Monday, 13 May 2013

Is Fibromyalgia an Autoimmune Disease?

This is a question I've been asked many times. What is meant by this question is this: is the immune system 'responsible' for the symptoms of fibromyalgia? In other words, is immune system dysfunction the CAUSE of fibro.  Examples of clearly autoimmune diseases are systemic lupus erythematosis (SLE) and rheumatoid arthritis, diseases in which a person's own immune cells (white blood cells) start attacking that person's own tissues. The theory is this: that someone is exposed to some virus, bacteria or other 'foreign invader', the immune system turns on to attack it (which is appropriate), but then the immune system also starts attacking the person's own tissue because some protein, sugar or fat or other molecule on the surface of the virus/bacteria looks close to some protein/sugar/fat on the surface of the person's own tissues.

There is definitely an autoimmune 'link' with fibro, as there is a significant association between fibro and a number of well-established autoimmune diseases, including systemic lupus, rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, and others. Specific abnormalities in white blood cell function have been identified as well, under a microscope. But none of this confirms that fibro itself is CAUSED by immune system dysfunction.

Attempts to identify a fibro-specific autoimmune antibody have not yet been successful.

And, though it's not difficult to rationalize that a fibro case is autoimmune in those whose symptoms start following a flu-like illness or other infection, or in the setting of some other auto-immune like lupus. On the other hand, it's somewhat difficult to justify an autoimmune cause in those whose fibro starts right after an injury, so-called 'post-traumatic fibromyalgia.'

Hence, I SUSPECT that a SUBSET of fibro cases have an autoimmune component to them. But how might affect treatment of fibro?

Well, those who have an underlying autoimmune disease (like lupus) should be treated accordingly, with attempts to reduce the autoimmune response. One such drug commonly used in severe cases of autoimmune disease, especially when the disease is out of control, is prednisone, a very potent immune system inhibitor. To date, the only study to assess whether suppressing the immune system in people with fibro works was a study, published about 20 years ago, in which patients were given Prednisone. In that study, Prednisone didn't seem to work. It IS possible, however, that such a drug MIGHT have an effect if we could isolate and treat those who specifically have an autoimmune component to their disease.

So, to get back to the question: Is Fibromyalgia an Autoimmune Disease?

I can confidently answer that I don't know. Again, I SUSPECT that SOME cases have an autoimmune basis. To date, all that can be done to identify such people is to look for the presence of other confirmable autoimmune diseases (like lupus) and treat them for those underlying diseases. In some, their fibro symptoms may improve as well.

Kevin White, MD, PhD, multiple award-winning researcher, author, teacher & speaker