Is Fibromyalgia an Autoimmune Disease?

Fibromyalgia Is (Probably) Not Autoimmune

Discussing symptoms with a doctor.
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Fibromyalgia is not currently classified as an autoimmune disease. However, we can't definitively say it's not one, since we still don't know the underlying cause(s) of the condition. It's possible that future studies may discover that autoimmunity plays a part in some or all cases.

Fibromyalgia affects about five-million adults in the United States. Autoimmune diseases can, and frequently do, occur alongside it.

Additionally, some autoimmune diseases, such as lupus, have similar symptoms.

Because fibromyalgia was once believed to be an arthritis-related condition, and many types of arthritis, such as rheumatoid arthritis, are autoimmune diseases, the assumption was that fibromyalgia fit into this category. Research, though, has pointed in different directions.

Why Isn't Fibromyalgia an Autoimmune Disease?

In autoimmune disorders, the immune system attacks a particular tissue or structure in the body. It typically causes damage and inflammation at that site.

People with fibromyalgia don't typically have high inflammatory markers, which autoimmune disease is linked to, and so far, researchers haven't found much evidence of damage.

However, emerging research does show that certain nerve structures, including the optic nerve, can be damaged. Whether this is evidence of autoimmunity remains to be seen, but that's one possible cause.

Some research suggests that the immune system in fibromyalgia may tend to have some irregularities, such as being chronically over active. Some people believe that means it's autoimmune, but in fact these are a different type of immune dysfunction.

Causes of Fibromyalgia

No particular trigger has been shown to spur the onset of fibromyalgia.

Clinicians believe there are a variety of causes, including:

  • emotional trauma
  • viral infections
  • physical injuries

More and more, fibromyalgia is being called a neuroimmune disorder or a central sensitivity syndrome.

Brain Chemicals & Hormones

Fibromyalgia patients typically exhibit brain chemical and hormonal abnormalities, but no singular pattern has emerged among patients. Although these imbalances are associated with fibromyalgia, there is no clinically conclusive evidence they cause this disorder.

Brain chemical and hormonal imbalances common in fibromyalgia include: 

  • reduced opioid receptor activity in the parts of your brain that regulate mood and the emotional aspects of pain
  • lower serotonin levels or activity
  • lower levels of the stress hormones norepinephrine and cortisol, which lead to inadequate responses to physical and psychological stresses
  • low levels of IFG-1, which promotes bone and muscle growth
  • up to three times the normal level of substance P, which is associated with increased pain perception

    Other Common Symptoms of Fibromyalgia

    As you now know, there is no singular pattern of symptoms for fibromyalgia. However, a group of symptoms is common in many patients and include:

    • aching, radiating, widespread pain and stiffness
    • pain from stimuli that don't normally cause pain (i.e., light pressure)
    • pain that moves from one part of the body to another and isn't associated with damage
    • sleep disorders (as overlapping conditions)
    • cognitive dysfunction (often called "fibro fog")
    • unrefreshing sleep that leads to extreme fatigue
    • restless leg syndrome (as an overlapping condition)
    • irritable bowel syndrome (as an overlapping condition)

    Similar Diseases

    Rheumatoid arthritis (RA) and lupus are two autoimmune diseases that may present symptoms similar to fibromyalgia. Additionally, fibromyalgia may also co-occur with both of these diseases, meaning you can have both at the same time. A correct diagnosis is important to an effective treatment plan.

    RA and lupus, however, do have diagnostic markers that doctors can look for when making a diagnosis. They're both associated with inflammation and damage.

    We'll need a lot more research to determine whether fibromyalgia belongs in the autoimmune category.

    Sources:

    Garcia-Martine E, Garcia-Campayo J, Puebla-Guedea M, et al. Fibromyalgia is correlated with retinal nerve fiber layer thinning. PLoS One. 2016 Sep 1;11(9):e0161574.

    Pilar Bambo M, Garcia-Martin E, Gutierrez-Ruiz F, et al. Study of perfusion changes in the optic disc of patients with fibromyalgia syndrome using new colorimetric analysis software. Journal francais d'opthalmologie. 2015 Sep;38(7):580-7.

    Uceyler N, Zeller D, Kahn AK, et al. Small fibre pathology in patients with fibromyalgia syndrome. Brain: a journal of neurology. 2013 Jun;136(Pt 6):1857-67.

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