The dysautonomia of fibromyalgia may simulate lupus

Some overlap between features of fibromyalgia and systemic lupus erythemato sus (SLE) is well-recognized. Our objective is to describe eight patients w ith an original diagnosis of SLE, in whom, after re-evaluation, the multi-s ystem symptoms could be explained on the basis of the dysautonomia that occ urs 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 fibromy algia. Their lupus-like features that could later be explained by dysautono mia were the following: diffuse arthralgias with subjective feeling of swel ling, malar erythema, syncopal episodes, profound fatigue, and distal vasos pastic changes. Six patients had low titer ANA. None of the patients had si gns of organic damage. Autonomic dysfunction was demonstrated by means of c ircadian studies of heart rate variability (6 patients) and/or tilt table t esting (3 patients). We conclude that autonomic dysfunction may be an expla nation for the lupus-like symptoms present in some patients with FM.