Is your fibromyalgia patient a candidate for Lyme disease treatment?

If you have been disappointed to find your fibromyalgia patient is not getting better, you may conclude your patient is a candidate for Lyme disease treatment. The medical conditions share similar symptoms, making an accurate diagnosis challenging.

Fibromyalgia and Lyme disease symptoms can include muscle pain, fatigue, sleep disturbances, gastrointestinal complaints, difficulty concentrating, headaches and temperature, light and sound sensitivities.

Women are also more likely to be diagnosed with the condition. According to the National Institutes of Health, between 80% and 90% of people diagnosed with fibromyalgia are women.

The treatments, unfortunately, are not always effective in eliminating symptoms. Studies have found that serotonin-norepinephrine reuptake inhibitors, Duloxetine (Cymbalta) [1] and Milnacipranz (Savella) [2] were only 30% and 50% respectively more effective than placebo in reducing the pain of fibromyalgia.

Pregabalin (Lyrica), the anticonvulsant drug used for neuropathic pain, was more effective than placebo in reducing pain and improving sleep in a meta-analysis of 3,808 fibromyalgia patients. However, “only a minority of patients achieve moderate or substantial pain relief.” [3] It remains unclear whether Cymbalta, Savella, or Lyrica will reduce other important manifestations of fibromyalgia including cognitive and affective presentations.

It also remains difficult to rule out Lyme disease in fibromyalgia patients with the limitations of current testing. The symptoms of fibromyalgia including fatigue, insomnia, and myalgias [4] are commonplace in Lyme disease. The trigger points described in fibromyalgia [5] are typically referred to as synovitis, [6-8] bursitis, [9] and sacroilitis in Lyme disease (LD).

Your patient may suffer from both fibromyalgia and Lyme disease. In one study, 4 out of 27 individuals (15%) in a chronic neurologic Lyme disease series also presented with fibromyalgia. [10] Three of 25 patients (12%) with active LD seen in a rheumatology based LD clinic were also diagnosed with fibromyalgia. [11] Four of nine fibromyalgia patients (44%) had abnormal CSF fluid analysis with elevated protein levels, slight pleocytosis, or intrathecal antibody production to Bb. [12]

In my clinical practice, I’ve seen men and women who were originally diagnosed with fibromyalgia, but who found symptom relief once given an antimicrobial regime. The symptoms of patients presumed to suffer from fibromyalgia were typically the same as patients who suffered from Lyme disease. The benefits of antibiotic treatment were also typically the same as patients who suffered from Lyme disease.

References:

1. Bradley LA, Wohlreich MM, Wang F et al. Pain response profile of patients with fibromyalgia treated with duloxetine. Clin J Pain, 26(6), 498-504 (2010).
2. Vitton O, Gendreau M, Gendreau J, Kranzler J, Rao SG. A double-blind placebo-controlled trial of milnacipran in the treatment of fibromyalgia. Hum Psychopharmacol, 19 Suppl 1, S27-35 (2004).
3. Straube S, Derry S, Moore RA, McQuay HJ. Pregabalin in fibromyalgia: meta-analysis of efficacy and safety from company clinical trial reports. Rheumatology (Oxford), 49(4), 706-715 (2010).
4. Cassisi G, Sarzi-Puttini P, Alciati A et al. Symptoms and signs in fibromyalgia syndrome. Reumatismo, 60 Suppl 1, 15-24 (2008).
5. Wolfe F, Smythe HA, Yunus MB et al. The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia. Report of the Multicenter Criteria Committee. Arthritis Rheum, 33(2), 160-172 (1990).
6. Steere AC, Malawista SE, Snydman DR et al. Lyme arthritis: an epidemic of oligoarticular arthritis in children and adults in three connecticut communities. Arthritis Rheum, 20(1), 7-17 (1977).
7. Steere AC, Snydman D, Murray P et al. Historical perspective of Lyme disease. Zentralbl Bakteriol Mikrobiol Hyg [A], 263(1-2), 3-6 (1986).
8. Milewski MD, Cruz AI, Jr., Miller CP, Peterson AT, Smith BG. Lyme arthritis in children presenting with joint effusions. J Bone Joint Surg Am, 93(3), 252-260 (2011).
9. Jennings F, Lambert E, Fredericson M. Rheumatic diseases presenting as sports-related injuries. Sports Med, 38(11), 917-930 (2008).
10. Logigian EL, Kaplan RF, Steere AC. Chronic neurologic manifestations of Lyme disease. N Engl J Med, 323(21), 1438-1444 (1990).
11. Sigal LH. Summary of the first 100 patients seen at a Lyme disease referral center. Am J Med, 88(6), 577-581 (1990).
12. Dinerman H, Steere AC. Lyme disease associated with fibromyalgia. Ann Intern Med, 117(4), 281-285 (1992).