If you’re living with fibromyalgia, you have probably wondered what causes it. Illnesses can be treated more effectively once researchers and clinicians have identified their underlying cause. Knowing why a disorder develops doesn’t just satisfy our curiosity; it can also help assure us that the treatment we are getting will be effective. It’s easier to be confident in something that makes sense. So, what causes fibromyalgia, and what does this mean for getting the right treatment?
Fibromyalgia has some of the same symptoms as autoimmune disorders like rheumatoid arthritis, lupus, and polymyalgia rheumatica. This raises the question: is fibromyalgia an autoimmune disease? Do fibromyalgia, lupus, rheumatoid arthritis, and polymyalgia rheumatica have the same underlying cause?
On the surface, it seems logical to think that they might. Although fibromyalgia and autoimmune disorders do share symptoms, they have some distinct differences, too. To get effective treatment, it’s essential that you have an accurate diagnosis. So, in this article, we’ll take a closer look at autoimmune conditions and how fibromyalgia relates to them. With this understanding, you’ll be able to see more clearly how to get the care you need.
What Is an Autoimmune Disease?
Let’s start by defining some terms. Autoimmune diseases are a group of conditions in which the immune system mistakenly attacks healthy cells and tissues in the body, as if they were foreign invaders like harmful bacteria or viruses. This response can lead to chronic inflammation and damage to various organs and systems, as well as a range of symptoms depending on the specific disease. Autoimmune diseases can affect virtually any part of the body, including the skin, joints, muscles, blood vessels, and nerves.
Researchers do not yet fully understand what causes autoimmune diseases. Most likely, a combination of genetic, environmental, and hormonal factors contributes to their development. You may be at higher risk for an autoimmune disease if you are female, take certain medications, have relatives with autoimmune conditions, smoke cigarettes, have been exposed to toxins, or have had certain infections, such as the Epstein-Barr virus. If you already have one autoimmune condition, you are at higher risk for developing another.
Generally speaking, autoimmune diseases are treated with medications to control inflammation and immune responses, as well as lifestyle strategies to manage symptoms and improve overall health and functioning.
Characteristics of Autoimmune Disorders
Although autoimmune diseases can affect many different organs and systems in the body, they share some common characteristics. They tend to have a genetic component, meaning that they run in families. Symptoms often come and go, such that you feel better at some times and worse at others. People with some autoimmune conditions describe the experience of having “flares,” which may sound familiar if you live with fibromyalgia.
Autoimmune diseases can be difficult to diagnose, since their symptoms can overlap with those of other conditions. And like fibromyalgia, some autoimmune conditions are invisible to other people, even though they come with significant symptoms. If you have either fibromyalgia or an autoimmune condition, you may feel alone or misunderstood by your loved ones – and, unfortunately, perhaps even by some of your medical providers.
The inflammation involved in autoimmune diseases can cause serious health problems in the long term if the condition is not managed. For example, untreated type I diabetes can damage the kidneys. Effective treatment can help prevent such problems.
Examples of Autoimmune Disorders
There are over a hundred known autoimmune conditions. Let’s take a closer look at three of the most common: rheumatoid arthritis, lupus, and polymyalgia rheumatica.
Rheumatoid arthritis (RA) involves inflammation in the lining of the joints. This causes pain, swelling, and stiffness in the joints, and possibly also fatigue, occasional fever, loss of appetite, and weight loss. Symptoms may come and go.
The inflammation typically shows up first in the hands and feet. Joints closer to the center of the body, such as the hips and shoulders, may be affected later. The pain tends to be felt in the same joints on both sides of your body – for instance, in both wrists.
If RA isn’t treated, or if the treatment isn’t effective, the chronic inflammation can damage tissues in the joints. Over time, RA may also cause damage to the heart, blood vessels, lungs, skin, or eyes.
Lupus can cause problems in many different parts of the body, and its symptoms can be difficult to tell apart from other conditions. For these reasons, lupus can be tricky to diagnose. The more common symptoms are fatigue; fever; and pain, stiffness, and swelling in the joints. The most distinctive sign of lupus is a rash covering the cheeks and the bridge of the nose. However, not everyone with lupus has this rash.
The symptoms of lupus may be mild or severe, and they may develop quickly or gradually. For many people, the symptoms come and go. Eventually, lupus can cause damage to the kidneys, brain, lungs, or circulatory system.
Polymyalgia rheumatica (PMR) is an inflammatory disorder that involves pain and stiffness in the muscles, especially in the shoulders, hips, and neck. The stiffness tends to be worse in the morning. PMR may also cause fatigue, fever, weight loss, and depression.
This condition mainly affects people over age 50. Some people with PMR also develop giant cell arteritis, or inflammation of the arteries in the head and neck.
Differences between Fibromyalgia and Autoimmune Conditions
For years, many clinicians and researchers – not to mention ordinary people curious about their own health – have noted the similarities between fibromyalgia and autoimmune conditions and wondered whether there might be a connection.
So, is fibromyalgia an autoimmune disease? Researchers are still working to determine the exact biological cause of fibromyalgia. However, according to the American College of Rheumatology, fibromyalgia is not considered to be an autoimmune disease. Most of the research conducted thus far suggests that it is caused by central sensitization¹, or changes in how the central nervous system processes and interprets sensory input, including pain signals.
If you have fibromyalgia, this is good news, in a sense. There isn’t much evidence to suggest that fibromyalgia in isolation causes inflammation, permanent tissue damage, or some of the major long-term health complications (such as heart attack, stroke, or kidney failure) that are associated with some autoimmune conditions.
Differences in Symptoms
Fibromyalgia causes significant pain throughout the body, along with fatigue, problems with thinking and memory, and unrefreshing sleep. While autoimmune diseases can also cause pain and fatigue, there are some differences in the symptoms that distinguish them from fibromyalgia.
Most importantly, the pain of fibromyalgia is widespread; it shows up throughout the body. It may be felt in the joints, as is the case with rheumatoid arthritis, for instance. However, when fibromyalgia causes joint pain, it is not limited to specific joints.
In addition to pain and fatigue, fibromyalgia can cause other symptoms, such as difficulties thinking and concentrating (“fibro fog”), headaches, and hypersensitivity to light, noise, and touch. These symptoms are not typically caused by autoimmune diseases.
Autoimmune diseases may cause a low-grade fever. This is rarely a symptom of fibromyalgia.
Differences in Diagnostic Criteria
Even with these distinctions, there can be a fair amount of overlap between the symptoms of fibromyalgia, lupus, rheumatoid arthritis, and other autoimmune diseases. How do doctors tell them apart? And how can you be sure you’ve gotten the right diagnosis?
Autoimmune diseases can be detected through lab tests that measure the levels of certain antibodies in the blood. Your doctors use these tests, in conjunction with your symptoms, to arrive at a diagnosis. Imaging tests, such as X-rays, MRIs, or ultrasounds, may also be used to help diagnose certain autoimmune diseases.
In contrast to autoimmune conditions, fibromyalgia does not have specific biomarkers that can be measured by lab tests. As a result, fibro is typically diagnosed based on an assessment of symptoms.
Unfortunately, either autoimmune disease or fibromyalgia can cause symptoms that are seemingly unrelated. For instance, fibromyalgia can cause both sleep difficulties and numbness in the hands, and lupus can cause both skin lesions and shortness of breath. It’s not always obvious that two or more symptoms affecting completely different tissues or processes in the body are caused by the same condition. Quite understandably, you might not think to mention the symptoms together, and if your doctor doesn’t ask the right questions, they might not notice the pattern either. For this reason, it can take some time – and perhaps appointments with several different doctors – before you get an accurate diagnosis.
Can You Have Fibromyalgia and Autoimmune Conditions?
So far, we’ve talked about telling the difference between fibromyalgia and an autoimmune disease, as if you have one or the other. But there’s a twist: it’s possible to have both. While fibromyalgia is not an autoimmune disease, it can show up along with other conditions that involve autoimmune responses such as inflammation.
In fact, having some autoimmune conditions can raise your risk for fibromyalgia, and vice versa. For instance, if you have lupus or rheumatoid arthritis, you are more likely to develop fibro, and people with fibromyalgia are more likely to develop Sjögren’s syndrome.²
Fibromyalgia and autoimmune conditions may be managed in different ways – and, as noted above, many autoimmune diseases can lead to tissue damage if they aren’t treated effectively. If you have symptoms that could be explained either by fibromyalgia or by an autoimmune condition, it’s important that you be evaluated thoroughly to get the right diagnosis, whether that’s a single condition or more than one.
If you’re not sure where to start, begin by seeing your primary care provider. You may also consider seeing a specialist for the type of condition that is affecting your life the most. For example, if you experience joint pain, you may wish to see a rheumatologist; if you experience widespread pain, you may wish to consult a fibromyalgia specialist.
And finally, ask your doctor about lab tests that could confirm or rule out an autoimmune disease. When you know exactly what you’re dealing with, you can be more confident that you’re getting the treatment that will keep you as healthy as possible now and in the future.
¹ Bradley, L. A., McKendree-Smith, N. L., Alarcón, G. S., & Cianfrini, L. R. (2002). Is fibromyalgia a neurologic disease? Current Pain and Headache Reports 6 (2): 106–114. https://doi.org/10.1007/s11916-002-0006-9
² Gau, S. Y., Leong, Gau, S. Y., Leong, P. Y., Lin, C. L., Tsou, H. K., & Wei, J. C. (2021). Higher Risk for Sjögren’s Syndrome in Patients With Fibromyalgia: A Nationwide Population-Based Cohort Study. Frontiers in immunology, 12, 640618. https://doi.org/10.3389/fimmu.2021.640618