Is Fibromyalgia an Autoimmune Disease?

The jury is still out on whether or not fibromyalgia is an autoimmune disease, with some experts arguing the case for, and others arguing against.

We’re going to break down the two sides of the debate. We’ll discuss what causes fibro and the ways in which the immune system is – and is not – involved.

Autoimmunity explained

First things first, what is an autoimmune disease?

Autoimmune diseases or disorders are conditions in which a person’s own immune system attacks the body. Our immune systems are amazing and complicated things that protect us from illness and infections caused by foreign bodies, such as bacteria, viruses, or parasites. So when someone’s immune system gets confused and starts attacking their own cells and tissues, it’s like scoring an own goal in a sports match^[1,2].

This attack on the self can cause inflammation and damage to bodily tissues, organs and systems, and can be fairly mild or can be very serious. There are over 80 known autoimmune diseases, and some of the commonly known ones are rheumatoid arthritis, multiple sclerosis, type 1 diabetes and lupus^[3].

The cause of autoimmune disorders can be hard to confirm. For many people, it runs in their family and therefore probably has a genetic link. Women are three times more likely to develop an autoimmune disorder than men – this is roughly in keeping with fibromyalgia, which disproportionately affects women. In fact, most women who develop an autoimmune disease do so during their childbearing years, and many women with fibromyalgia attribute menopause, pregnancy, childbirth or breastfeeding to the start of their symptoms, which could mean that there is a link to female sex hormones^[4].

The case for: fibromyalgia is an autoimmune disorder

Just like fibromyalgia, autoimmune diseases can be very hard to diagnose because they have such varied and widespread symptoms and can present as similar to other diseases. In fact, joint pain and inflammation are often symptoms, just like in fibro and other chronic pain disorders!

Key factors that tend to be present in autoimmune disorders include:

• damage to the body, caused by the person’s own immune system
• inflammation, again as part of the immune response
• autoantibodies, which are proteins from the immune system.

An important argument for the case of fibromyalgia being an autoimmune disease is the presence of these three things.

First, people with fibro tend to have small-fiber neuropathy, which is a disorder that affects the small nerve fibers in the body, often in the feet. This can cause pain, pins and needles, a feeling of coldness, or other sensations^[5,6].

Low-grade, chronic inflammation is commonly found in people who have fibromyalgia, as are some autoantibodies, known as anti-G protein-coupled receptor antibodies. These antibodies might sensitize pain receptors in the body.

In a 2021 study, scientists injected different mice with the antibodies from people with fibromyalgia and people without fibromyalgia.

The mice injected with antibodies from people who do not have fibromyalgia were unaffected, but those mice who received antibodies from people with fibro started showing hypersensitivity to touch and cold. They also started moving less and became weaker, mimicking some of the common symptoms of fibromyalgia in people. After 2-3 weeks, the antibodies had cleared from the mice and they stopped displaying the symptoms, all of which implies that the antibodies could be to blame^[7].

This is exciting news and could be a real step forward in identifying physical markers for fibromyalgia that can then be targeted for treatment options – perhaps in the future, scientists can work out how to identify and remove fibro-associated antibodies.

The case against: fibromyalgia is not an autoimmune disease

Despite the presence of autoimmune markers and inflammation in many people with fibromyalgia, these things are not always present^[8]. And even in people who do have autoimmune markers, not everyone has the same antibodies. So there’s more to it.

Fibromyalgia often presents with low-grade inflammation and pro-inflammatory proteins called cytokines. These cytokines are produced by the person’s immune system and they control other immune system cells, telling the immune system to do its job. They can also enhance the detection and transmission of nociception, which means more pain!

But it’s a chicken and egg situation. This is a correlation, but doesn’t tell us whether one thing (e.g. the immune system) causes the other (e.g. the pain response system), or vice versa. These factors are all interrelated.

Whichever came first, how do we treat chronic inflammation? Unfortunately, for many people, the inflammation in fibromyalgia is not well-treated by anti-inflammatory medication and immune suppressing drugs also don’t tend to help.

For these people, central sensitization of the nervous system is the best fitting explanation for their pain. This can also explain the myriad other symptoms that are often present, and which have not yet been linked to antibodies, such as fatigue, brain fog and sleep problems. This is best treated with a multidisciplinary approach, which we’ll discuss more in a moment.

So, which is it?

As we started with, the jury is out. Fibromyalgia is a complex condition and it’s possible that different people have different causes. So, for some people it might be linked to an autoimmune disorder, but for others it might not be.

As research continues we can hope to get more clarity, and perhaps even a test and treatment for different autoantibodies^[9]. But until that point, regardless of whether or not fibromyalgia is an autoimmune disease, the best treatment for fibromyalgia continues to be a multidisciplinary approach, involving pain science education, pacing and movement, nutrition, and psychological approaches, among others.

Your outlook depends on the severity of your fibromyalgia. The condition usually continues long-term, but it’s milder in some people than in others.

Fibromyalgia isn’t life-threatening, but it can be life-altering. Learning how to cope with your condition will give you the best possible outcome. Talk with your doctor about finding the best treatment and support options.

If you’d like to learn more about how to treat fibromyalgia, the MoreGoodDays® program is a science-backed multidisciplinary approach to pain-management. Check your suitability today.