Moving my blog
This is a question I've been asked many times. What is meant by this question is this: is the immune system 'responsible' for the symptoms of fibromyalgia? In other words, is immune system dysfunction the CAUSE of fibro. Examples of clearly autoimmune diseases are systemic lupus erythematosis (SLE) and rheumatoid arthritis, diseases in which a person's own immune cells (white blood cells) start attacking that person's own tissues. The theory is this: that someone is exposed to some virus, bacteria or other 'foreign invader', the immune system turns on to attack it (which is appropriate), but then the immune system also starts attacking the person's own tissue because some protein, sugar or fat or other molecule on the surface of the virus/bacteria looks close to some protein/sugar/fat on the surface of the person's own tissues.
There is definitely an autoimmune 'link' with fibro, as there is a significant association between fibro and a number of well-established autoimmune diseases, including systemic lupus, rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, and others. Specific abnormalities in white blood cell function have been identified as well, under a microscope. But none of this confirms that fibro itself is CAUSED by immune system dysfunction.
Attempts to identify a fibro-specific autoimmune antibody have not yet been successful.
And, though it's not difficult to rationalize that a fibro case is autoimmune in those whose symptoms start following a flu-like illness or other infection, or in the setting of some other auto-immune like lupus. On the other hand, it's somewhat difficult to justify an autoimmune cause in those whose fibro starts right after an injury, so-called 'post-traumatic fibromyalgia.'
Hence, I SUSPECT that a SUBSET of fibro cases have an autoimmune component to them. But how might affect treatment of fibro?
Well, those who have an underlying autoimmune disease (like lupus) should be treated accordingly, with attempts to reduce the autoimmune response. One such drug commonly used in severe cases of autoimmune disease, especially when the disease is out of control, is prednisone, a very potent immune system inhibitor. To date, the only study to assess whether suppressing the immune system in people with fibro works was a study, published about 20 years ago, in which patients were given Prednisone. In that study, Prednisone didn't seem to work. It IS possible, however, that such a drug MIGHT have an effect if we could isolate and treat those who specifically have an autoimmune component to their disease.
So, to get back to the question: Is Fibromyalgia an Autoimmune Disease?
I can confidently answer that I don't know. Again, I SUSPECT that SOME cases have an autoimmune basis. To date, all that can be done to identify such people is to look for the presence of other confirmable autoimmune diseases (like lupus) and treat them for those underlying diseases. In some, their fibro symptoms may improve as well.
People still tell me I was crazy. But way back in 1989, my wife and I, just married, packed up and left sunny California to move to Canada, the land of ice and snow. I had just spent a year working as a private Internal Medicine specialist, but now was returning to do two years of training to become a Rheumatologist, an arthritis specialist. Meanwhile, my wife was returning to school too, to further her training as a biochemist.
"But WHY Canada?" people asked us, thinking that this meant we were suddenly going to start living in igloos and eating whale blubber, and only speak some strange northern native language. To be honest, the main reason we were making the plunge (or should I say slide, since everyone knows Canadian waters are frozen 13 months every year) was that Donna and I both are Canadian, love Canada, and enjoy donuts. But another reason I looked forward to the move was that I heard that where I was going, they had specialized inpatient Rheumatology units, where patients with severe arthritis and sudden attacks of arthritis could be admitted for intensive treatment, including physiotherapy and pool therapy and so on. That seemed really progressive and patient-centred to me. Soon after I arrived, I learned that, not only did they have a unit for arthritis patients, they also had 3 inpatient beds reserved for patients with fibromyalgia, to give them intensive therapy and education early in their illness, to help them feel as good as possible as quickly as possible.
But then things changed. I think it was about 1991 that University Hospital lost its three designated fibromyalgia patient beds. But no worries: to replace it, a nice new 2-week, intensive outpatient program was created. Of course, this made it difficult for fibro patients who lived out of town (just where do they stay during those 2 weeks?); but at least it was something. Next to go, a couple of years later, were all the arthritis beds, so fibro patients could no longer even be squeezed into an arthritis bed. But that was okay, because fibromyalgia patients still were being seen by most if not all the Rheumatologists in town. But then, that all changed. Sometime about five years ago, none of the Rheumatologists working out of the hospital were seeing fibro patients anymore. A couple working in a community clinic and private office were. But at least everyone still had that wonderful and now well-established and perfected two week program.
I just found out that this program is now closing too. And this comes on the heels of a recently-published survey of Ontario (that's where I live) Rheumatologists, in which more than half (55%) said they felt fibromyalgia was MOSTLY a psychosomatic disease, and only one in four were even willing to see fibro patients anymore. This, to me, is both tragic and inexcusable. To begin with, as I clearly demonstrate in my book, Breaking thru the Fibro Fog: Scientific Proof Fibromyalgia Is Real, the evidence is now OVERWHELMING that fibro is a REAL PHYSICAL ILLNESS. In fact, it is a multi-systemic disease, which involves the central and peripheral nervous system, the autonomic nervous system, the immune system, the endocrine system (hormones), the gastrointestinal system and the cardiovascular system. In many ways, it is as complex as diseases like systemic lupus.
The other way in which the disheartening results of this most recent poll are so horrific is that it was Rheumatologists who have been behind much of the positive research that has been done in this area. People with fibro and those who love them owe much gratitude to the likes of fibro pioneers like Hugh Smythe, Muhammad Yunus, Jon Russell, Robert Bennett, Dan Buskila and many, many others. Though they still advocate for those with fibro... what about all the other Rheumatologists? Don't they believe their colleagues anymore? Again, the research proving fibro is real should now be considered undeniable.
And so it is that next month I set off on tour again, starting in the UK where I have a series of talks. But I can't do this alone. Please send people to my website to learn more... there's lots of free information there, including a famous editorial I published in 2004 called Fibromyalgia: The Answer Is Blowin' in the Wind. In that article, I borrow two lines from the incomparable Bob Dylan's wonderful song:
How many times can a man turn his head, and pretend that he just doesn't see?
How many ears must one man have before he can hear people cry?
It's time for people with fibromyalgia and those who love and support them to fight back. It is time for everyone who sufferers from this tragically-misunderstood disease to be seen and heard.
Kevin White, MD, PhD, multiple award-winning researcher, author, teacher & speaker