Editor's Note: This is the last of three articles from Cort Johnson's 2014 review of Dr. Manuel Martinez-Lavin's research on fibromyalgia.
As we continue our series on Dr. Martinez-Lavin’s book Fibromyalgia: How Stress Becomes Real Pain, he takes us on a tour of pain and fatigue disorders that look like Fibromyalgia and are often misdiagnosed in people with FM (or vice versa).
Being given heavy duty immune suppressants or undergoing surgery to no avail is not a happy thing, particularly when you’re already suffering. This list will hopefully alert people to the pitfalls of misdiagnosis in disorders like FM and ME/CFS.
It’s instructive in several ways; the fact that six of the disorders on it are inflammatory/autoimmune disorders probably comes as no surprise, given the fatigue and pain these disorders often cause and the similar gender imbalance in them. Dr. Martinez-Lavin notes that a key difference between these disorders and Fibromyalgia is that anti-inflammatory drugs usually help out in these disorders and don’t usually help out in FM.
Two of the disorders listed are endocrine, two involve structural damage to the nerves, and several are neurological. Dr. Martinez-Lavin warns that if you are due to have surgery to decompress a compressed nerve, as in carpal tunnel syndrome or back pain, make sure that you actually have a compressed nerve and are not simply in pain from Fibromyalgia.
Now let’s take a look at them.
The Fibromyalgia Mimics
Rheumatoid arthritis (RA)
Affecting mostly women, RA causes swelling in multiple joints, morning stiffness, fatigue, and pain.
Telling the Difference between RA and FM
There’s less swelling in FM, and rheumatoid factors and antibodies are present in RA. One study also found far more neurological symptoms in FM than in RA; if you have lots of nerve symptoms like burning, tingling, or numbness, you probably don’t have RA.
Lupus is one of the more misdiagnoses FM patients receive.
Dr. Martinez-Lavin calls lupus misdiagnoses a “real problem” for FM patients. He stated it’s not uncommon for women with FM to be misdiagnosed with lupus and treated (unsuccessfully) as if they have lupus. Both conditions primarily affect women, and both cause fatigue, diffuse pain, joint pain, ruddy cheeks, and fainting.
Telling the Difference between Lupus and FM
ANA (Antinuclear Antibody) tests can be positive in both diseases but are positive in lupus even after the individual’s blood serum has been diluted numerous times. Antibodies specific to lupus are also present. Anemia and kidney problems can be present in lupus and are not often found in FM.
Polymyalgia Rheumatica (PMR) causes diffuse pain mainly in the neck and lumbar region as well as morning stiffness, mostly in people over fifty.
Telling the Difference between Polymyalgia Rheumatica and FM
High erythrocyte sedimentation rate (ESR) and altered c-reactive protein levels indicate PMR is an inflammatory disorder. Those results generally are not seen in FM. PMR responds well, in contrast to FM, to low doses of cortisone.
Affecting mostly young males but also women, ankylosing spondyloarthritis slowly fuses the spine. Inflammation in the tendons and joints is common. Women tend to experience more neck pain.
Telling the Difference between spondyloarthritis and FM
X-rays show alterations in the spine, particularly the sacroiliac joint in spondyloarthritis. HLA-B27 is often positive in spondyloarthritis. As with PM, anti-inflammatories work in spondyloarthritis but usually don’t in FM. If you’re not responding to anti-inflammatories, you probably don’t have spondyloarthritis or PM or RA.
Like Fibromyalgia, gluten intolerance can cause pain, headaches, dizziness, depression, and tingling in the arms and legs as well as gut problems. Gut problems, of course, are common in FM. (Dr. Rowe would probably add dairy intolerance to the list of dietary ME/CFS mimics as well.) Recent studies suggest gluten intolerance may be common in FM.
Telling the Difference between Gluten Intolerance and FM
Positive antibody tests and atrophy of the intestinal villi and intestinal inflammation are present in gluten intolerance.
Nerve Trunk Compression
Anywhere nerves are compressed, whether it’s near the spine or in the limbs (e.g., carpal tunnel syndrome), tingling, numbness, and pain can result. The same symptoms, of course, are often present in FM, and Dr. Martinez-Lavin has seen undiagnosed FM patients undergo unsuccessful spinal, cervical, or other surgeries to try and relieve their pain.
Telling the Difference Between Nerve Trunk Compression and FM
Check to see if the symptoms are localized in the area of the suspected nerve. Check for signs of compression using electromyography including nerve conduction velocity studies.
Chiari Malformation (aka Arnold-Chiari Malformation) refers to compression of the lower part of the cerebellum where the skull meets the spinal area, causing pain, weakness, unsteady gait, and diminished reflexes. Surgical intervention can be very effective in people with Chiari malformation.
Difference between Chiari Malformation and FM
An MRI of the base of the spine shows compression in the main orifice leading to the cervical spine.
Sjogren’s Syndrome (SS) is an autoimmune disease that causes dryness of mouth and eyes, fatigue, and joint pain. In more severe cases it can affect the organs.
Telling the Difference between Sjogren’s Syndrome and FM
Lab tests show positive autoantibody results, but only lip biopsies are definitive for SS. As with lupus, people can have both FM and SS.
Early Stages of Multiple Sclerosis (MS)
MS causes inflammation in the brain and spinal cord and the loss of the myelin sheath that covers the nerves. Like FM, MS can cause enormous fatigue as well as weakness and abnormal sensations.
Telling the Difference Between Multiple Sclerosis and FM
FM can appear like the early stages of MS. The two disorders can be differentiated by the neurological symptoms that only appear as MS progresses.
Either too much or too little circulating thyroid stimulating hormone can cause extreme fatigue. Dr. Martinez-Lavin did not go into the specific thyroid tests to be taken, but it’s clear that the normal slate of thyroid tests will not always pick up thyroid dysfunction in either ME/CFS or FM. With Dr. Bateman stating that no less than 30% of her ME/CFS patients are hypothyroid, thyroid dysfunction is clearly a big deal in these disorders. A blog on thyroid dysfunction is coming up.
Telling the Difference Between Thyroid Dysfunction and FM
Thyroid tests will indicate dysfunction.
Adrenal Gland Disease
People with deficient adrenal cortisol production are chronically tired, weak, and lose weight. Sometimes they present with increased skin pigmentation and low blood pressure. They look more like ME/CFS than FM patients, but FM patients can be misdiagnosed with adrenal cortex problems.
Telling the Difference Between Adrenal Gland Deficits and FM
When given ACTH the adrenal glands of people with adrenal cortex deficiencies will not respond, but people with FM will.
Chronic Hepatitis C Virus causes liver infection that produces intense fatigue. Dr. Newton also finds many of the same autonomic nervous system irregularities as well as enormous fatigue problems in another liver disease, primary biliary cirrhosis, as in ME/CFS.
Telling the Difference Between Chronic Hepatitis C Infection and FM
Determine if the patient has a history of transfusions, tattoos, or intravenous drug use. All increase their risk for hepatitis C. If yes, test for the virus.
Vitamin D Deficiency
Dr. Martinez-Lavin states people with FM, in particular older people with FM, often present with vitamin D deficiency. Only rarely – in FM patients with very low vitamin D levels – does he find that people with FM respond favorably to vitamin D supplementation, however.
Telling the Difference Between Vitamin D Deficiency and FM
Low vitamin D levels in the blood are present.
Prescription Drug Use
Statins are widely-used drugs that can cause muscle weakness and muscle pains. Laboratory tests will show a high level of creatine kinase.
About the Author: ProHealth is pleased to share information from Cort Johnson. Cort has had myalgic encephalomyelitis /chronic fatigue syndrome for over 30 years. The founder of Phoenix Rising and Health Rising, he has contributed hundreds of blogs on chronic fatigue syndrome, fibromyalgia and their allied disorders over the past 10 years. Find more of Cort's and other bloggers' work at Health Rising.