Fibromyalgia and Rheumatoid Arthritis Connection
Rheumatoid arthritis (RA) and fibromyalgia syndrome (FMS) are two chronic pain disorders that commonly go together. While the makeup of these conditions is different, they can share similar symptoms, making it harder for doctors to diagnose them.
Further, the pain associated with RA can also trigger FMS flares (periods of high disease activity), and this makes FMS symptoms harder to control. FMS can also amplify RA pain and make RA symptoms worse.
What’s the Link?
Researchers don’t know what causes RA or FMS or exactly why these two conditions go together. However, they do know that people with RA are more likely to have FMS, but people who have FMS don’t usually develop RA.
A 2017 study found that FMS is more common in people who have rheumatoid arthritis. Further, having both has a major effect on quality of life.
Another study from the same year, reported in Rheumatology and Therapy, finds fibromyalgia has a greater impact in people with RA over any other factor — even depression and anxiety.
Researchers think chronic pain related to RA and other inflammatory pain conditions can lead to FMS, because it changes the way the nervous system processes and perceives pain; this is the same process associated with FMS.
One 2017 study reported in Arthritis Care & Research suggests people with RA can develop high pain sensitization (an exaggerated pain response) related to high disease activity in RA. High pain sensitization is a main feature of FMS. This similarity suggests a similar disease makeup, potentially explaining the overlap between RA and FMS.
Comparing Fibromyalgia and Rheumatoid Arthritis
FMS is known for causing pain, tenderness and stiffness in the muscles and connective tissues. RA, on the other hand, causes pain, swelling, and tenderness in the joints, with the smaller joints of the hands and feet most affected.
Similarities
The two conditions share some similar symptoms including:
- Pain on various areas of the body
- Symmetrical pain and symptoms, meaning if one body part is affected, so is the one on the other side. For example, if the right hand is affected, so is the left hand.
- Stiffness that is worse in the morning and after resting
- Chronic fatigue and exhaustion
- Reduced mobility and range of motion in muscles and joints
- Depression and/or anxiety
Differences
Despite the fact that these diseases have some similarities, they are different in many regards, including what causes them.
FMS is a chronic disorder of the nervous system, that changes the way the brain and nervous system process and interpret pain. One of the major symptoms of fibromyalgia is that sufferers will feel amplified pain.
RA is an autoimmune disease where the immune system attacks the synovial tissues, which line the joints. These attacks lead to pain and inflammation.
Over time, RA may cause permanent damage to the bones and connective tissues of the joints. Ongoing inflammation may also affect organs throughout the body, including the skin, eyes and lungs.
Doctors do not believe inflammation is the cause of FMS pain. However, a recent report in the Journal of Pain Research suggests FMS may induce inflammation not detectable in bloodwork.
To date, researchers have not found any evidence suggesting inflammation is a feature of FMS or a driving force. Further, in FMS, there are no visible signs of damage; this is similar to what is seen with RA.
Diagnosis
Fibromyalgia is more difficult to diagnose than RA because it is a diagnosis of exclusion. This means your doctor will need to rule out all other possible causes of symptoms before making an FMS diagnosis.
Fibromyalgia
In reaching an FMS diagnosis, you will be tested for numerous other conditions that cause widespread pain.
If nothing else explains symptoms, a diagnosis of FMS can be made if:
- Pain is felt when pressure is applied in 18-24 tender points
- Symptoms impact all of the four body quadrants
- Symptoms have lasted for three months or more without any relief
There are currently no blood or lab tests for making an FMS diagnosis. Your doctor will still order blood and lab work to rule out any other potential causes of symptoms though.
Rheumatoid Arthritis
There is no single test to diagnose RA. Your doctor or rheumatologist will rely on:
- Personal and family medical history: personal medical history includes symptoms on both sides of the body, especially in the hands and feet. You will also be asked about other relatives who have RA, as it has been known to run in families.
- Blood work: many people with RA have signs of inflammation and certain antibodies for RA in their blood. According to the Arthritis Foundation, up to 80% of people with RA have an antibody called rheumatoid factor.
- Imaging studies: your doctor will also request x-rays, MRIs and ultrasounds to look for joint damage.
Treatment
Doctors treat fibromyalgia and rheumatoid arthritis differently. The medications for RA depend on how active the disease is.
In general, RA is treated with:
- Nonsteroidal anti-inflammatory drugs (NSAIDs): for treating pain and inflammation
- Steroids: for easing and reducing inflammation
- Disease-modifying antirheumatic drugs (DMARDs): DMARDs calm down the immune system, relieve symptoms and prevent joint damage.
- Biologic drugs: new types of DMARDs target specific parts of the immune system to slow RA processes down.
FMS is treated with a combination of medications and lifestyle changes to manage symptoms. Medications include:
- Over-the-counter pain relievers for treating pain
- Antidepressants to help ease aches, fatigue and sleep problems
- Anti-seizure medicines to manage pain sensitivity
Lifestyle changes can help you to manage both RA and FMS, and may include:
- Low impact exercise: walking, jogging and swimming are all good choices for managing RA or FMS symptoms.
- Improving sleep: a good night’s sleep can help ease symptoms, because it allows your body to rest, something people with RA and FMS need.
- Physical and occupational therapy: physical therapy can help with improving strength, flexibility and stiffness. Occupational therapy helps you to learn new ways to do tasks with less pain.
Takeaway
Neither RA nor FMS has a cure and they are not preventable. However, they are both manageable and treatable.
The outlook for people with FMS is pretty good since they don’t suffer damage to joints, muscles or organs. Furthermore, while the condition is chronic, treatment is helpful and can get symptoms to a manageable level.
There have been many advancements in RA treatment over the past couple decades, and many treatments can stop and slow down the disease. Current treatment goals for people with RA are little or no disease activity, with few or no swollen and tender joints, and low inflammation blood levels.
If you are experiencing any of the symptoms associated with RA or FMS, make an appointment with your doctor. Your doctor will diagnose you and recommend the right treatments.