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Consideration of Fibromyalgia in the Assessment and Treatment of SLE

  • Pain in Rheumatology (W Nielson and M Harth, Section Editors)
  • Published:
Current Treatment Options in Rheumatology Aims and scope Submit manuscript

Abstract

Purpose of Review

Fibromyalgia (FM) is highly prevalent amongst patients with systemic lupus erythematosus (SLE) and can complicate diagnosis and management in patients with both disorders. In this article, we review the current understanding of FM as a disease and highlight how it can impact the assessment and treatment of patients with SLE and comorbid FM.

Recent Findings

While FM is prevalent amongst patients with SLE, studies do not suggest that FM patients are at increased risk of developing rheumatic disease. A growing body of evidence demonstrates that health-related quality of life (HRQoL) in SLE patients is not strongly associated with disease activity or damage, but rather associated with the presence of comorbid FM. Several new therapies, both pharmacological and non-pharmacological, are under investigation for FM.

Summary

FM is highly prevalent amongst patients with SLE and negatively impacts HRQoL, independent of disease activity or damage. In patients with both disorders, it is important that thorough assessment by a rheumatologist familiar with SLE is undertaken to avoid misdiagnosis or inappropriate treatment. Current FM therapy includes a combination of both pharmacological and non-pharmacological modalities; emphasis should also be placed on ensuring patient understanding and expectations of the disease course are clear. While a number of new therapies are being investigated for FM, there is not yet strong enough evidence to support their inclusion in clinical care.

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References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Sarzi-Puttini P, Giorgi V, Marotto D, Atzeni F. Fibromyalgia: an update on clinical characteristics, aetiopathogenesis and treatment. Nat Rev Rheumatol. 2020;16(11):645–60.

    Article  PubMed  Google Scholar 

  2. Yang TY, Chen CS, Lin CL, Lin WM, Kuo CN, Kao CH. Risk for irritable bowel syndrome in fibromyalgia patients: a national database study. Medicine (Baltimore). 2017;96(14):e6657.

    Article  Google Scholar 

  3. Hudson JI, Arnold LM, Keck PE Jr, Auchenbach MB, Pope HG Jr. Family study of fibromyalgia and affective spectrum disorder. Biol Psychiatry. 2004;56(11):884–91.

    Article  PubMed  Google Scholar 

  4. Wolfe F, Petri M, Alarcon GS, Goldman J, Chakravarty EF, Katz RS, et al. Fibromyalgia, systemic lupus erythematosus (SLE), and evaluation of SLE activity. J Rheumatol. 2009;36(1):82–8.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Heidari F, Afshari M, Moosazadeh M. Prevalence of fibromyalgia in general population and patients, a systematic review and meta-analysis. Rheumatol Int. 2017;37(9):1527–39.

    Article  PubMed  Google Scholar 

  6. Duffield SJ, Miller N, Zhao S, Goodson NJ. Concomitant fibromyalgia complicating chronic inflammatory arthritis: a systematic review and meta-analysis. Rheumatology (Oxford). 2018;57(8):1453–60.

    Google Scholar 

  7. Inanici F, Yunus MB. History of fibromyalgia: past to present. Curr Pain Headache Rep. 2004;8(5):369–78.

    Article  PubMed  Google Scholar 

  8. Agarwal A, Oparin Y, Glick L, Fitzcharles MA, Adachi JD, Cooper MD, et al. Attitudes toward and management of fibromyalgia: a national survey of Canadian rheumatologists and critical appraisal of guidelines. J Clin Rheumatol. 2018;24(5):243–9.

    Article  PubMed  Google Scholar 

  9. Dohrenbusch R, Sodhi H, Lamprecht J, Genth E. Fibromyalgia as a disorder of perceptual organization? An analysis of acoustic stimulus processing in patients with widespread pain. Z Rheumatol. 1997;56(6):334–41.

    Article  CAS  PubMed  Google Scholar 

  10. McDermid AJ, Rollman GB, McCain GA. Generalized hypervigilance in fibromyalgia: evidence of perceptual amplification. Pain. 1996;66(2-3):133–44.

    Article  CAS  PubMed  Google Scholar 

  11. Lautenbacher S, Rollman GB. Possible deficiencies of pain modulation in fibromyalgia. Clin J Pain. 1997;13(3):189–96.

    Article  CAS  PubMed  Google Scholar 

  12. Geisser ME, Casey KL, Brucksch CB, Ribbens CM, Appleton BB, Crofford LJ. Perception of noxious and innocuous heat stimulation among healthy women and women with fibromyalgia: association with mood, somatic focus, and catastrophizing. Pain. 2003;102(3):243–50.

    Article  PubMed  Google Scholar 

  13. Russell IJ, Vaeroy H, Javors M, Nyberg F. Cerebrospinal fluid biogenic amine metabolites in fibromyalgia/fibrositis syndrome and rheumatoid arthritis. Arthritis Rheum. 1992;35(5):550–6.

    Article  CAS  PubMed  Google Scholar 

  14. Staud R, Vierck CJ, Cannon RL, Mauderli AP, Price DD. Abnormal sensitization and temporal summation of second pain (wind-up) in patients with fibromyalgia syndrome. Pain. 2001;91(1-2):165–75.

    Article  CAS  PubMed  Google Scholar 

  15. Staud R. Evidence of involvement of central neural mechanisms in generating fibromyalgia pain. Curr Rheumatol Rep. 2002;4(4):299–305.

    Article  PubMed  Google Scholar 

  16. Uceyler N, Hauser W, Sommer C. Systematic review with meta-analysis: cytokines in fibromyalgia syndrome. BMC Musculoskelet Disord. 2011;12:245.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  17. Sturgill J, McGee E, Menzies V. Unique cytokine signature in the plasma of patients with fibromyalgia. J Immunol Res. 2014;2014:938576.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  18. Littlejohn G, Guymer E. Neurogenic inflammation in fibromyalgia. Semin Immunopathol. 2018;40(3):291–300.

    Article  CAS  PubMed  Google Scholar 

  19. Tan AC, Jaaniste T, Champion D. Chronic widespread pain and fibromyalgia syndrome: life-course risk markers in young people. Pain Res Manag. 2019;2019:6584753.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Wolfe F, Smythe HA, Yunus MB, Bennett RM, Bombardier C, Goldenberg DL, et al. The American College of Rheumatology 1990 criteria for the classification of fibromyalgia. Report of the multicenter criteria committee. Arthritis Rheum. 1990;33(2):160–72.

    Article  CAS  PubMed  Google Scholar 

  21. Wolfe F, Walitt BT, Hauser W. What is fibromyalgia, how is it diagnosed, and what does it really mean? Arthritis Care Res. 2014;66(7):969–71.

    Article  Google Scholar 

  22. Wolfe F. Editorial: the status of fibromyalgia criteria. Arthritis Rheum. 2015;67(2):330–3.

    Article  Google Scholar 

  23. Wolfe F, Clauw DJ, Fitzcharles MA, Goldenberg DL, Katz RS, Mease P, et al. The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthritis Care Res. 2010;62(5):600–10.

    Article  Google Scholar 

  24. Vanderschueren S, Van Wambeke P, Morlion B. Fibromyalgia: do not give up the tender point count too easily: comment on the article by Wolfe et al. Arthritis Care Res. 2010;62(11):1675.

  25. Wolfe F, Clauw DJ, Fitzcharles MA, Goldenberg DL, Hauser W, Katz RL, et al. Revisions to the 2010/2011 fibromyalgia diagnostic criteria. Semin Arthritis Rheum. 2016;46(3):319–29.

    Article  PubMed  Google Scholar 

  26. Arnold LM, Bennett RM, Crofford LJ, Dean LE, Clauw DJ, Goldenberg DL, et al. AAPT diagnostic criteria for fibromyalgia. J Pain. 2019;20(6):611–28.

    Article  PubMed  Google Scholar 

  27. Hauser W, Brahler E, Ablin J, Wolfe F. 2016 modified American College of Rheumatology fibromyalgia criteria. Arthritis Care Res (Hoboken): ACTTION-APS pain taxonomy criteria and the prevalence of fibromyalgia; 2020. This study compares the characteristics of the two most recent FM diagnostic criteria (ACR 2016, ACTTION-APS) in a German population.

  28. Kotter I, Neuscheler D, Gunaydin I, Wernet D, Klein R. Is there a predisposition for the development of autoimmune diseases in patients with fibromyalgia? Retrospective analysis with long term follow-up. Rheumatol Int. 2007;27(11):1031–9.

    Article  PubMed  Google Scholar 

  29. Aho K, Koskela P, Makitalo R, Heliovaara M, Palosuo T. Antinuclear antibodies heralding the onset of systemic lupus erythematosus. J Rheumatol. 1992;19(9):1377–9.

    CAS  PubMed  Google Scholar 

  30. Al-Allaf AW, Ottewell L, Pullar T. The prevalence and significance of positive antinuclear antibodies in patients with fibromyalgia syndrome: 2–4 years’ follow-up. Clin Rheumatol. 2002;21(6):472–7.

    Article  CAS  PubMed  Google Scholar 

  31. Wallace DJ, Gavin IM, Karpenko O, Barkhordar F, Gillis BS. Cytokine and chemokine profiles in fibromyalgia, rheumatoid arthritis and systemic lupus erythematosus: a potentially useful tool in differential diagnosis. Rheumatol Int. 2015;35(6):991–6.

    Article  CAS  PubMed  Google Scholar 

  32. Jeong J, Kim DH, Park G, Park S, Kim HS. Clinical significance of anti-dense fine speckled 70 antibody in patients with fibromyalgia. Korean J Intern Med. 2019;34(2):426–33.

    Article  CAS  PubMed  Google Scholar 

  33. Mahler M, Hanly JG, Fritzler MJ. Importance of the dense fine speckled pattern on HEp-2 cells and anti-DFS70 antibodies for the diagnosis of systemic autoimmune diseases. Autoimmun Rev. 2012;11(9):642–5.

    Article  CAS  PubMed  Google Scholar 

  34. Seelig CA, Bauer O, Seelig HP. Autoantibodies against DFS70/LEDGF exclusion markers for systemic autoimmune rheumatic diseases (SARD). Clin Lab. 2016;62(4):499–517.

    CAS  PubMed  Google Scholar 

  35. Mahler M, Parker T, Peebles CL, Andrade LE, Swart A, Carbone Y, et al. Anti-DFS70/LEDGF antibodies are more prevalent in healthy individuals compared to patients with systemic autoimmune rheumatic diseases. J Rheumatol. 2012;39(11):2104–10.

    Article  PubMed  Google Scholar 

  36. Shovman O, Gilburd B, Chayat C, Amital H, Langevitz P, Watad A, et al. Prevalence of anti-DFS70 antibodies in patients with and without systemic autoimmune rheumatic diseases. Clin Exp Rheumatol. 2018;36(1):121–6.

    PubMed  Google Scholar 

  37. Touma Z, Moghaddam B, Su J, Katz P. Cognitive function trajectories are associated with the depressive symptoms trajectories in systemic lupus erythematosus over time. Arthritis Care Res (Hoboken). 2020.

  38. Martinez-Lavin M, Leon A, Pineda C, Amigo MC, Hermosillo AG. The dysautonomia of fibromyalgia may simulate lupus. J Clin Rheumatol. 1999;5(6):332–4.

    Article  CAS  PubMed  Google Scholar 

  39. Calvo-Alen J, Bastian HM, Straaton KV, Burgard SL, Mikhail IS, Alarcon GS. Identification of patient subsets among those presumptively diagnosed with, referred, and/or followed up for systemic lupus erythematosus at a large tertiary care center. Arthritis Rheum. 1995;38(10):1475–84.

    Article  CAS  PubMed  Google Scholar 

  40. Morand EF, Miller MH, Whittingham S, Littlejohn GO. Fibromyalgia syndrome and disease activity in systemic lupus erythematosus. Lupus. 1994;3(3):187–91.

    Article  CAS  PubMed  Google Scholar 

  41. Kwan A, Strand V, Touma Z. The role of patient-reported outcomes in systemic lupus erythematosus. Current Treatment Options in Rheumatology. 2017;3(4):308–21.

    Article  Google Scholar 

  42. Strand V, Simon LS, Meara AS, Touma Z. Measurement properties of selected patient-reported outcome measures for use in randomised controlled trials in patients with systemic lupus erythematosus: a systematic review. Lupus Sci Med. 2020;7(1).

  43. McElhone K, Abbott J, Teh LS. A review of health related quality of life in systemic lupus erythematosus. Lupus. 2006;15(10):633–43.

    Article  CAS  PubMed  Google Scholar 

  44. Jolly M. How does quality of life of patients with systemic lupus erythematosus compare with that of other common chronic illnesses? J Rheumatol. 2005;32(9):1706–8.

    PubMed  Google Scholar 

  45. Gladman DD, Urowitz MB, Ong A, Gough J, MacKinnon A. Lack of correlation among the 3 outcomes describing SLE: disease activity, damage and quality of life. Clin Exp Rheumatol. 1996;14(3):305–8.

    CAS  PubMed  Google Scholar 

  46. Fortin PR, Abrahamowicz M, Neville C, du Berger R, Fraenkel L, Clarke AE, et al. Impact of disease activity and cumulative damage on the health of lupus patients. Lupus. 1998;7(2):101–7.

    Article  CAS  PubMed  Google Scholar 

  47. Khanna S, Pal H, Pandey RM, Handa R. The relationship between disease activity and quality of life in systemic lupus erythematosus. Rheumatology (Oxford). 2004;43(12):1536–40.

    Article  CAS  Google Scholar 

  48. Kuriya B, Gladman DD, Ibanez D, Urowitz MB. Quality of life over time in patients with systemic lupus erythematosus. Arthritis Rheum. 2008;59(2):181–5.

    Article  PubMed  Google Scholar 

  49. Etchegaray-Morales I, Mendez-Martinez S, Jimenez-Hernandez C, Mendoza-Pinto C, Alonso-Garcia NE, Montiel-Jarquin A, et al. Factors associated with health-related quality of life in Mexican lupus patients using the LupusQol. PLoS One. 2017;12(1):e0170209.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  50. Piga M, Congia M, Gabba A, Figus F, Floris A, Mathieu A, et al. Musculoskeletal manifestations as determinants of quality of life impairment in patients with systemic lupus erythematosus. Lupus. 2018;27(2):190–8.

    Article  CAS  PubMed  Google Scholar 

  51. Fung W, Lim LSH, Tomlinson G, Engel L, Su J, Diaz-Martinez JP, et al. Joint trajectories of disease activity, and physical and mental health-related quality of life in an inception lupus cohort. Rheumatology (Oxford). 2020. Our previous study demonstrates that, in trajectories over time in an inception lupus cohort, HRQoL does not associate strongly with disease activity or damage, but rather seems to have a relationship with the presence of fibromyalgia.

  52. Macfarlane GJ, Kronisch C, Dean LE, Atzeni F, Hauser W, Fluss E, et al. EULAR revised recommendations for the management of fibromyalgia. Ann Rheum Dis. 2017;76(2):318–28.The EULAR guidelines for FM management are the most recent ones available and can serve as a practical guide for addressing FM in day-to-day practice.

  53. Arnold LM, Hirsch I, Sanders P, Ellis A, Hughes B. Safety and efficacy of esreboxetine in patients with fibromyalgia: a fourteen-week, randomized, double-blind, placebo-controlled, multicenter clinical trial. Arthritis Rheum. 2012;64(7):2387–97.

    Article  CAS  PubMed  Google Scholar 

  54. Arnold LM, Chatamra K, Hirsch I, Stoker M. Safety and efficacy of esreboxetine in patients with fibromyalgia: an 8-week, multicenter, randomized, double-blind, placebo-controlled study. Clin Ther. 2010;32(9):1618–32.

    Article  CAS  PubMed  Google Scholar 

  55. Younger J, Noor N, McCue R, Mackey S. Low-dose naltrexone for the treatment of fibromyalgia: findings of a small, randomized, double-blind, placebo-controlled, counterbalanced, crossover trial assessing daily pain levels. Arthritis Rheum. 2013;65(2):529–38.

    Article  CAS  PubMed  Google Scholar 

  56. Walitt B, Klose P, Fitzcharles MA, Phillips T, Hauser W. Cannabinoids for fibromyalgia. Cochrane Database Syst Rev. 2016;7:CD011694.

    PubMed  Google Scholar 

  57. Sagy I, Bar-Lev Schleider L, Abu-Shakra M, Novack V. Safety and efficacy of medical cannabis in fibromyalgia. J Clin Med. 2019;8(6).

  58. Lloyd DM, Wittkopf PG, Arendsen LJ, Jones AKP. Is transcranial direct current stimulation (tDCS) effective for the treatment of pain in fibromyalgia? A systematic review and meta-analysis. J Pain. 2020.

  59. Dailey DL, Vance CGT, Rakel BA, Zimmerman MB, Embree J, Merriwether EN, et al. Transcutaneous electrical nerve stimulation reduces movement-evoked pain and fatigue: a randomized, controlled trial. Arthritis Rheum. 2020;72(5):824–36.

    Article  CAS  Google Scholar 

  60. Saltychev M, Laimi K. Effectiveness of repetitive transcranial magnetic stimulation in patients with fibromyalgia: a meta-analysis. Int J Rehabil Res. 2017;40(1):11–8.

    Article  PubMed  Google Scholar 

  61. Tanwar S, Mattoo B, Kumar U, Bhatia R. Repetitive transcranial magnetic stimulation of the prefrontal cortex for fibromyalgia syndrome: a randomised controlled trial with 6-months follow up. Adv Rheumatol. 2020;60(1):34.

    Article  PubMed  Google Scholar 

  62. BI I, A AS, SengUl I, Tosun A. Effects of high frequency neuronavigated repetitive transcranial magnetic stimulation in fibromyalgia syndrome: a double-blinded, randomized controlled study. Am J Phys Med Rehabil. 2020.

  63. Guinot M, Maindet C, Hodaj H, Hodaj E, Bachasson D, Baillieul S, et al. Effects of repetitive transcranial magnetic stimulation and multicomponent therapy in patients with fibromyalgia: a randomized controlled trial. Arthritis Care Res. 2019.

  64. Yeh SW, Hong CH, Shih MC, Tam KW, Huang YH, Kuan YC. Low-level laser therapy for fibromyalgia: a systematic review and meta-analysis. Pain Physician. 2019;22(3):241–54.

    PubMed  Google Scholar 

  65. Cheng CA, Chiu YW, Wu D, Kuan YC, Chen SN, Tam KW. Effectiveness of Tai Chi on fibromyalgia patients: a meta-analysis of randomized controlled trials. Complement Ther Med. 2019;46:1–8.

    Article  PubMed  Google Scholar 

  66. Wang C, Schmid CH, Fielding RA, Harvey WF, Reid KF, Price LL, et al. Effect of tai chi versus aerobic exercise for fibromyalgia: comparative effectiveness randomized controlled trial. BMJ. 2018;360:k851.

    Article  PubMed  PubMed Central  Google Scholar 

  67. Kim CH, Vincent A, Clauw DJ, Luedtke CA, Thompson JM, Schneekloth TD, et al. Association between alcohol consumption and symptom severity and quality of life in patients with fibromyalgia. Arthritis Res Ther. 2013;15(2):R42.

    Article  PubMed  PubMed Central  Google Scholar 

  68. van de Donk T, Niesters M, Kowal MA, Olofsen E, Dahan A, van Velzen M. An experimental randomized study on the analgesic effects of pharmaceutical-grade cannabis in chronic pain patients with fibromyalgia. Pain. 2019;160(4):860–9.Patients are increasingly proactive about bringing up the topic of medical cannabis, especially in the context of chronic pain. This is a small randomized, controlled trial providing some newer data about this. An older Cochrane review on this subject is also available (reference 56).

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Authors and Affiliations

  1. Toronto Western Hospital – Lupus Clinic, Toronto, Ontario, Canada

    William Fung MD

  2. Division of Rheumatology, Department of Medicine, Toronto Western Hospital - Lupus Clinic, Toronto, Canada

    Zahi Touma MD, PhD

  3. Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada

    Zahi Touma MD, PhD

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Correspondence to Zahi Touma MD, PhD.

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Fung, W., Touma, Z. Consideration of Fibromyalgia in the Assessment and Treatment of SLE. Curr Treat Options in Rheum 7, 182–193 (2021). https://doi.org/10.1007/s40674-021-00181-2

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