Fibromyalgia vs. Lupus: Understanding the Key Differences & Similarities

Wondering if fibromyalgia or lupus causes the symptoms you're dealing with?

It's tough to tell them apart because they both can make you feel similar kinds of pain and tiredness.

In this article, we're going to help you understand how they're different and how they're alike. We'll also explain how doctors figure out which one you might have, and what you can do to start feeling better.

What is fibromyalgia?

Fibromyalgia is a long-term condition that affects the muscles and soft tissues of the body.

The symptoms of fibromyalgia are caused by a disordered state of the central nervous system, known as central sensitization, in which the nervous system becomes overly sensitive to pain signals.

Picture the nervous system as a vast communication network that relays updates about your body's sensations, similar to a stream of text messages. In the case of central sensitization, this communication network is on high alert, vibrating intensely at the slightest notification. Consequently, a light caress could be perceived as intense pain because the body's messaging system is amplifying the sensation far beyond its actual severity.

A variety of factors may trigger symptoms, including emotional and physical stressors such as trauma or psychological strain.

What is lupus?

Systemic lupus erythematosus (SLE) represents a type of lupus, an autoimmune disorder in which the body's defense system mistakenly attacks its own tissues¹. This results in a broad range of effects throughout different organs and systems, including major organs such as the heart, lungs, and kidneys.

Like fibromyalgia, lupus can affect the entire body and cause a variety of different symptoms. These symptoms can change a lot, easing off so the person feels okay one day, and then flaring up and causing the person to feel very unwell another day.

Lupus usually starts when people are teenagers or young adults, and occurs more often in women². Lupus also affects people from different ethnic backgrounds to different extents³.

Fibromyalgia vs. lupus symptoms

Symptoms of fibromyalgia

People with fibromyalgia encounter a unique collection of symptoms, which can include:

• pain that's widespread and ongoing, which can affect both muscles and skin, and that isn't the result of injury
• chronic fatigue
• sleep disturbances and waking up feeling unrefreshed
• increased pain response to touch, sound, light, and other stimuli that are not typically painful
• trouble thinking clearly, remembering, and focusing, which some people call "fibro fog"⁴‍
• muscle stiffness
• stomach and digestive problems
• feeling numb or tingly, particularly in their hands and feet.

Symptoms of lupus

Lupus can cause some skin problems that only happen with this disease⁵. Imagine a rash shaped like a butterfly over your cheeks and nose, or circle-shaped rashes that appear when you're in the sun. The kidneys can be affected too, which might make your legs swell up and change how much you need to pee.

Left untreated, lupus can cause significant problems, such as:

• kidney damage⁶
• chest pain⁷
• blood clots⁸
• trouble having a baby⁹
• blood problems that cause extreme tiredness and aches.

Can you have fibromyalgia & lupus at the same time?

Yes, it's possible for someone to have both fibromyalgia and lupus at the same time.

Think of your body as a machine that can have a few things go wrong at once. Having both fibromyalgia and lupus is like having to deal with two big problems at the same time.

Because fibromyalgia and lupus share some of the same symptoms, it can be challenging for doctors to figure out which one you have.

How to tell the difference between fibromyalgia & lupus

When you understand the signs of fibromyalgia and lupus, you can tell them apart more easily. Both conditions can cause pain all over your body, but they also have some distinct symptoms. For example, lupus can make your joints swell, but fibromyalgia cannot.

Shared symptoms

Both fibromyalgia and lupus can cause pain all over your body, constant tiredness, headaches, muscles that ache and that hurt when you touch them, and challenges thinking straight.

Studies have shown that almost 25% of those with lupus also have fibromyalgia symptoms, further complicating the task of identifying the unique signs of each condition¹⁰.

Symptoms distinct to only lupus

There are certain symptoms that are typically exclusive to lupus patients and uncommon in those with fibromyalgia alone. These symptoms include:

• an overreaction of the small blood vessels to cold or stress, known as Raynaud’s phenomenon, which causes fingers, toes, and sometimes other areas to change color
• signature skin rashes, such as the butterfly-shaped malar rash that appears across the cheeks and nose, particularly when aggravated by sunlight
• fevers, which are a sign of the body's inflammatory response due to the hyperactivity of the immune system
• an increased tendency to bruise, which might indicate blood clotting issues caused by the immune system's effect on blood and blood vessels
• hair loss if the immune system is targeting hair follicles
• joint swelling and stiffness, caused by significant inflammation and discomfort in the joints, potentially leading to long-term damage without proper treatment.

Moreover, in the case of lupus, the immune system launches an attack on various organs and tissues across the body, resulting in an inflammatory response that can be identified through specific lab tests or imaging procedures – an inflammatory response not present in people with fibromyalgia.

Symptoms distinct to only fibromyalgia

Fibromyalgia is characterized by a constellation of distinctive symptoms, which include:

• specific areas of tenderness
• excessive sweating
• involuntary muscle spasms
• feelings of numbness or pins and needles
• cognitive difficulties commonly referred to as "fibro fog"
• an amplified sensitivity to touch, as well as heightened reactions to smells and sounds.

How is fibromyalgia diagnosed vs. lupus?

Diagnosing fibromyalgia

Diagnosing fibromyalgia largely relies on patient-reported symptoms, including pain and other symptoms, such as fatigue or sleep disturbances. For a fibromyalgia diagnosis, the person must have experienced widespread pain for at least three months, and other potential causes for the pain must be ruled out.

Previously, the diagnosis process involved checking specific tender points on the body. In 2010, the American College of Rheumatology introduced the widespread pain index and the symptom severity scale to quantify a person's pain and its impact on their daily life. However, the current guidelines from the American College of Rheumatology consider a wider array of fibromyalgia symptoms, capturing the full spectrum of patient experiences. These symptoms can include widespread pain, fatigue, gastrointestinal issues, mood swings, cognitive difficulties known as "fibro fog," and a plethora of other fibromyalgia-related symptoms that individuals may encounter.

Diagnosing lupus

Diagnosing lupus usually involved a series of tests and a doctor will look for symptoms that are often seen with lupus, such as skin rashes and joint pain.

A blood test, called the antinuclear antibody (ANA) test, can indicate lupus if it finds specific antibodies¹¹. In this case, your doctor will likely run additional blood tests. these test will look for other signs of lupus, such as the presence of particular antibodies (including anti-double-stranded DNA and anti-Smith), and inflammation with tests that measure your ESR (erythrocyte sedimentation rate) and CRP (C-reactive protein) levels¹².

In some cases, the doctor may take a biopsy – a small sample of skin or body tissue to examine under a microscope – to look for signs of damage that could be due to lupus. They may also use imaging tests, such as X-rays, or check your urine to gather more information about what's happening inside your body.

Ruling out other conditions

Physicians need to eliminate the possibility of other ailments with overlapping symptoms before confirming a diagnosis of fibromyalgia or lupus. Such conditions include:

• celiac disease
• hypothyroidism
• Lyme disease
• rheumatoid arthritis
• chronic fatigue syndrome
• myofascial pain syndrome.

Symptoms like muscle aches, often associated with these disorders, may be misconstrued as fibromyalgia.

Treatment options for fibromyalgia & lupus

Treatments for lupus usually consist of immunosuppressant drugs, to reduce the damaging impact of the immune system on the body, and treatments and lifestyle modifications to reduce specific symptoms and improve quality of life.

The main goals in managing fibromyalgia are to ease pain, better manage a person's energy levels, enhance sleep quality and improve mood.

Medications

Managing the symptoms of both fibromyalgia and lupus can involve the use of medications.

For managing fibromyalgia, medication is just one part of a broader approach to pain management and should be used in conjunction with other pain control strategies that include educational, lifestyle, and psychological support.

Common medicinal treatments encompass:

• over-the-counter pain relievers such as acetaminophen and naproxen
• antidepressants like sertraline and fluoxetine
• pain-specific medications such as Low Dose Naltrexone (LDN)
• anticonvulsants, which are also effective in treating nerve pain, including topiramate and carbamazepine.

On the other hand, because lupus is an autoimmune disease, it is addressed with a distinct set of medications that include:

• corticosteroids
• nonsteroidal anti-inflammatory drugs (NSAIDs)
• immunosuppressive
• antimalarials
• biologics.

These aim to mitigate an overactive immune response that targets healthy cells, which leads to symptom management in those suffering from lupus.

Non-medicated treatments for fibromyalgia syndrome

Non-medication strategies are key in handling fibromyalgia. By learning new ways for your body to deal with pain you can make your energy go further, do more without flaring, and even reduce the amount of pain that you feel. You might work with a physical therapist or try exercises that fit your needs, or find ways to lower stress and get better sleep, all of which are important for managing your pain.

Retraining your pain

To understand how you can change your brain's response to pain, it's important to know that pain isn't just about what you feel physically. It's also connected to your thoughts, feelings, and what's happening around you.

Learning what makes your pain worse, like stress, negative thoughts, or certain activities, is the first step. Once you know what these triggers are, you can start to change them. You might need to eat differently, sleep better, get more exercise, or use special techniques that help your brain see these triggers in a new way. With time and practice, you can train your brain to react differently to pain, which can make the pain feel less intense and less controlling in your life.

The following strategies are some of the things you can add to your toolkit.

Stress management

While it is true that stress cannot be completely eliminated from life, understanding how to manage it can significantly aid you. When you're better at managing stress, your body is less likely to interpret sensations as pain. There are effective strategies for reducing stress. Techniques including cognitive behavioral therapy (CBT) and mindfulness meditation can teach you to think in healthier ways, focus on the present, and relax. It's also beneficial to talk to friends, a counselor, or join a support group where you can express your feelings and receive encouragement.

Movement & exercise

Movement and exercise can seem challenging at first, yet they are truly beneficial for managing pain. Engaging in physical activity can boost your mood, increase your energy, and improve your sleep. The key is to discover activities that you enjoy and that are suitable for your current health status. This might include gentle practices like yoga, light dancing, or tending to your garden.

Incorporating stretching and low-impact activities such as walking can aid in relaxing your muscles. As you become more supple, you may find some relief from pain, which can enhance your overall well-being.

It's important to start with simple exercises and gradually build up your strength and fitness. Treat yourself with patience and care throughout this process. By progressing at a pace that respects your body's signals, you can gradually increase your activity levels without causing harm to yourself.

Sleep quality

Sleep plays a crucial role in managing your fibromyalgia. Consider it an essential part of your self-care routine that can actually reduce your pain.

Most individuals with fibromyalgia, indeed over 90%, have a hard time achieving the deep sleep necessary for the body to heal itself.

To improve your sleep, which can contribute to your overall well-being, here are some steps you can take:

• Aim for approximately eight hours of sleep each night and maintain consistent sleep and wake times.
• If you need to nap, keep it brief. Short naps can rejuvenate you without disrupting your nighttime sleep.
• Stay active during daylight hours. This will help you fall asleep more easily at bedtime.
• Limit your use of electronic devices before bedtime. This helps your brain wind down and makes falling asleep easier.
• Make your bedroom a sanctuary for sleep. It should be dark and quiet to minimize disturbances.
• Monitor your caffeine intake, especially later in the day. Caffeine can linger in your system and affect your sleep.
• Avoid heavy meals or alcohol close to bedtime. These can interfere with the quality of your sleep.
• And remember to relax in other ways as well. This contributes to better sleep routines and more effective symptom management.

Physical therapy approaches

Using warmth, like with a warm cloth or heating pad, can be a good first step before you start moving and stretching. It helps soothe your pain, so when you begin exercising, it feels a bit easier. This is because the warmth helps relax your muscles, making it less painful when you stretch or do activities.

More information

At MoreGoodDays®, we have carefully developed an approach to help you manage your fibromyalgia. We understand how this condition can really change your day-to-day life, so we've created resources and techniques that are easy to understand and apply. These tools are designed to educate you about fibromyalgia and to equip you with ways to cope with the pain and fatigue you may experience.

We are dedicated to supporting you on your journey to a healthier and more joyful life, even with the presence of fibromyalgia.

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