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Research ArticleArticle

Fibromyalgia, Systemic Lupus Erythematosus (SLE), and Evaluation of SLE Activity

FREDERICK WOLFE, MICHELLE PETRI, GRACIELA S. ALARCÓN, JOHN GOLDMAN, ELIZA F. CHAKRAVARTY, ROBERT S. KATZ and ELIZABETH W. KARLSON
The Journal of Rheumatology January 2009, 36 (1) 82-88; DOI: https://doi.org/10.3899/jrheum.080212
FREDERICK WOLFE
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  • For correspondence: fwolfe@arthritis-research.org
MICHELLE PETRI
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GRACIELA S. ALARCÓN
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JOHN GOLDMAN
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ELIZA F. CHAKRAVARTY
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ROBERT S. KATZ
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ELIZABETH W. KARLSON
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Abstract

Objective

To determine if fibromyalgia (FM) or fibromyalgia-ness (the tendency to respond to illness and psychosocial stress with fatigue, widespread pain, general increase in symptoms, and similar factors) is increased in patients with compared to those without systemic lupus erythematosus (SLE); to determine whether FM or fibromyalgia-ness biases the SLE Activity Questionnaire (SLAQ); and to determine if the SLAQ is overly sensitive to FM symptoms.

Methods

We developed a 16-item SLE Symptom Scale (SLESS) modeled on the SLAQ and used that scale to investigate the relation between SLE symptoms and fibromyalgia-ness in 23,321 patients with rheumatic disease. FM was diagnosed by survey FM criteria, and fibromyalgia-ness was measured using the Symptom Intensity (SI) Scale. As comparison groups, we combined patients with rheumatoid arthritis and noninflammatory rheumatic disorders into an “arthritis” group and also utilized a physician-diagnosed group of patients with FM.

Results

FM was identified in 22.1% of SLE and 17.0% of those with arthritis. The SI scale was minimally increased in SLE. The correlation between SLAQ and SLESS was 0.738. SLESS/SLAQ scale items (Raynaud’s phenomenon, rash, fever, easy bruising, hair loss) were significantly more associated with SLE than FM, while the reverse was true for headache, abdominal pain, paresthesias/stroke, fatigue, cognitive problems, and muscle pain or weakness. There was no evidence of disproportionate symptom-reporting associated with fibromyalgia-ness. Self-reported SLE was associated with an increased prevalence of FM that was unconfirmed by physicians, compared to SLE confirmed by physicians.

Conclusion

The prevalence of FM in SLE is minimally increased compared with its prevalence in patients with arthritis. Fibromyalgia-ness does not bias the SLESS and should not bias SLE assessments, including the SLAQ.

Key Indexing Terms:
  • SYSTEMIC LUPUS ERYTHEMATOSUS
  • SYSTEMIC LUPUS ACTIVITY MEASURE
  • SYSTEMIC LUPUS ERYTHEMATOSUS ACTIVITY QUESTIONNAIRE
  • FIBROMYALGIA

Footnotes

    • Accepted for publication August 6, 2008.
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The Journal of Rheumatology
Vol. 36, Issue 1
1 Jan 2009
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Fibromyalgia, Systemic Lupus Erythematosus (SLE), and Evaluation of SLE Activity
FREDERICK WOLFE, MICHELLE PETRI, GRACIELA S. ALARCÓN, JOHN GOLDMAN, ELIZA F. CHAKRAVARTY, ROBERT S. KATZ, ELIZABETH W. KARLSON
The Journal of Rheumatology Jan 2009, 36 (1) 82-88; DOI: 10.3899/jrheum.080212

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Fibromyalgia, Systemic Lupus Erythematosus (SLE), and Evaluation of SLE Activity
FREDERICK WOLFE, MICHELLE PETRI, GRACIELA S. ALARCÓN, JOHN GOLDMAN, ELIZA F. CHAKRAVARTY, ROBERT S. KATZ, ELIZABETH W. KARLSON
The Journal of Rheumatology Jan 2009, 36 (1) 82-88; DOI: 10.3899/jrheum.080212
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