Fibromyalgia and lupus have a lot in common. For starters, both are relatively rare. Fibromyalgia affects only about 4 million U.S. adults, and lupus only about 2.5 million.
Women are more likely to have either of these conditions than men. They share many of the same symptoms such as joint aches, muscle aches, and fatigue, which can make them tricky to diagnose. To make it even more confusing, some people have both at the same time. Your doctor can tell the difference.
Lupus and Fibromyalgia Explained
Lupus is an autoimmune disorder. That’s a condition in which your immune system attacks your own body in the way that a healthy immune system would attack infection. In lupus, this immune system malfunction can cause pain, swelling, and even damage to your heart, lungs, kidneys, and brain.
It’s not clear exactly what causes lupus, but your genes may play a role. It mainly affects women and generally develops between the ages of 15 and 44.
Fibromyalgia, on the other hand, is a chronic pain disorder that affects connective tissues like your muscles, ligaments, and tendons. It is commonly found in patients with systemic rheumatic diseases. In people who have it, these tissues may be more sensitive to pain. This could explain why people with fibromyalgia are more likely to get other pain-related disorders like irritable bowel syndrome (IBS), chronic fatigue syndrome, chronic headaches, and chronic pelvic, bladder, jaw, and facial pain. Fibromyalgia has been reported in at least 22 % of patients with lupus.
As in lupus, your genes may raise your risk for this condition. Certain things can trigger fibromyalgia, including:
- Viral infections
- Physical or emotional trauma
- Autoimmune diseases that involve joint inflammation, like rheumatoid arthritis (RA) and lupus
How to Tell the Difference
Lupus and fibromyalgia share many symptoms, such as joint aches, fatigue , and muscle pain. But there are some key ways your doctor can tell the two apart.
- Sleep patterns. While both conditions cause fatigue, people with fibromyalgia often have trouble with sleep. They may find it hard to fall asleep or stay asleep, which can make them feel exhausted when they wake up.
- Unique symptoms. Lupus may cause a rash across your cheeks and nose that gets worse with sun exposure. People who have lupus may also have a history of other health issues, such as kidney disease or a past heart attack or stroke.
- Different findings on physical exams. Joint and muscle pain are common in both conditions. But people with lupus often have stiffness and swelling in their joints. It can be hard for people with this condition to move. In people with fibromyalgia, on the other hand, the joints move normally and aren’t swollen.
- Different blood test results. If your doctor suspects lupus or fibromyalgia, they may check your blood for a protein called antinuclear antibody (ANA). You’re likely to have this protein if you have lupus or another autoimmune disease such as RA, scleroderma, or Sjogren’s syndrome. This blood test will usually be normal if you have fibromyalgia.
It’s very important to get the right diagnosis because treatment for each condition is different. If you do have lupus, for example, your doctor will have to monitor you closely for signs of organ damage. That’s not a risk of fibromyalgia.
Of course, it’s possible to have both conditions. About 25% of people with lupus also have fibromyalgia. If you have lupus and your symptoms, like pain and extreme tiredness, don’t get better with treatment, you may have fibromyalgia, too. It’s important to get an accurate diagnosis of both conditions to help your doctor pinpoint the right treatment for you.
How Is Fibromyalgia Treated?
If you have fibromyalgia, your doctor can treat you with drugs that target brain chemicals that process pain. These include:
Antidepressants. The first thing doctors usually try for fibromyalgia is a tricyclic antidepressant (TCA), such as amitriptyline or nortriptyline. Your doctor may recommend that you take it before bedtime to help you sleep. If it doesn't work, you might try another type of antidepressant called a serotonin-norepinephrine reuptake inhibitor (SNRI), like duloxetine (Cymbalta, Irenka) or milnacipran (Savella).
Anticonvulsants. Epilepsy drugs like pregabalin (Lyrica) and gabapentin relieve pain and improve sleep by blocking certain chemicals that increase pain transmission. You can take these along with an antidepressant.
How Is Lupus Treated?
If you have lupus, your doctor will probably start you on drugs that help bring down inflammation and stop your body from attacking itself. These include:
Hydroxychloroquine. This lupus medicine relieves whole-body symptoms like fever, fatigue, muscle and joint pain, and skin rashes.
Nonsteroidal anti-inflammatory drugs (NSAIDs). Drugs like ibuprofen and naproxen can relieve joint pain caused by inflammation.
Immunosuppressives. If lupus is damaging your organs, such as your kidneys, heart, or lungs, you’ll need treatment with steroids, other immunosuppressive medicines, or both. Steroid-sparing immunosuppressants, like mycophenolate (Cellcept), cyclophosphamide, azathioprine (Imuran, Azasan), voclosporin (Lupkynis), and methotrexate (Rheumatrex), calm down the immune system to stop it from attacking your body.
Targeted therapies. If you have serious organ damage, or if immunosuppressive therapy doesn’t work, you may get targeted drugs such as anifrolumab-fnia (Saphnelo), belimumab (Benlysta), or rituximab (Truxima). These drugs can shut down or slow down the cells, proteins, or processes in your body that help promote lupus.
If you’re diagnosed with both lupus and fibromyalgia, your doctor can prescribe medications to treat both, like antidepressants and an immunosuppressive.
How Lifestyle Can Help With Lupus and Fibromyalgia
If you have either or both of these conditions, some lifestyle strategies can help you cope better and manage your symptoms. These include:
- A well-balanced, low-fat, plant-based diet
- Regular low-impact exercise, such as walking, swimming, or biking, to ease muscle pain and improve strength
- Yoga or tai chi to strengthen muscles and lessen stress and anxiety
