Question and Answer Forum

Comparing CFS and Lupus

By David S. Bell, MD, FAAP

Published in Lyndonville News, November 2000

Question:

Does Dr. Bell have any information on comparisons of Lupus and CFS as he did in Newsletter No. 2 when he compared MS to CFS?

Answer:

Lupus erythematosis is an autoimmune illness with numerous symptoms that are very close to those of CFS. The term "autoimmune" means that the mechanism of the body is mistakenly attacking the body. Other autoimmune diseases include rheumatoid arthritis, where the immune system attacks the joints, and MS, where it attacks the brain. Fatigue is nearly always an important symptom of autoimmune disease.

There has been discussion about CFS as an autoimmune disease for years, but most researchers do not feel that it is. In practical terms, it is always important to look for lupus in an initial evaluation. In lupus, the joints may be red and swollen, and a butterfly rash may be present over the nose and cheeks, a rash that is different from the flushing rash of CFS. Laboratory tests are helpful in distinguishing the two. The first test is the sedimentation rate, a nonspecific test, which acts as a marker for inflammation. In CFS the sed rate is usually low, while in lupus it is usually high. Kidney disease with abnormal renal tests are found in lupus but not in CFS. The ANA (antinuclear antibody) is usually negative in CFS, but may be present at low levels in up to 25%. In lupus, this test is often extremely high. And lastly, there are more specific antibody tests that are present in lupus but not in CFS.

It is essential to distinguish CFS from lupus. The treatment is completely different, as is the prognosis. With every patient with fatigue and joint pain, the physician should have lupus in the back of his or her mind, and be satisfied that it is not the cause of the illness. Finally, I have never seen CFS turn into lupus, even after many years of follow-up.

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