Would you consider/ have experience with Duloxetine for Fibromyalgia in Systemic Lupus Erythematosus (SLE) patients?
Or for depression/ anxiety in SLE patients?
Are there any reported effects in these patients in regard to fatigue?
Are you sure you can diagnoze fibromyalgia in SLE?
SSRI, SNRI, Tricyclics are quite common in use in treatment of depression with coexisting pain in SLE.
A chronic diffuse-pain syndrome in a patient with SLE with negative clinical and biological markers of disease activity would qualify for a diagnosis of fibromyalgia. In that context of a young person, fatigue and anxiety/depression would likely be also present. So in order to be able to participate in what Dr C.M. proposes, a bit of duloxetine may be needed. Both empirical approaches are not mutually exclusive. Finally, am not aware of any definitive study documenting effects on fatigue for either approaches. Best.
HM
How certain is the diagnosis of SLE?
If the patient only has anti nuclear antibodies without anti DNA, chances are you are not dealing with lupus but psoriatic arthritis. This condition is associated with antinuclear antibodies and chronic pain. If it is so, fatigue may resolve under TNF blockers....
Hi Jean,
important point! Idiopathic SLE can and should be proven while idiopathic FM is an exclusion diagnosis. When they coexist, it is a sine qua non condition that SLE is inactive clinically and also, biologically. Otherwise FM is just one of the Lupus symptoms.
NB for the readers : anti-TNFs are not so good for SLE and will usually mean trouble...
best
Thank you very much for all answers.
My question was related to well-defined SLE cases (fulfilling the ACR 1997 classification criteria if we consider the SLICC 2012 too sensitive) +/- anti-DNA positivity.
The drug-induced lupus syndromes (eventually anti-histone positive or even anti-DNA positive) is part of the systemic autoimmune conditions associated with TNF inhibitors use, I did't consider this treatment.
I found very difficult to sustain a FM diagnosis in SLE (as fatique in 80%, non-specific arthralgia and even myalgia, depression etc occurring in SLE).
However, FM appears to be more frequent in SLE than in general population and to have an impact on the life quality ( PMID: 23681396 ).
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