Fibromyalgia: The Challenges of Diagnosis

Fibromyalgia (FM) is a chronic condition where the diagnosis is made by elimination since there are no specific lab tests for diagnosis. In the past, we’ve discussed the different types of FM, the lack of good diagnostic tests, many management recommendations derived from interviews with FM patients, and more.

One of the many causes of FM involves the autoimmune system, thus suggesting that FM may be an autoimmune disease. In summary, the autoimmune system is very important system for all of us, as it controls the means by which our body fights off unwanted foreign particles like viruses, bacteria, and a host of other triggers that can negatively affect our body. The autoimmune process is best explained by example: Let’s say a certain type of food is eaten to which a person has an allergy. As particles from that food are absorbed into the blood stream, the body senses that something is wrong –foreign particles are there that shouldn’t be there. As a result, the body produces antibodies, which function like an army trained to “fight” the foreign particles. If the body’s autoimmune system handles it without a problem, the person may not even know anything is “wrong” or that this process is going on. However, if the foreign particle is not handled easily or properly, then all kinds of symptoms can occur. In this food allergy example, stomach pain, nausea, cramping, diarrhea, and perhaps hives on the skin may even occur. Another common autoimmune example occurs in the spring when flowers bloom, grass grows, trees bud, and so on. Many of us suffer from what is commonly referred to as “hay fever” and possible symptoms include a runny nose, itchy watery eyes, and sneezing (lots of it).

FM is sometimes thought to be associated with rheumatoid arthritis but the scientific evidence is not in full agreement with this theory either. More consistent evidence for causation seems to support the following possibilities: 1. Following trauma or injury. 2. A central nervous system origin (the topic of last month’s FM article). 3. Changes in muscle metabolism. 4. A decrease in muscle blood flow.

However, there are still those who support the cause of FM being triggered by an infectious agent like a virus in susceptible people, even though no specific agent has yet to be identified. For those who state that FM is not an autoimmune disease, they do admit FM may have an “autoimmune component” to it. One study published in the Journal of Rheumatology reported, “…that scientists have discovered a new antibody in the blood of many FM patients.” Subsequently, a new test was developed for detection of the “Anti-Polymer Antibody” (APA) that was reportedly found in more than 60% of FM patients with severe symptoms. The idea of a specific blood test for FM is certainly welcomed by all experts and clinicians who manage FM as a reported $16 billion/year in direct medical costs are associated with FM. Unfortunately, when comparing the APA levels in FM patients to those with rheumatoid arthritis and controls with neither, the APA levels were not able to distinguish between the groups. Unfortunately, until better testing methods are developed, doctors and researchers will continue to look for the “gold standard” FM test.

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