lupus patients typically have swollen joints, joint pain, joint stiffness and/or limited motion.
The most common blood test to help with the diagnosis is the antinuclear antibody test (ANA).
It is almost always positive in lupus patients. Unfortunately, it can also be positive in patients who have rheumatoid arthritis, scleroderma and Sjogren’s syndrome.
People with fibromyalgia usually have normal lab results. The patients who have a positive ANA test have more laboratory tests to confirm a diagnosis of lupus.
A definitive diagnosis is critical because the treatments differ for the two diseases.
Learn the ABC’s of Laboratory Tests.
Lupus patients quickly learn a new set of ABC’s when they get a definitive diagnosis.
According to Fibromyalgia News Today, there is now a new test to distinguish fibromyalgia from lupus. Some 15-25 percent of fibromyalgia patients also have a positive ANA test.
Lupus patients have specific anti-DNA antibodies in addition to a positive ANA test. This new test utilizes these cell-bound complement activation products (CB-CAPs) biomarkers (including erythrocyte-C4d, EC4d, and B-lymphocyte-C4d, BC4d).
Researchers compared 75 lupus patients and 75 fibromyalgia patients who had confirmed diagnoses.
Sixty percent of the lupus patients were positive for this test while 100 percent of the confirmed fibromyalgia patients were negative.
This cell-bound component test (CB-CAP) serves two distinct purposes:
- Positive confirmation of a lupus diagnosis
- Exclusion of fibromyalgia patients from further testing for lupus
Why Is the Differential Diagnosis So Important?
According to Dr. Robert Katz, it is critical to determine which syndrome a patient is suffering. Although there is an overlap of symptoms, the treatments are different.
Consequences of undiagnosed lupus are serious, including heart attacks, miscarriages, and strokes.
Lupus symptoms may develop over a period of time. At first, only muscle soreness, sleep loss, and fatigue are apparent.
The early stages of lupus are frequently confused with fibromyalgia. Yet it’s critical to distinguish because the treatments are very different.
Fibromyalgia patients are treated with muscle relaxers, antidepressants and nerve pain medicines. Treatment is aimed at symptom relief.
Lupus patients may receive very aggressive treatment with a number of drugs simultaneously depending on which organs have been affected.
Treatments include anti-malarial drugs, steroids, immunosuppressive drugs, and Benlysta.
Lupus patients suffer from more debilitating and dangerous symptoms. They may experience:
- Long-term facial rash
- Swollen, painful joints that restrict normal activities such as writing, kneeling or walking
- Shortness of breath and pleurisy
- Blood clots, sometimes resulting in heart attacks or strokes
- Pregnancy complications
Take the Quiz.
About 90 percent of both fibromyalgia and lupus patients are women. Since fatigue and sleep issues are common for women who work and women who have children, women may be reluctant to bring up their seemingly vague symptoms to their physician.
These quizzes are not designed to definitive diagnose a person. But they will help you decide if your symptoms may warrant a visit with your physician.
Can I Have Both?
Sufferers of both lupus and arthritis may suffer from fibromyalgia too. The NCBI wanted to know if fibromyalgia created a bias in the Systemic Lupus Erythematosus Activity Questionnaire to assure this questionnaire was not overly biased toward fibromyalgia symptoms.
The study showed that 21 percent of SLE (systemic lupus erythematosus) and 17 percent of arthritis patients suffered from fibromyalgia.
The NCBI concluded that having fibromyalgia symptoms did not create a bias in for assessment questionnaire.
What about Tender Points?
Sometimes, a lupus patient experiences an increase in pain. Their physician might assume that the patient is experiencing a flare and simply increase the patient’s steroid medication. But, not so fast…the lupus patient may have developed fibromyalgia.
Dr. Robert Bennett relates that it is rare for fibromyalgia patients to develop lupus. However, it is not uncommon for lupus patients to develop fibromyalgia.
Fibromyalgia causes symptoms including headaches, PMS, IBS, and cold intolerance. So how does the physician proceed?
Fibromyalgia patients describe that they hurt all over. And that is an accurate description of the patient’s perspective.
However, it is well-known that there are 18 (9 pairs) of tender points that are unique to fibromyalgia patients.
The American College of Rheumatology suggests that patients who have at least 11 of these tender points probably suffer from fibromyalgia. In other words, tender points are usually diagnostic for fibromyalgia.
What are the Diagnostic Symptoms of Lupus?
According to the Lupus Foundation of America, there are 11 criteria developed by the American College of Rheumatology. If four out of the 11 are present, the patient is diagnosed with lupus.
- Butterfly rash on the face
- Red, disk-shaped rash or patches
- Sensitivity to the sun resulting in a skin rash
- Mouth ulcers
- Joint pain and/or swelling in two or more joints
- Pleurisy or pericarditis
- Protein in the urine
- Seizures or psychotic episodes
- Low blood counts
- Anti-DNA or anti-Sm autoantibodies or antiphospholipid antibodies
- Positive or abnormal ANA
Because of the requirement that four of these symptoms/signs be present, it’s easier to understand why it may take months or even, years before a definite diagnosis of lupus is made for some patients.
Understanding Lupus Better.
The medical term for lupus is SLE, systemic lupus erythematosus. The important word to help a patient understand their disease is “systemic.”
That means the disease affects the entire body and can affect multiple organs, including the kidneys, heart, brain, and lungs.
Brigham and Women’s Hospital in Boston is a well-known hospital located in Boston, Massachusetts.
They have produced a YouTube video to help patients better understand what lupus is and how it is treated.
What Are the Diagnostic Symptoms of Fibromyalgia?
According to the National Fibromyalgia and Chronic Pain Association, there are 3 primary symptoms plus a number of overlapping conditions.
- Pain – widespread, ongoing and intense
- Fatigue – a deep level of fatigue that interferes with everyday life
- Sleep – the inability to experience deep, restorative sleep
- Overlapping symptoms including headaches, irritable bowel, and bladder syndrome, brain fog, sensitivity to the cold, anxiety and/or depression and dry eyes.
Will Exercise Really Help Fibromyalgia Pain?
The Mayo Clinic makes a strong case for exercise to help combat the pain caused by fibromyalgia. That might seem to be contradictory to patients at first. After all, if you’re in pain and tired, won’t exercise make you feel worse?
Study after study has shown that exercise relieves fatigue and alleviates pain. Patients should start slowly and build up.
The healthcare professionals at Mayo Clinic suggest beginning with just two minutes of walking.
Ask your physician for a referral to a physical therapist (preferably one who has worked with fibromyalgia patients).
If you’ve been house-bound and inactive, you will need to gradually build up to exercising three times weekly for 30 minutes.
Concentrate on low impact exercises like walking, biking (a stationary bike at home will do) and swimming. Chair yoga offers gentle stretching exercises. There are a number of DVD’s available online for chair yoga.
How Can I Find Lupus Symptom Relief?
Chronic pain in lupus often disappears once a flare is under control. About 30 percent of lupus patients also suffer from fibromyalgia and experience chronic pain.
The advice given above for fibromyalgia patients will work for the chronic pain of lupus sufferers.
Other symptom relief options from the Lupus Foundation of America include moist heat for joint pain and warm showers or soaking in a warm tub. Deep breathing exercises, yoga, tai chi, and guided imagery work too.
Patients need to consult with their physician before beginning an exercise program.
What’s the Answer for You?
As you’ve seen, the diagnosis of lupus, in particular, can be a long, complicated process that may take months or years.
Even rheumatologists can be reluctant to formally diagnose you until they are absolutely sure because the diagnosis constitutes a pre-existing condition.
Perhaps the best answer is to recognize the similarity of symptoms for fibromyalgia and lupus, accept that the diagnosis may take time and seek symptom control through the use of exercise, stress relief, pacing yourself in daily life and getting enough rest and sleep.
The definitive diagnosis will come. Be willing to seek a qualified second opinion when your symptoms worsen.