What other illnesses mimic fibromyalgia?

What other illnesses mimic fibromyalgia?

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What is the Difference Between Fibromyalgia and Polymyalgia?

Understand the similarities and differences between polymyalgia and fibromyalgia

Question: I’ve been diagnosed with polymyalgia. What is the distinction between polymyalgia and fibromyalgia? What is the treatment for polymyalgia?

Answer: I can certainly understand the confusion between fibromyalgia and polymyalgia; the names and, to an extent, the symptoms of both conditions are similar.

The word myalgia means pain within the muscles. Both fibromyalgia and polymyalgia are characterized by muscle pain, but many other aspects of the two conditions differ.

Polymyalgia, or polymyalgia rheumatica, is an inflammatory disease of muscle. The cause is uncertain but it is believed to be an autoimmune disease in which the body’s own immune system attacks the connective tissues. The primary symptoms are severe stiffness and pain in the muscles of the neck, shoulder and hip areas. People with this condition also may have flu-like symptoms, including fever, weakness and weight loss. Approximately 15% develop a potentially dangerous condition called giant cell arteritis – an inflammation of the arteries that supply the head.

Fibromyalgia is not an inflammatory condition. It is caused by abnormal sensory processing in the central nervous system. People with fibromyalgia may be extremely sensitive to pain and other unpleasant sensations. To be diagnosed with fibromyalgia, you must experience pain on both sides of the body and in both the upper and lower half of the body. You also will typically have tender points throughout your body. Other common symptoms of fibromyalgia include fatigue, difficulty sleeping and concentrating, irritable bowel syndrome and headaches.

Both fibromyalgia and polymyalgia are more common in women than men. Fibromyalgia can occur at any age, but polymyalgia rarely occurs before age 50. The average age of onset is 70. And whereas fibromyalgia is chronic, often lasting a lifetime, polymyalgia usually resolves itself within two years.

Treatment differs, too. Fibromyalgia is treated with exercise, relaxation techniques, analgesic medications and antidepressants to relieve pain and promote sleep. Treatment for polymyalgia is targeted at relieving inflammation. For some people, daily doses of NSAIDs, such as ibuprofen (Advil, Motrin), are sufficient, but more often corticosteroids, such as prednisone, are required to control inflammation.

Although your polymyalgia will eventually go away completely, it’s important that you be mindful – both now and after your disease resolves – of symptoms such as headaches and blurred vision, which could mean giant cell arteritis. If you develop arteritis, high doses of corticosteroids may be necessary to control the condition and prevent vision loss.

Daniel Clauw, MD
Professor, Anesthesiology
Professor, Medicine (Rheumatology)
Professor, Psychiatry
University of Michigan Medical School
Ann Arbor, Michigan

Lupus and Fibromyalgia

Can you have lupus and fibromyalgia at the same time?

Fibromyalgia is a disorder that can occur alone or secondary to connective tissue disorders such as lupus. Studies suggest that about 25% of people who have lupus also have fibromyalgia.

How can you tell the difference between lupus and fibromyalgia?

It is important for people who have lupus to learn about fibromyalgia because symptoms of both conditions can be similar, but the treatments are different.

People who have lupus or fibromyalgia may experience any or all of the following:

• fatigue
• joint and muscle pain
• stiffness
• numbness
• headaches

However, there are separate treatments for lupus and fibromyalgia. If you are being treated with immunosuppressive medications for your lupus, but have continued pain and fatigue, then it is important for you and your doctor to be able to differentiate symptoms of fibromyalgia from ongoing lupus activity. If your doctor believes that some of your symptoms may be related to fibromyalgia, rather than lupus, then higher doses of immunosuppressive medications, which do not help fibromyalgia, may not be needed at that time for your lupus. Among people with lupus, fatigue has been shown to be correlated with presence of fibromyalgia more so than with lupus disease activity.

A correct diagnosis can alleviate anxiety. For example, if you experience numbness that can be attributed to fibromyalgia rather than lupus, then this can be reassuring. Fibromyalgia does not have the same internal organ manifestations and potential for damage that lupus-mediated problems can have. If some of your symptoms are caused by fibromyalgia instead of lupus, then you may have a better prognosis (outlook).

Distinguishing between lupus and fibromyalgia is also important for research. The presence of fibromyalgia can affect the measurement of lupus disease activity. This may have important implications for studies on medications and other treatments for lupus.

What is fibromyalgia?

Fibromyalgia is a syndrome (a cluster of symptoms and signs) of chronic widespread or multisite musculoskeletal pain. The syndrome typically includes multiple areas of increased pain, as well as fatigue, a sense of waking unrefreshed, and cognitive symptoms. Fibromyalgia is often associated with one or more other symptoms, including sleep problems, stiffness, skin and soft tissue tenderness, headaches, lightheadedness, or tingling sensation.

Diagnosing fibromyalgia can be difficult because there are no definitive routinely available laboratory or imaging tests to confirm the diagnosis and because the symptoms can be similar to so many other disorders. Fibromyalgia is a clinical diagnosis made by your doctor after ruling out other possible causes of your symptoms, including lupus or other connective tissue diseases and thyroid dysfunction.

People with fibromyalgia have ups and downs, just as people with lupus do. They may not experience pain all the time. Stress, anxiety, and other emotional or physical stressors may make symptoms worse.

Is fibromyalgia considered an autoimmune disorder?

Although fibromyalgia may be treated by your rheumatologist, it is not believed to be an autoimmune disorder. Further, while pain is a hallmark of fibromyalgia, the muscles do not show signs of inflammation.

What causes fibromyalgia?

The most widely accepted theory of the cause of fibromyalgia is called central sensitization, in which the central nervous system becomes hypersensitive to sensations. Different nerves carry different kinds of messages to the brain. Some carry pain messages, and others carry other messages, such as pressure sensations. In people with fibromyalgia, it is believed that sensitivity is increased such that the brain experiences a range of messages as representing pain.

Is fibromyalgia linked to mental health conditions or depression?

Fibromyalgia is commonly associated with depression and other mental health conditions. Because depression can cause symptoms similar to those of fibromyalgia, it can be difficult to distinguish between depression and fibromyalgia. Depression itself may affect how people respond to pain, and further research is needed to clarify the association between depression and fibromyalgia.

What are the treatments for fibromyalgia?

There are multiple medications used for treatment of fibromyalgia, including pregabalin (Lyrica) and duloxetine (Cymbalta). Various nonpharmacological treatments, such as cognitive behavioral therapy and different forms of exercise, also have been shown to help some patients.

Pharmacological treatments

Pregabalin (Lyrica), approved by the FDA for treatment of fibromyalgia in June 2007, was originally developed as an antiseizure medication. It is generally well tolerated, with possible side effects that include drowsiness, ankle swelling, and weight gain.

Duloxetine (Cymbalta) and milnacipran (Savella) are antidepressant medications that were approved for treatment of fibromyalgia in June 2008 and January 2009, respectively. They may be associated with nausea, constipation, dizziness, or drowsiness as possible side effects.

Other common treatments include amitriptyline (Elavil), which was originally developed as an antidepressant medication, but is also prescribed for certain types of pain relief. Amitriptyline has potential side effects such as sleepiness, dry eyes and mouth, and weight gain. In addition, gabapentin is an antiseizure medication similar to pregabalin (Lyrica) with a similar spectrum of side effects. Your doctor also may suggest other medications for fibromyalgia, such as cyclobenzaprine (Flexeril), or combinations of medications. Ongoing clinical trials may broaden the range of FDA-approved medications for people with fibromyalgia.

Corticosteroids, such as prednisone and methylprednisolone (Medrol), have not been found to be helpful for fibromyalgia. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin), may help some people with fibromyalgia by providing pain relief, but not due to its anti-inflammatory action.

Nonpharmacological treatments

A number of behavioral approaches have been shown to be useful for fibromyalgia, including aerobic exercise and cognitive behavioral therapy.

Aerobic exercise – such as brisk walking, low-impact aerobics, and swimming – has been found to decrease pain and improve health-related quality of life over time. While it can be challenging to maintain an exercise regimen, many people with fibromyalgia may find this helpful.

Cognitive behavioral therapy (CBT) also has been shown to improve health-related quality of life in people with fibromyalgia. CBT is a directed kind of behavioral modification that involves education and can help people with fibromyalgia approach and cope with pain.

Other complementary approaches have been shown to be effective in some studies, including yoga, tai chi, and acupuncture.

A useful approach may be to combine medication, aerobic exercise, and therapeutic support. Some studies have demonstrated that these combined approaches can be particularly effective.

How can fibromyalgia symptoms be differentiated from lupus activity?

Generally, in people with fibromyalgia and no other underlying condition, tests for inflammatory markers show normal results. Any of the following scenarios also may suggest that fibromyalgia, rather than lupus, is the underlying cause:

• symptoms that do not respond to corticosteroids
• widespread pain despite otherwise successful control of lupus symptoms or flares
• absence of previously positive laboratory tests suggestive of lupus activity

Because fibromyalgia can cause so many different types of symptoms, patients may seek care from a wide variety of specialists. This may contribute to the difficulty of getting a correct diagnosis and in determining whether lupus or fibromyalgia is the cause of any particular symptom. Communication among your doctors (for example, your primary care doctor and your rheumatologist) can help them make an agreed-upon diagnosis. It is also helpful for people with lupus to keep track of all of their symptoms to help their doctors discern any new patterns that may suggest a different diagnosis – and different treatment.

Authors

Sarah B. Lieber, MD, MS
Assistant Attending Physician, Hospital for Special Surgery
Assistant Professor of Medicine, Weill Cornell Medicine

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13 Conditions That Mimic Fibromyalgia

Do you think you might have fibromyalgia? The symptoms may be due to some other condition.

Published on April 15, 2013

Think you might have fibromyalgia? It can be surprisingly hard to tell, even for your physician. There are no blood tests or scans that offer an easy answer.

As a result, the first step toward a fibromyalgia diagnosis is ruling out all other possibilities.

Here are some common conditions that your doctor may consider when trying to figure out if your pain (or other symptom) is caused by fibromyalgia, something else, or possibly both.

Arthritis

The most common form of arthritis is called osteoarthritis, and it is characterized by cartilage degeneration that can lead to tissue and bone damage and terrible joint pain.

This type of pain can mimic the pain in fibromyalgia tender points, such as the hips and knees.

What’s more, both osteoarthritis and fibromyalgia can cause morning stiffness.

Chronic Fatigue Syndrome

Another hard-to-diagnose condition is chronic fatigue syndrome (CFS).

CFS has no known cause, but is characterized by fatigue so severe it derails the whole day. Even after getting adequate sleep and rest, someone with CFS may not have any energy

The fatigue can be accompanied by memory problems, headaches, and pain in the muscles and joints, which are all symptoms of fibromyalgia as well.

«At least 50 percent of people with fibromyalgia meet criteria for CFS,» says Daniel Clauw, MD, the Director of the Chronic Pain and Fatigue Research Center at the University of Michigan. «That can be confusing to patients.»

Depression

Fibromyalgia can often trigger depression; after all, living with everyday pain can be challenging and sometimes demoralizing. However, the symptoms of the two conditions often overlap as well.

Depression, which includes profound feelings of sadness, hopelessness, and loss of interest in activities, can cause a person to think or speak slower than usual or have memory and concentration problems—as can fibromyalgia.

Hypothyroidism

Hypothyroidism—an underproduction of hormones by the thyroid gland in the neck—is caused by an abnormal immune system response that mistakenly attacks normal body tissue.

In this case, the immune response causes a drop in thyroid hormone, a key player in how the body uses energy.

«Having low levels of this hormone can cause people to ‘hurt all over’,» says Dr. Clauw.

The condition is also linked to a slew of other symptoms that overlap with fibromyalgia, such as fatigue, depression, memory loss, and constipation.

«We generally recommend to check thyroid function before diagnosing someone with fibromyalgia,» says Dr. Clauw.

Irritable Bowel Syndrome

Fibromyalgia symptoms like alternating bouts of constipation or diarrhea may be caused by irritable bowel syndrome (IBS), a digestive problem that has no known cause but can be exacerbated by stress or eating certain foods.

Medications may help reduce IBS symptoms, which can also include cramps and stomach pain.

The good news is that IBS does not seem to increase the risk of cancer like some types of inflammatory bowel disease, an ailment that can cause ulcers and inflammation in the digestive tract.

Jaw Problems

Temporomandibular disorder is an ailment in which jaw problems result from nighttime teeth grinding or clenching.

Chewing, yawning, or talking can be painful, and headaches are common—all of which may be confused for fibromyalgia pain.

Lupus

The immune system of a person with lupus will attack normal body tissues, causing inflammation and pain through the muscles and joints, much like the pain experienced by people with fibromyalgia.

People with both conditions are likely to see their symptoms come and go in flares, and they may also experience fatigue. However, lupus patients are likely to have a fever or skin rash (such as a butterfly-shaped rash across the nose and cheeks) along with their fibromyalgia-like symptoms.

Lyme Disease

Some people diagnosed with fibromyalgia report having had Lyme disease in the past. While there’s no research yet to prove a direct connection between the two conditions, «there are a number of infections [including Lyme disease] that seem to be capable of triggering fibromyalgia,» says Dr. Clauw.

The fatigue, headaches, muscle and joint pain, and stiffness characteristic of Lyme disease are caused by bacteria spread via the bite of an infected deer tick, but blood tests for Lyme disease aren’t always reliable. Diagnosing Lyme disease can therefore be difficult, as the symptoms overlap with fibromyalgia and a slew of other conditions.

Lyme disease can be treated with antibiotics.

Interstitial Cystitis

Interstitial cystitis, sometimes called painful bladder syndrome, inflammation of the bladder wall is likely to feel like a urinary tract infection.

Similarly misunderstood, fibromyalgia and interstitial cystitis both seem to originate in the nerves and produce chronic pain.

The two conditions often occur together and are both more common in women.

Polymyalgia Rheumatica

«Fibromyalgia is probably most likely to be confused for this inflammatory disorder in people over 50,» says Dr. Clauw. Its characteristic pain and stiffness in the hips, neck, and shoulders are all common in fibromyalgia patients too.

Polymyalgia rheumatica is most common in people older than 50 and may also cause morning stiffness and headaches—both common in people with fibromyalgia.

Restless Legs Syndrome

Characterized by uncomfortable pins-and-needles sensations in the legs and the irresistible urge to move the legs, the cause of restless legs syndrome (RLS) remains mostly a mystery.

Moving the legs seems to temporarily alleviate the intense feelings, but people with RLS tend to get poor sleep in general and to experience severe fatigue like that felt by many people with fibromyalgia.

Rheumatoid Arthritis

The painful, swollen, and stiff joints characteristic of rheumatoid arthritis (RA) are also common complaints for people with fibromyalgia. Unlike the more common osteoarthritis, which is caused by age-related wear and tear, rheumatoid arthritis can occur at any age and is caused by inflammation and destruction of the lining of the joints.

RA can strike in the same joints on both sides of the body, similar to the symmetrical tender points used to diagnose fibromyalgia, and can cause fatigue and morning stiffness.

Sleep Apnea

Many fibromyalgia patients have trouble sleeping. The catch-22 is that sleeping better could actually improve their symptoms.

In some instances, the fibro pain itself could be interfering with sleep. But an underlying disorder like sleep apnea may, in fact, be the problem keeping you up at night.

A person with sleep apnea tends to snore and stop breathing for several seconds or more while asleep, then snorts and gasps for breath. This results in fitful sleep and feeling tired upon waking.

Treating the sleep disorder should lead to better z’s, even if fibro symptoms persist.