The latest research indicates that fibromyalgia and rheumatoid arthritis often coexist due to a variety of different reasons. They have some similarities in their genetic background, and females are more prone to both of them. Chronic stress also plays an important role with the development of these conditions, even when they are both different.
RA belongs to the group of diseases called autoimmune disorders. It is a condition that, due to unknown reasons, the immune system cannot recognize the tissues in joints and starts attacking them. These wrong immune responses lead to damage joints. Though RA is mostly a disease of joints, it may spread to other organs, creating diseases with the lungs, heart, and even kidney.
Fibromyalgia, on the other hand, is a very poorly understood condition. It is characterized by the decreased threshold to painful stimuli. This means that a person with fibromyalgia feels more pain than usual. The disease is characterized by general fatigue, the unexplained pain of muscles, and psychological changes. The most common theory is that chronic inflammation and stress lead to the alterations in the brain, causing changes in the way a person feels pain.
The statistic shows that around 2 percent of Americans have fibromyalgia. However, its prevalence is much higher in those living with RA. Various epidemiological studies indicate that as many as 10-20 percent of those living with RA may also have fibromyalgia.
Identifying the conditions
Both these conditions are challenging to diagnose in their initial stages. There are tens if not hundreds of diseases that may cause pain in the joints. However, as RA progresses, it becomes easier to diagnose. With the progression of RA there are specific symptoms, changes in the joints, visible changes in imaging tests, and there are specific blood tests that are able to confirm the diagnosis.
Fibromyalgia is an altogether different story, and there is no straight forward way to diagnose the conditions. There is no specific imaging or blood test to confirm the diagnosis. Diagnosis of fibromyalgia is made purely on the symptoms reported by the person. The American College of Rheumatology is the first organization to come up with a clear diagnostic criteria for the condition. Diagnosis is made on the basis of chronic fatigue, mood changes, and pain in several areas of the body for no apparent reason.
Diagnosis of fibromyalgia is simpler in the presence of generalized painful conditions, and absence of other illness. However, if a person is living with RA, physicians may fail to recognize fibromyalgia as they may think that the pain is caused by RA. However, identification of fibromyalgia in RA is essential since both the conditions require different treatment approaches.
Treatment options in RA and Fibromyalgia
Although, the treatment for both conditions differs, treating one condition efficiently would also help the other condition. A significant difference between the two conditions is that RA is an autoimmune, inflammatory, and painful condition, with pain mainly localized in the joints, while fibromyalgia is a generalized painful condition with psychological changes.
Treatment approach for RA
In RA, physicians would usually start with NSAIDs (non-steroid anti-inflammatory drugs). In some cases, even over-the-counter medications like ibuprofen may help. NSAIDs may also help to relieve the symptoms of fibromyalgia as they have both anti-inflammatory and pain reducing effects. However, NSAIDs often cause side effects like gastric discomfort, though newer NSAIDs have fewer side effects and ease of once-a-day dosing.
If NSAIDs did not help, and joint pains keep on getting worse, physicians may have to prescribe steroids. Steroids are powerful anti-inflammatory drugs, but they are also toxic. These drugs are reserved for only severe conditions as they cause changes in the immune system, causing a weakening of bones, and they may even precipitate diabetes.
In some conditions, the so-called disease modifying antirheumatic drugs (DMARDs) may help. These drugs help by altering the immune responses. However, they are only useful in a small number of cases. In recent years, several biological DMARDs have been developed, and it is expected that soon researchers may come up with drugs that may be able to alter the course of the disease altogether.
In a small number of cases, when therapy fails, a surgical correction of joints may be the only option.
Alternative medicine and supplements may help in some cases, but what makes physiotherapy and alternative medicine so attractive is that it may help in both rheumatoid arthritis and fibromyalgia.
Treatment approach to fibromyalgia
In fibromyalgia, both medications and non-pharmacological treatments have equal importance and effectiveness. In some cases, anti-inflammatory drugs used to treat RA may also help in fibromyalgia.
However, if NSAIDs do not help, doctors may switch to opioids. Opioids are excellent in suppressing pain, but they would not help in other symptoms related to fibromyalgia. Antidepressants and anti-seizure drugs have been widely used to treat the condition.
In fibromyalgia, non-pharmacological treatment has high importance. Research shows that these methods are not only useful, they are also much safer. No one method would work for all, there is just trial and error that will choose the optimal approach.
In some specific dietary and lifestyle changes, some may benefit from hypnosis or acupuncture. Certain health supplements may also help with the condition. Aerobic exercises have been widely studied in the condition and known to help in the majority of the cases.
- 2016 Revisions to the 2010/2011 Fibromyalgia Diagnostic Criteria. ACR Meeting Abstracts. http://acrabstracts.org/abstract/2016-revisions-to-the-20102011-fibromyalgia-diagnostic-criteria/. Accessed March 10, 2018.
- Bellato E, Marini E, Castoldi F, et al. Fibromyalgia Syndrome: Etiology, Pathogenesis, Diagnosis, and Treatment. Pain Res Treat. 2012;2012. doi:10.1155/2012/426130
- Naranjo A, Ojeda S, Francisco F, Erausquin C, Rúa-Figueroa I, Rodríguez-Lozano C. Fibromyalgia in patients with rheumatoid arthritis is associated with higher scores of disability. Annals of the Rheumatic Diseases. 2002;61(7):660-661. doi:10.1136/ard.61.7.660