The dysautonomia of fibromyalgia may simulate lupus

Some overlap between features of fibromyalgia and systemic lupus erythematous (SLE) is well-recognized. Our objective is to describe eight patients with an original diagnosis of SLE, in whom, after re-evaluation, the multi-system symptoms could be explained on the basis of the dysautonomia that occurs in fibromyalgia.Seven of the eight patients were females. Their mean age was 31 years. All of them fulfilled the American College of Rheumatology criteria for fibromyalgia. Their lupus-like features that could later be explained by dysautonomia were the following: diffuse arthralgias with subjective feeling of swelling, malar erythema, syncopal episodes, profound fatigue, and distal vasospastic changes. Six patients had low titer ANA. None of the patients had signs of organic damage. Autonomic dysfunction was demonstrated by means of circadian studies of heart rate variability (6 patients) and/or tilt table testing (3 patients). We conclude that autonomic dysfunction may be an explanation for the lupus-like symptoms present in some patients with FM.