Is It Lupus Or Fibromyalgia? Complications Of Misdiagnosis

By Nicole Dorsey, MS. Medically reviewed by Tom Iarocci, MD. May 7th 2016

Everyone suffers from fatigue, joint pain and the occasional headache, but when these symptoms become chronic and they are accompanied by other troubling signals, it may indicate something more serious. The two usual suspects are fibromyalgia and lupus, which share many of the same painful, hard-to-diagnose symptoms. Treatment options exist, but unfortunately, there is no cure for either condition.

Fibromyalgia is a chronic disease that causes exhaustion, digestive problems and widespread pain throughout the body; it may also be associated with depression. In contrast, lupus is an autoimmune disease that can attack any part of the body but most commonly targets the skin, joints, heart, lungs, blood, brain and kidneys.

In the general population, many people have fibromyalgia (roughly 20 in 1,000) than have lupus (about 1 in 1,000). Rates of lupus in certain groups are higher, however; African American women have the highest rates of lupus (about 4 people in 1,000) of all.

How Lupus and Fibromyalgia Appear Similar

Symptoms of both lupus and fibromyalgia can seem to come from all over the body, particularly the muscles and joints. Both conditions are more common in women than in men and can be challenging to diagnose because symptoms are typical of other conditions, too, such as hypothyroidism, Lyme disease, arthritis and chronic fatigue syndrome.

  • Joint and muscle pain,
  • Fatigue,
  • Non-restorative sleep (you wake up not feeling refreshed),
  • Morning stiffness,
  • Brain fog (problems concentrating and remembering),
  • Coldness, numbness of the fingers, and
  • Headache.

How Lupus and Fibromyalgia Are Different

Fibromyalgia can take a serious toll on a person’s life, but it does not typically cause physical damage to human tissues. In contrast, lupus may involve the formation of antibodies and inflammation throughout the body. When lupus involves the kidneys, for example, much of the damage to kidney tissue is due to the body’s inflammatory responses to antibodies deposited in the kidneys. 

Treatment for lupus depends on which organs are involved and severity of the condition. Typically, patients receive nonsteroidal anti-inflammatory medications for pain and corticosteroid cream for skin rashes. They should also protect their skin from sun exposure and get screened annually for osteoporosis.

Fibromyalgia is treated in a variety of ways, including physical therapy, cognitive behavioral therapy and with medications such as antidepressants, pain relievers and muscle relaxants.

Because fibromyalgia and lupus have so many symptoms in common, misdiagnosis is possible. In rare cases, blood work for someone with fibromyalgia results in a false positive, leading to an incorrect diagnosis of lupus. Furthermore, some patients may be given corticosteroids to soothe symptoms of lupus but are not helped by the drugs. This suggests the symptoms are not due to an inflammatory cause like lupus and could be fibromyalgia instead.

There’s no easy test to confirm a fibromyalgia diagnosis, so doctors look at a wide variety of symptoms and findings to rule out other possible causes. Corticosteroids or immunosuppressive agents used in the treatment of lupus may have serious side effects and aren’t helpful in treating fibromyalgia, so a correct diagnosis is essential. In addition, a misdiagnosis can cause unnecessary anxiety because the outcomes of lupus tend to be more serious, according to the Hospital for Special Surgery.

Unfortunately, having one or both disorders can make it very difficult to find an effective treatment. It’s a slippery slope: If doctors and patients attribute new symptoms to a flare-up of lupus and not to fibromyalgia, the additional medications or increased dosages for lupus may not be needed and won’t help symptoms — and can put the patient at risk for side effects.

Next Steps

  • Whether you have fibromyalgia, lupus or both, doctors’ understanding of these confusing conditions, although still incomplete, is much better today than ever before. More studies have identified effective interventions, and increased awareness of the importance of sleep and healthy living can empower patients as they work toward feeling better.
  • If you’re experiencing any symptoms of either lupus or fibromyalgia, see a doctor. Make sure to be very specific when mentioning your symptoms, including when and how severely you experience them. This can help you and your doctor make an accurate diagnosis together.

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