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While I believe that this "type 2" (chronic achy) lupus is largely due to secondary FM and is seen in up to half of SLE patients, I believe there is the possibility that FM like manifestations may be part of systemic lupus. I back this up with our mRNA studies of lupus vs ANA+ consults vs FM w/ ANA+ that showed a significant number (5-10%) of ANA+ FM pts had an "immune signature" identical to the active SLE patient. Moreover, many of us have given HCQ to such pts for achy complaints and seen improvement. Is that from the immune benefits of HCQ or is HCQ capable of changing pain thresholds (A. Kavanaugh showed that in a small study done at UT Southwestern nearly 30 years ago). I believe this concept deserves more stringent translational studies!