Is Fibromyalgia an Autoimmune Disease? Dr. Mike Gendreau Explains

Fibromyalgia (FM) is an often severe and painful condition that can cause affected individuals to struggle with routine activities. Although the precise cause of fibromyalgia is unknown there are reasons that experts are hesitant to classify fibromyalgia as one of the autoimmune diseases. Fibromyalgia is a disorder that causes widespread chronic pain. The term "autoimmune disease" refers to any disease that triggers an immune response or abnormal immune system function. So, does fibromyalgia have an autoimmune component?

Classic autoimmune disorders are diseases such as Rheumatoid Arthritis (RA) and Systemic Lupus Erythematosus (SLE), in which the immune system targets normal body tissue and cases swelling, inflammation, joint destruction and pain. So while fibromyalgia is commonly associated with pain, fatigue, muscle and joint pain and sleep disruption, we typically do not see the swelling or joint damage associated with these classic autoimmune disorders.

While we no longer have to ask what is fibromyalgia, the jury is still out on whether fibromyalgia may have an autoimmune component, perhaps more in the central nervous system. One study published in October 2013 in PLoS ONE, for instance, found that women with FM also were likely to have greater levels of anti-cyclic citrullinated peptide antibodies (anti-CCP) in their blood. These anti-CCP antibodies have been associated with rheumatoid arthritis risk factors, so it is possible that some of the genetic risk factors for RA also extend to the development of FM.

The bottom line? While there’s no reason for someone who does not have symptoms to be overly concerned about the development of an autoimmune disease, there is reason for increased awareness that it may be part of the fibromyalgia picture.

Is there any cure for Fibromyalgia?

Pain management is the main treatment for fibromyalgia and these treatments can result in various degrees of success. Opioid drugs are absolutely not recommended because of the risk of addiction and the fact that they can actually make the underlying pain worse over time by inhibiting the body’s natural pain control mechanisms. Non-steroidal anti-inflammatory drugs such as Ibuprofen and Naproxen while not specific treatments for FM, may help treat other sources of pain such as that due to osteoarthritis.

Sleep medications may be prescribed to you by your doctor to assist with sleep difficulties. Exercise can be effective in relieving fibromyalgia pain and discomfort. Talk with your doctor and let them help decide what will be the right treatment for you. A doctor will be ready to help when you decide on an individual treatment plan.

How is fibromyalgia diagnosed?

Because there is no specific single test for FM, doctors often use a variety of tests along with physical exams to rule out the alternative causes of pain. Symptoms may improve with exercise, physical therapy, massage or other ways to relieve stress.

Fibromyalgia can be classified as mild, moderate or severe depending on the number of symptoms you have and their severity. The American College of Rheumatology (ACR) has put forward criteria to help health care providers diagnose FM and differentiate it from other potential causes of chronic pain. These so-called ACR 2016 fibromyalgia criteria require a certain number of tender areas throughout the body, as well as presence of typical symptoms of FM such as fatigue and poor quality sleep.

Other conditions such as hypothyroidism (underactive thyroid gland) and polymyalgia rheumatica often mimic fibromyalgia. Blood tests can help rule out causes such as hypothyroidism.

How is fibromyalgia treated?

There is no proven cure to fibromyalgia but symptoms are usually managed with a non-pharmacologic and medications-based approach. Physical exercise should also be recommended before any drug regimen. Cognitive behavioral therapies as well as mindfulness helps teach patients how to be more relaxed and accepting of their condition.

What causes fibromyalgia?

Fibromyalgia is a common neurological medical condition that causes widespread pain and tenderness. People affected typically suffer from fibromyalgia symptoms that include fatigue, sleep disruption, and memory problems in addition to the widespread pain. It usually begins late in adulthood, but it can occur in the teen years and in old age. Fibromyalgia occurs most commonly in women but can also affect men.

While the cause of fibromyalgia is unknown, there are many theories as to why it occurs with many believing it's due to multiple contributing factors rather than one single cause. This is because some people who suffer with the condition notice that symptoms occur or are triggered with certain events or periods of their lives such as emotional or physical trauma.

FM runs in families so there is a hereditary susceptibility and sometimes, but not always, people can trace their symptoms back to an event which happened during childhood.

Any combination encompassing the above factors could be identified as a cause of FM to happen. This is what makes it difficult for doctors and researchers to understand completely what causes the condition.

At Virios Therapeutics we postulate that when significant physical stressors or emotional life stressors are experienced, these will tend to make the immune system less effective at suppressing viral infections. For patients who are otherwise susceptible due to genetics or previous life stresses, this decrease in immune system activity can result in herpes viruses that are generally always present in the nervous system but inactive, suddenly activating and initiating a cascade of events. This reactivation of herpes viruses can also maintain or amplify existing FM symptoms through flare ups.

Herpes viruses are unique due to the way in which they remain dormant (latent) in neuronal nuclei as nonintegrated, circular DNA associated with nucleosomes. We believe that the reactivation of nerve resident viruses may be associated with the pain response seen in FM. The overall cyclical process that occurs when the HSV-1 virus reactivates combined with lytic infection (killing the cell) is believed to increase symptoms in FM patients.

This article was written and medically reviewed for accuracy by Virios Therapeutics Chief Medical Officer R. Michael Gendreau, M.D., Ph.D.