Fibromyalgia and RA

RA With a Side of Fibromyalgia

For years, fibromyalgia was a mystery illness. No one knew what caused it, how to diagnose it or how best to treat it. Some people, including doctors, even questioned its existence. In the last few years, however, researchers have cleared up some of the mystery. Although much about fibromyalgia still isn’t understood completely, two things are clear: It’s very real, and it affects a disproportionate number of people with rheumatoid arthritis (RA).

What Is Fibromyalgia?

Fibromyalgia is a syndrome marked by widespread pain, fatigue, poor sleep and memory problems. It’s often associated with other symptoms, too, including headache, irritable bowel syndrome and increased sensitivity to temperature changes, light and sound. In some respects, it can resemble RA, which is why patients with both RA and fibromyalgia sometimes go years without the fibromyalgia being diagnosed.

Unlike arthritis, however, fibromyalgia doesn’t affect or damage joints or other tissues. “Fibromyalgia pain tends to occur where arthritis pain doesn’t, such as the trunk, back and muscles in the thighs and arms,” explains Daniel Clauw, MD, a professor at the University of Michigan and noted fibromyalgia researcher. “Qualitatively, it’s a different kind of pain, too, more diffuse and migratory — not as constant from day to day as, say, rheumatoid arthritis in a finger joint.”

The cause of fibromyalgia pain is also different. Instead of resulting from inflammation, it’s thought to result from changes in the way the brain and spinal cord process and transmit pain signals.

Robert Bennett, MD, professor emeritus at Oregon Health & Science University in Portland, Oregon, and executive director of the Fibromyalgia Information Foundation, explains that in fibromyalgia, pain impulses are intensified, as if the volume on a radio has been turned up full blast.

Dr. Clauw and colleagues first demonstrated an association between fibromyalgia and a heightened pain response in 2002. In their study, people with fibromyalgia had measurable responses to gentle finger pressure in pain-processing areas of the brain. It took twice as much pressure to create similar responses in controls.

These findings have since been corroborated by other research, including a 2013 Harvard study published in Arthritis & Rheumatism suggesting that the brains of people with fibromyalgia are less able to guard against pain signals. This hypersensitivity to pain is known as central sensitization.

Double Trouble

Having inflammatory forms of arthritis increases the risk of fibromyalgia. This may be due, at least in part, to chronic pain itself, which causes the brain to become highly sensitized not only to things that hurt but also to things that normally aren’t painful. The hypersensitivity makes arthritis pain worse and can create widespread pain and other symptoms, such as fatigue, even when arthritis is well controlled.

Ann Vincent, MD, a physician-investigator specializing in fibromyalgia at the Mayo Clinic in Rochester, Minnesota, points out, “People with fibromyalgia have pain receptors firing all the time. And in fighting that pain, people become fatigued, have unrefreshing sleep and cognitive problems. It’s important to recognize that chronic pain kicks the symptom burden much higher.”

It’s not clear how many people with RA have fibromyalgia. Researchers used to think it was around 20–30%, but that number may be too low. The current thinking, based on a 2013 study in Arthritis Care & Research, is that fibromyalgia is a spectrum disorder, with symptoms ranging from mild to severe. That means more people are likely to fall under the fibromyalgia umbrella.

“Once patients are diagnosed with RA or lupus, rheumatologists tend to attribute all pain and fatigue to the autoimmune disease. What can end up happening is that the RA is over-treated with disease-modifying drugs or biologics because symptoms such as fatigue and memory problems persist even after joint swelling and inflammation are reduced. Persistence of symptoms should be a blinking neon light to look for central sensitization,” Dr. Clauw says.

How Is Fibromyalgia Treated?

Dr. Clauw says one of the most common misconceptions is that there are no effective therapies for fibromyalgia.

“Fibromyalgia requires both pharmacological and nonpharmacological therapies,” he explains. “Pharmacological therapies address pain processing, and nonpharmacological therapies address the functional consequences of pain. So, for instance, we know [physical] activity is extremely important. Research has repeatedly shown that regular activity is one of the most effective treatments for pain syndromes, just as it is one of the most effective treatments for arthritis. I tell people to take it slowly because if they try to do too much at first, they get frustrated.”

Deep, restorative sleep is also essential for reducing chronic pain, but for many people with fibromyalgia, that’s easier said than done. Pain interferes with normal sleep, and lack of sleep makes pain worse. Conversely, a good night’s rest can significantly improve fibromyalgia symptoms.

Relaxation techniques, meditation, massage, deep breathing and cognitive behavioral therapy — a type of therapy that can help change certain thought and behavior patterns — are also helpful for relieving pain and fatigue.

Nonpharmacologic approaches are particularly important because the three drugs approved to treat fibromyalgia — pregabalin (Lyrica), duloxetine (Cymbalta) and milnacipran (Savella) — are only moderately effective. Dr. Clauw emphasizes that most patients find relief with a combination of treatments.

He also recommends that people with RA who have ongoing pain and other symptoms ask their doctor about fibromyalgia.

“That question may cause your physician to have an ah-ha moment,” he says.

Linda Rath for the Arthritis Foundation

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23 thoughts on “RA With a Side of Fibromyalgia

  1. It was so reassuring to read that Im not being overly dramatic about my pian. I have RA but also have fibro. The pain in middle of back and back of top part of thighs, was a revolution for me.

  2. I truly appreciate this comprehensive article. The information confirms the reasons I have cognitive problems. All my life I have had extreme reactions to unexpected sounds (I jump, scream) which annoy my husband. Bright lights give me migraines. My rheumatologist dismisses the fibromyalgea and Sjogren’s Syndrome. He contends no treatment is effective for those two. Anyway, thank you for this contribution. I feel validated.

  3. I had been diagnosed with fibromyalgia decades ago, then osteoarthritis 2 decades ago, and RA about 7 years ago.

  4. This is good information. I have both. BUT my RA Doc refuses to treat my fibormyalgia because he says there are not related. It appears more education needs to be provided to the doctor on this issue.

  5. In my opinion I think they have it backwards I think most people start with the fibromyalgia and get RA. FIbromyalgia has just recently been acknowledged as a real illness and was not recognized for what is was for a long time if there was a way to go back and look at this I think that is what would be found.

  6. Hi my name isUrsula, I have fibromyalgia for 15 years, I tried everything nothing works I’m in pain 24/7, last year I was diagnosed of RA, I also a diabetic so I have a lot on mine plate,I can’t due very much getting tied very easy need a lot of rest, I don’t sleep very good every 2-3hr I’m awake, i don’t take any mess for my fibro but I do take for my RA Leflunomide.

  7. I have fibromyalgia and RA and it is hard to find a medicine that works for me because most of them I cant take because I have an allergic reaction to them so most of the time I just hurt .

  8. I have so much pain, I walk daily, exercise mildly, do stretches, work 8.5 hrs 5 days a week. Have tried Cymbalta, Lyrica, antidepressant , amytreptiline, gabapantin, nothing works. Sleeping is very restless after 3 hrs. Lots of heat & ice to try & relieve pain. I just wish I could get some relief, my worst pain is neck, shoulders, feet, I also have psoriatic arthritis , but no psoriasis. Also osteoarthritis in my knee. Any suggestions I would appreciate. Thank you

  9. I have had RA for around 12 years now, and I was told about 7 years ago I had Osteoarthritis. Well I was also “Blessed” with fibromyalgia 5 years ago, so I have read a LOT about each. I have worked most of my life in law enforcement, so I have to learn about the medical problems as they come.

    I will say that this is one of the best ( if not the best ) down to earth, in plain language articles that I have come across in as many years.

    Even though I have read a lot about Fibro. I still am learning more and more, and the one thing that nobody has touched on is why do men (like me) get this disease when it is supposedly a “ladies” disease.

    I truly mean NO disrespect to any lady about that remark, by far!
    Just the opposite, I want to know why is it that This person, over that person might get fibro.

    People do not realize that my very active life came to a screeching halt when this disease came upon me. I now days (for the most part) wake up make myself a coffee, find something to eat that is very high in protein ( Stomach surgery, lost 180 lbs). then if I feel ok enough I might make a run to “A” store ride the darn scooter and buy what we needed from there.
    If I do not feel well I curl up with at least 1 – 3 heating pads, a blanket and pain meds. (BROKE THE HABIT OF THE HUGE PAIN MEDS!) I only take as needed LOL pain meds. If I go anywhere I am blessed enough to (by far paying on it) have a SUV that has heated seats, they are on almost all the time, EVEN IN THE SUMMER! ( Oh did I mention I live in Southwest Florida where it is almost always hot!)

    SO sorry getting off track (normal for me now days) I do want people to realize that Men too get Fibromyalgia also, and we hurt just as much. (not more or less)
    Please people when you see somebody that does not “look” handicapped—- stop and think before you mouth hurts their feelings.
    (Oh don’t think for a second that I do not realize that we have people faking the system, because I know we do!!!)

    God speed all with this horrid disease, and any other too!

  10. I was diagnosed with Epstein Bar 17 years ago which causes fibromyalgia. And no matter what the new info says regarding contracting Epstein Bar from having mononucleosis, I have NEVER had mono! In the last year I have started experiencing severe joint pain and now issues with my liver because of meds, Ibuprofen and alcohol that I’ve used for years to control pain and sleep. I would love more information and help on this issue.

  11. How can I get help with my Rheumatoid Arthritis I go from doctor to doctor and still I’m in so much pain

  12. Thank you. My dr wanted to start me on biologic s and I have been putting her off. The pain I am experiencing is not in my hands or wrist joints it is more muscle hip and thigh. I’m am experiencing sleepless nights and fatigue. I’m useless after about 3-4pm. The info about fibromyalgia was very eye opening.

  13. Excellent article! Finally a spotlight on Fibromyalgia, and its relationship with RA. I have been diagnosed with both for six years now, and my mother had Fibromyalgia from her 50s on, when not much info was available on it and at a time when doctors told her the debilitating pain and fatigue was “all in her head.” So very frustrating for her and to watch her go through it and have flares when she was very ill. A chiropractor finally diagnosed her in 1981. The analogy of the pain being like a radio being turned on full blast is dead on. I take my RA with a heaping side of FM. ?. I am sharing this article! Thank you!

  14. hi i have ra.and fibroyalgia and bad hands and feet dont sweĺ as much as they used to do.but ive noticed ive lost lots of muscle in my arms my hands have gone smaller too and my legs and ankle are lots thinner.since ive had this nee anyone feeling lime me please

  15. Hey thanks for posting this. I really appreciate it. One thing I have found about fibromyalgia through the years (I’ve had it which is like 12 – diagnosed anyways) is about 10 years ago doctors considered it a “waste basket diagnosis” (i.e. if it’s a good doctor they will immediately throw it in the waste basket and move on. If it’s a bad doctor though they would ‘label’ you with it.

    Why was the latter the bad doctor? Because the diagnosis meant nothing, solved nothing and did nothing so if you ‘label’ the patient that (I.e. fibromyalgia) then you could be missing something much more serious (I.e. RA) and end up not treating either. As a 26 year old, I have come to realize the concept of a waste basket diagnosis is pretty much the worst analogy anyone could ever conceptualize for a diagnosis (or worse, a patient).

    However, this is what I was told at 12 when I asked my doctor about fibromyalgia. Unfortunately for her, what she didn’t know is I was the type of kid who metaphorically dug through her trash when she left the room and sometimes no label is worse than any label at all (even if it’s written on a napkin, thrown away and eventually some customer outside a bar finds it in the trash and starts a support group for himself and his friends to treat their shared label (e.g. fibromyalgia).

    P.s. if they tell you about someone with MS leave the clinic and find a doctor who will take your situation more seriously.

  16. Interesting and informative article…I never connected the two RA and Fibro (bc I always wondered where the Fibro came from). Now if I could get a grip on my SLE/Descoid Lupus and Osteoarthritis I’ll be doing good.

  17. Finally, the link that I intuitively “knew” was there, is validated. The various doctors , who, at different times, tell me that I do, and/or don’t, have an “inflammatory disorder” can now shake hands ! For 30 years, I have been told by about half of the Doctors with whom I have consulted, that I “only have fibromyalgia”, due to chronic pain, fascial knots, trigger points, etc. The acute exacerbations, the visible joint swelling, elevated ANA, CT scans that show extreme inflammation, etc, have been brushed aside. My first diagnosis of an inflammatory disorder ( at a teaching hospital) , was when I was 36. I am now 67 and have been under-treated for the most part of all theses years. Thank you for bringing this link to light and continuing research on the connection(s). Sincerely, Barbara Harris

  18. Some days I wake up and sit on the couch and I’m so exhausted that I literally sleep all day on the couch. When I wake up I’m in a fog and it’s all I can do to get up and move around and all I want to do is sleep. What can help with that? It’s not all the time but it’s usually a day or two couple times a month.

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