Multiple Sclerosis, Fibromyalgia and Lupus -
How Do You Know Which One You Have?
By Laurie Long
Many people who are eventually diagnosed with Multiple Sclerosis (MS) often spend years misdiagnosed with other diseases and conditions. (We have concentrated on 3 main ones, although there are also other conditions with similar symptoms.) Even worse, some patients who present doctors with a bewildering variety of complaints may be written off as having psychosomatic symptoms - basically being told that it's "all in your head"! So how do you avoid this problem? How do you find out what is really going on with you? The initial answers to these questions are:
Research each disease and cross-reference listed symptoms against your own.
Write a complete symptom history for your doctor or neurologist. Too often, doctors are only told about symptoms that are occurring right now, and only getting part of the picture.
To help you accomplish this, we'll give you a brief description of MS, Fibromyalgia and Lupus, their symptoms, and tests for each. We'll also provide you with questionnaires to help you document your own symptoms that will give you and your doctor a head start on a solid diagnosis.
~ What Is It? ~
Multiple Sclerosis
MS is an autoimmune disease of the central nervous system (CNS). The nerve cells in the brain and spinal cord, which make up the CNS, are connected to each other by long fibers called axons which are covered with a protective myelin sheath. The body's own immune system attacks the myelin sheaths and axons, causing inflammation and scarring (thus multiple sclerosis - multiple scars). When enough axons and nerves are damaged, the messages carried by the nervous system are disrupted, causing the symptoms of MS. The symptoms of any one individual with MS are dependent on what areas of the CNS have been damaged. For this reason, symptoms differ from one person to another, and can be temporary, recurring or permanent. Symptoms also come and go depending on whether a person is having an exacerbation (attack) or a remission.
Fibromyalgia
Fibromyalgia syndrome (FMS) is characterized by widespread pain and fatigue. Fibromyalgia means pain in the muscles, ligaments and tendons - the fibrous tissues in the body. There is also a substantial symptom overlap between fibromyalgia and chronic fatigue syndrome (CFS). Some experts even believe that fibromyalgia syndrome and chronic fatigue syndrome are one and the same. If you can remember what it felt like the last time you had the flu - exhaustion, every muscle feeling pulled and overworked, hypersensitive skin, etc. - then you have an idea of what fibromyalgia entails. As with MS however, FMS presents a wide range of symptoms which can wax and wane, and can differ from person to person.
Lupus
Lupus is a widespread and chronic autoimmune disease that causes the immune system to attack the body's own tissue and organs, including the joints, kidneys, heart, lungs, brain, blood or skin. In lupus the immune system, for unknown reasons, loses the ability to tell the difference between foreign cells and the body's own cells and tissue. Once this happens, the antibodies attack different areas of the body. Symptoms can range from mild to life-threatening and can vary greatly from person to person. Approximately one third of patients with lupus also develop fibromyalgia. Lupus can also have periods of flares (attacks) and remission.
~ Who Gets It? ~
Who Gets Multiple Sclerosis?
Multiple sclerosis usually affects people between the ages of 20-50 with most people experiencing their first symptoms in their 20's or 30's.There are higher numbers of cases in certain northern latitudes, including Washington. Approximately two thirds more women than men have MS, and more Caucasian people are affected than other ethnic populations. Studies indicate that genetic factors may make certain individuals more susceptible to MS, but no evidence exists that it is directly inherited.
Who Gets Fibromyalgia?
Approximately 20 out of every 1000 people get this condition. Over 85% of these are women. Viral or bacterial infections, automobile accidents, or development of another disorder, such as rheumatoid arthritis, lupus or hyperthyroidism can bring about the onset of fibromyalgia. There is a genetic component to this disease and a genetic predisposition, combined with a triggering event, may cause disease onset.
Who Gets Lupus?
Lupus develops most often between the ages of 15 and 44. It occurs 10-15 times more frequently among adult females than adult males. It is also 2-3 times more common among African Americans, Hispanics, Asians and Native Americans*. 10% of people with lupus have a parent or sibling with lupus and 5% of children born to someone with lupus will develop the disease. Both genetic predisposition and environmental factors play a role in triggering the disease. Triggering factors include infections, antibiotics, ultraviolet light, extreme stress, and hormones. Hormonal factors may explain why lupus occurs more frequently in women than men.(*Statistics taken from Lupus Foundation of America).
~ What are the Symptoms? ~
Symptoms of Multiple Sclerosis include, but are not limited to:
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Blurred or double vision |
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Bladder or bowel problems |
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Coordination and balance difficulties |
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Muscle spasticity, or stiffness |
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Tremors |
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Paralysis |
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Slowing or slurring of speech |
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Memory problems |
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Depression and/or mood swings |
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Heat sensitivity |
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Overwhelming or unusual fatigue |
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Diminished sexual sensation |
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Numbness and/or tingling sensations |
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Confusion, difficulty focusing, organizing or planning |
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Weakness in the arms or legs |
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Headaches |
Symptoms of fibromyalgia include, but are not limited to:
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Pain - muscular aching, burning throbbing, shooting, stabbing pain |
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Irritable Bladder Syndrome |
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Stiffness & pain - especially in morning |
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Dysmenorrhea (painful menstrual periods) |
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Overwhelming or unusual fatigue |
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Cognitive or memory problems |
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Sleep disorder |
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Cold sensitivity (Raynaud's phenomenon) |
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Depression |
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Numbness and/or tingling sensations |
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Irritable Bowel Syndrome |
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Impaired coordination |
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Chronic headaches |
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Dizziness |
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Temporomandibular Joint Dysfunction Syndrome (TMJD) - face & jaw pain |
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Multiple Chemical Sensitivity Syndrome - odors, noise, bright lights, medications, various foods, etc. |
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Muscle twitching |
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Dry eyes and mouth |
Symptoms of lupus include, but are not limited to:
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Achy joints |
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Photosensitivity |
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Fevers (over 100F) |
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Hair loss |
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Arthritis |
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Abnormal blood clotting problems |
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Overwhelming or unusual fatigue |
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Cold sensitivity (Raynaud's phenomenon) |
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Skin rashes |
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Seizures |
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Anemia |
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Mouth or nose ulcers |
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Kidney involvement |
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Depression |
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Pleurisy (pain in chest while breathing) |
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Cognitive dysfunction |
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GI problems |
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Headaches |
~ For the Symptom Cross-Reference Chart, go to the end of this article ~
~ How Do You Test For It? ~
Testing for Multiple Sclerosis
For a clear diagnosis of MS, the doctor has to find evidence that multiple distinct parts of the central nervous system are affected. The neurologist will first take the patient's medical history of what the symptoms are; when the first symptoms occurred, how long they lasted, whether they cause any pain, and a variety of other physical health questions. We provide questionnaires on our website or by mail (to request a questionnaire call us at 206-633-2606) that help you to recall and document your symptom history before your appointment with the doctor. Then the doctor will conduct a physical and neurological examination to determine the particular problems.
Once these tests are performed, the neurologist may order an MRI (Magnetic Resonance Image). MRIs look for plaques, or lesions, in the brain and spine. A gadolinium-enhanced MRI reviewed by an MS specialist neurologist will provide your best chance at accurate diagnosis via this method.
While MRIs are the most useful testing device doctors have for finding MS, they do not uncover every case of MS. At least 10% require further testing and a complete symptom history to facilitate diagnosis. Many times evoked potential tests (EP) are used to measure the impulses along neural pathways running throughout the body that may be damaged. In addition, a lumbar puncture (LP) may be done to look for abnormalities in the Cerebral Spinal Fluid (CSF) and blood tests may be ordered to exclude other diseases that mimic MS symptoms. With all this information gathered during the examination and testing, a diagnosis of multiple sclerosis can usually be determined.
Testing for Fibromyalgia
Because in the past fibromyalgia has not been considered a disease but rather a clinical invention to describe a chronic pain syndrome, there were no blood tests or x-rays which reliably diagnose fibromyalgia. A new test is being researched, and may soon provide an additional tool to diagnose fibromyalgia (see APA Assay test). Currently, in order to diagnose fibromyalgia a physician must take a careful history and perform an examination which focuses on specific local areas of tenderness. These locations are called tender points. There are 18 specified tender points, and the patient must have a finding of pain (not just tenderness) in at least 11 of the 18 points, together with a history of widespread pain in all 4 quadrants of the body for 3 months or more. The doctor will also look at symptom history to determine whether the symptoms reported match the symptoms for FMS.
Testing for Lupus
To help distinguish Lupus from other diseases, the American Rheumatism Association established a list of 11 abnormalities which help distinguish lupus from other diseases. To make a diagnosis of Lupus the patient must have had at least 4 of these, though they do not all have to occur at the same time.
- Malarrash (rash over the cheeks) or Discoid rash (raised red patches)
- Photosensitivity (reaction to sunlight - rash)
- Oral Ulcers (sores in nose or mouth)
- Arthritis (pain in joints)
- Serositis (inflammation of organ tissue and abdominal pain)
- Pleuritis (inflammation of lining of lung) or Pericarditis (inflammation of lining of the heart)
- Renal disorder (excessive protein or cells in urine)
- Neurological disorder (seizures or psychosis)
- Hematological disorder (low red blood count, low white blood count, low lymphocyte count, low platelet count)
- Immunologic disorder (positive LE cell, anti-DNA or anti-SM antibodies tests or positive syphilis (VDRL) test)
- Anti-Nuclear Antibodies (positive ANA test)
In addition to these tests your doctor will take a complete symptom history, so having a list of your symptoms, when they started, and how long they have been manifesting, is an important first step.
~ Summary ~
Whether you have multiple sclerosis, fibromyalgia, lupus, or some other immunological, or neurological disease or syndrome, your chance at getting a quick and accurate diagnosis is immensely greater if you inform yourself about the various diseases, and if you create or keep an accurate accounting of all your symptoms.
You can access our questionnaires on this website, or you can call us at 206-633-2606 for copies. Our questionnaires are specifically designed for people with MS, but they can also be used to help establish many symptoms of other neurological and immunological diseases. They provide a springboard for your research into your own symptoms - to help you and your doctor to the diagnosis that will tell you what you really have.
This article is a compilation of information from many different MS, fibromyalgia, and lupus sites and articles. We have listed these sites below as a starting point for further research, as well as a bibliography of our source material, and a symptom cross-reference chart.
~ Symptom Cross-Reference Chart ~
Symptom |
MS |
Fibromyalgia |
Lupus |
Paresthesias& Dyesthesias (pins & needles, tingling, shivering, burning pains, aching, pressure, areas of skin with heightened sensitivity) |
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Spasticity (muscle spasms or stiffness) |
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Weakness in arms or legs |
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Coordination or balance difficulties |
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Dizziness |
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Paralysis |
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Trigeminal Neuralgia (sharp facial pain brought on by chewing or touch) |
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TMJD (Temporomandibular |
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Optic Neuritis (blind spot(s), pain around eye,) |
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Headaches (chronic, migraine, tension) |
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Depression |
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Fatigue (excessive or chronic fatigue) |
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Sleep disorders (poor sleep, disturbed sleep, can't fall asleep) |
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Irritable Bowel Syndrome |
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Irritable Bladder Syndrome |
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Premenstrual Tension Syndrome |
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Cold Intolerance (including Raynaud's Syndrome) |
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Heat Intolerance |
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Cognitive or Memory Impairment |
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Multiple Chemical Sensitivity Syndrome (sensitivity to odors, light, noise, medications, and some foods) |
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Frequent Fevers |
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Skin Rashes |
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Arthritis |
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Involvement of major organs (heart, brain, lungs, blood, kidneys, etc.) |
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Seizures |
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Hair Loss |
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Mouth/Nose ulcers |
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~ Informational Websites ~
MS:
http://www.msakc.org Multiple Sclerosis Association of King County
http://www.nmss.org The National MS Society
http://www.msaa.comThe Multiple Sclerosis Association of America
Fibromyalgia:
http://www.fmnetnews.com/ Fibromyalgia Network
http://www.myalgia.com/ The Oregon Fibromyalgia Foundation
http://www.afsafund.org/ The American Fibromyalgia Syndrome Association
Lupus:
http://www.lupus.org/ Lupus Foundation of America, Inc.
http://www.lupusresearchinstitute.org/ The Lupus Research Institute
http://www.uklupus.co.uk/ The Lupus Site (UK)
Was this information helpful? Then please consider making a donation. We are a small, independent nonprofit agency and are dependent on donations from our supporters. Thank you from all the staff at the MSA.
~ References and Bibliography ~
Diagnostic Criteria for Fibromyalgia and CFS The Fibromyalgia Network
Overlapping Syndromes The Fibromyalgia Network
Fibromyalgia Basics - Symptoms, Treatments and Research The Fibromyalgia Network
Research on Fibromyalgia The American Fibromyalgia Syndrome Association
The Scientific Basis for Understanding Pain in Fibromyalgia Robert Bennett, MD, The Oregon Fibromyalgia Foundation
Do I have lupus or fibromyalgia? Robert Bennett, MD, The Oregon Fibromyalgia Foundation
Lupus Fact Sheet Lupus Foundation of America, Inc.
Is It Lupus? The Lupus Site (UK)
Symptoms of Lupus Robert G. Lahita, M.D., Chief, Division of Rheumatology and Connective Tissue Diseases, St. Luke's/Roosevelt Hospital Center
Frequently Asked Questions about MS The Multiple Sclerosis Association of King County
Ways to Deal with MS Pain The Multiple Sclerosis Association of King County
Kalb, Rosalind C., MD, Multiple Sclerosis: The Questions You Have - The Answers You Need 2nd Ed. 2000. Demos Medical Publishing, NY
Schapiro, Randall T., MD, Symptom Management in Multiple Sclerosis 3rd Ed. 1998. Demos Medical Publishing, New York
Sibley, WA Therapeutic Claims in Multiple Sclerosis 4th Ed., Demos Medical Publishing, New York
Lechtenberg, Richard, MD, Multiple Sclerosis Fact Book 2nd Ed., 1995. FA David Co., Philadelphia