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Fibromyalgia and Rheumatoid Arthritis
CFS & Fibromyalgia
Related Conditions

How fibromyalgia complicates life with RA

By
Adrienne Dellwo Arthritis Curehow to Arthritis Cure for
Adrienne Dellwo is an experienced journalist who was diagnosed with fibromyalgia and has written extensively on the topic.
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Adrienne Dellwo
Medically reviewed by
Arthritis Curehow to Arthritis Cure for Medically reviewed by Grant the 1 last update 2020/06/02 Hughes, MDGrant Hughes, MD on July 22, 2017

Grant Hughes, MD, is board-certified in rheumatology and is the head of rheumatology at Seattle's Harborview Medical Center.

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Grant Hughes, MD
Updated on April 06, 2020
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In This Article

Rheumatoid arthritis (RA) and fibromyalgia (FMS) are chronic pain conditions that commonly go together. RA is an autoimmune disease, which causes your immune system to attack the lining of your joints and sometimes other body parts, as well. It can cause significant disability and deformity. FMS, meanwhile, is primarily thought of as a neurological or neuroimmune condition in which the central nervous system amplifies pain signals. Fatigue, cognitive dysfunction, and sleep problems are primary symptoms.

While these two conditions are very different, their symptoms can be remarkably similar, making it hard for doctors to diagnose them. When you have both, it becomes even harder. However, without proper diagnoses, you likely won't get the treatment you need to manage your illness(es) and remain as functional as possible.

Why They're Linked

Researchers don't know the precise causes of either condition or why fibromyalgia and rheumatoid arthritis go together so often, but some theories have emerged. One thing that's become clear is that there's substantial overlap in risk factors and causal factors for these illnesses.

Causes and Risk Factors

The suspected causes and risk factors behind RA and FMS have some similarities. They both include:

  • Gender: Women developing these conditions more than men, accounting for about 75% of RA diagnoses and between 75% and 90% of FMS diagnoses.
  • Hormones: Sex hormones, especially estrogen, and hormonal events such as pregnancy and menopause are believed to play a role in the development of both conditions.
  • Genetics: Both conditions have a tendency to "cluster" in families, suggesting a genetic predisposition. Some specific genes have been identified as potential causal factors, and genes for a part of the immune-system called the human leukocyte antigen complex (HLA) may play a role in both RA and FMS. The specific HLA genes may not be the same in both conditions, though.
  • Infectious agents: Exposure to certain infectious agents (i.e., viruses or bacteria) is suspected of altering some people's immune systems and triggering autoimmunity or other types of immune dysfunction (such as those seen in FMS). While both conditions are tentatively linked to several different infectious agents, they both appear to be associated with the Epstein-Barr virus (EBV), which causes mononucleosis (mono).
  • Age: Most cases of RA are diagnosed in people between the ages of 40 and 60. FMS skews younger, developing most often between 20 and 50.
  • Smoking cigarettes: Smoking is tied to an elevated risk and also more severe symptoms in both conditions.
  • Obesity: Higher body weight is associated with an elevated risk and may also exacerbate symptoms of both illnesses.

While any or all of the above elements may contribute to the development of RA and FMS, these conditions can strike anyone, and at any age.Arthritis Curehow to Arthritis Cure for the 1 last update 2020/06/02 Both conditions also have juvenile forms: juvenile idiopathic arthritis and juvenile fibromyalgia.

Which Comes First

While the list of causes and risk factors seems to paint a picture of two diseases with multiple common causes, if that were the whole picture, people with FMS would develop RA at about the same rate as those with RA developed FMS; this is not the case.

Studies show that people with RA are more likely to develop FMS, but people with FMS are no more likely than anyone else to develop RA. In fact, it appears that people with a wide array of chronic-pain conditions develop FMS at a high rate. Some scientists believe that's because chronic pain, from RA or other sources, can cause changes in the way the nervous system perceives and processes pain, and that this process can trigger FMS.

Arthritis Curehow to Arthritis Cure for Not everyone with chronic pain will develop FMS, though. The common causal and risk factors outlined above, therefore, probably play a role. This idea is supported by a study published in Arthritis Care & Research, which demonstrates how people with RA can develop high levels of pain sensitization (an exaggerated physical response to pain) that is a known feature of FMS.

Regardless of why you have both conditions, they can make each other worse. The pain of RA can trigger FMS flares and make your symptoms harder to control, and FMS amplifies the pain of RA.

In people with both, a 2017 study shows that FMS is not only especially common in people with RA, it also has a major impact on your quality of life. That finding is backed by another the 1 last update 2020/06/02 study published the same year in Rheumatology and Therapy, which found that FMS had a bigger impact on global assessment of RA than any other latent factor. In people with both, a 2017 study shows that FMS is not only especially common in people with RA, it also has a major impact on your quality of life. That finding is backed by another study published the same year in Rheumatology and Therapy, which found that FMS had a bigger impact on global assessment of RA than any other latent factor.

Differences

These two conditions have some striking differences when it comes to what's going on in your body, how they progress, and how they're treated.

Perhaps the most notable difference is that RA causes damage and deformity in your joints. FMS is not linked to any joint damage, deformity, or deterioration.

RA is an autoimmune disease. FMS isn't currently classified as autoimmune, although research suggests that some cases may involve autoimmunity. for 1 last update 2020/06/02 Even so, the pain of FMS is felt in the muscles and connective tissues and comes from the nervous system, whereas the pain of RA comes from inflammation and joint damage.

Arthritis Curehow to Arthritis Cure for The Disease Course

The course of RA is unpredictable, but most cases are progressive. After many years (or without treatment), some people with RA develop painful and debilitating deformities to the hands and feet. The larger joints, such as the hips and knees, can become severely disabled and make walking difficult or impossible.

It's common for people to believe that someone with RA will always end up in a wheelchair, but this is a myth. With proper treatment, that's far rarer than you might expect. Even so, RA can cause structural damage that imposes limits movement and mobility.

Arthritis Curehow to Arthritis Cure for FMS is also unpredictable. Research suggests that nearly half of people with the condition will make a significant improvement over a three-year period, and about two-thirds will improve over a ten-year period. So far, researchers don't know what factors influence the course of the illness.

FMS is debilitating in different ways that RA. Physical activity takes a high toll on people with fibromyalgia, intensifying all of their symptoms, and a significant amount of rest is required for recovery. Fatigue is often extreme and isn't relieved by sleep. The cognitive dysfunction alone makes it impossible for some people to do their jobs.

Flares and Remissions

Some cases of RA have prolonged remissions in which symptoms vanish for several years. Others have periodic flares (when symptoms are more severe) and remissions (periods of lighter symptoms). The majority, however, have a chronic, progressive form of RA.

FMS typically involves flares and remissions as well,Arthritis Curehow to Arthritis Cure for but a small minority of cases involve more or less consistent symptom levels. Long-term remissions are rare but possible.

Arthritis Curehow to Arthritis Cure for RA can impact any joint and even your organs, but it most often involves the small joints of the hands and feet. FMS pain can strike anywhere, but it's widespread by definition, and it's more common along the spine than in the extremities.

Getting a Diagnosis

When you go to the doctor with pain that could be due to rheumatoid arthritis, fibromyalgia, or something with a similar presentation, your doctor will likely start by listening to your symptoms, asking about your medical and family history, and performing a physical exam.

No single blood test can diagnose either condition, so doctors look at multiple test results to get the total picture of what's going on. They'll likely order several tests to look for markers of inflammation in your blood, such as:

High Inflammatory the 1 last update 2020/06/02 Markers High Inflammatory Markers

FMS doesn't involve high levels of inflammation. RA does, so high levels of inflammatory markers are a good indication that you have something inflammatory and possibly autoimmune.

From there, your doctor may order blood tests for specific autoantibodies depending on which conditions they believe are likely. Antibodies for RA include:

  • Anti-cyclic citrullination peptide (anti-CCP): This autoantibody is found almost exclusively in people with RA and is present in between 60% and 80% of them.
  • Rheumatoid factor (RF): This antibody is indicative of RA and is found in about 70% to 80% of people who have it.

Your doctor may also order several other blood tests, imaging tests such as X-rays and magnetic resonance imaging (MRI) to confirm the diagnosis and get an idea of how the disease may progress.

How Rheumatoid Arthritis Is Diagnosed

Arthritis Curehow to Arthritis Cure for Low the 1 last update 2020/06/02 or Normal Inflammatory Markers Low or Normal Inflammatory Markers

If inflammatory markers are low or in the normal range, it can help point to an FMS diagnosis, which is a diagnosis of exclusion. Depending on your symptoms, your doctor may order more blood tests for 1 last update 2020/06/02 or imaging to rule things out. If inflammatory markers are low or in the normal range, it can help point to an FMS diagnosis, which is a diagnosis of exclusion. Depending on your symptoms, your doctor may order more blood tests or imaging to rule things out.

Once other possible causes of your symptoms are eliminated, your doctor can confirm an FMS diagnosis in two ways: a tender-point exam or scores on a specially designed evaluation.

How Fibromyalgia Is Diagnosed

What If I Have Both?

It's uncommon for RA and FMS to be diagnosed at the same time. If you have a new RA diagnosis and suspect you also the 1 last update 2020/06/02 have FMS, your doctor will probably want to see how you respond to RA treatments before considering FMS.It's uncommon for RA and FMS to be diagnosed at the same time. If you have a new RA diagnosis and suspect you also have FMS, your doctor will probably want to see how you respond to RA treatments before considering FMS.

Symptoms

Symptoms of RA and FMS can be extremely similar. They both include:

  • Pain (although the types of pain are different)
  • Symmetrical pain patterns (pain in the same place on both sides)
  • Fatigue and loss of energy
  • Depression

RA also can cause symptoms that aren't associated with FMS, such as:

  • Joint swelling, with warmth around affected joint
  • Deformity in the hands and feet
  • Problems with organs
  • Limited range of motion
RA's Impact on Different for 1 last update 2020/06/02 Parts of the BodyRA's Impact on Different Parts of the Body

FMS involves numerous symptoms that aren't linked to the 1 last update 2020/06/02 RA, including: FMS involves numerous symptoms that aren't linked to RA, including:

The Big List of Fibromyalgia Symptoms

If you're diagnosed with one of these conditions but have symptoms that could indicate the other, make sure to bring it up with your doctor.

the 1 last update 2020/06/02 Treatments Treatments

A lot of drugs are available for treating RA. They include:

The treatment regimen may also include steroid injections, physical therapy, massage therapy, and lifestyle modifications.

Sometimes, surgery may be performed to help people with severe joint damage.

Arthritis Curehow to Arthritis Cure for Common drugs for treating FMS include:

Other common treatments are:

Treating Fibromyalgia

If you're taking medications for both RA and FMS, be sure to talk to your doctor and pharmacist about possible drug interactions.

Some FMS experts believe that the corticosteroids sometimes used to treat RA can make FMS symptoms worse; at the very least, they're ineffective against fibromyalgia symptoms. By working closely with your doctor, you should be able to find treatments that work for both the 1 last update 2020/06/02 of your conditions. Some FMS experts believe that the corticosteroids sometimes used to treat RA can make FMS symptoms worse; at the very least, they're ineffective against fibromyalgia symptoms. By working closely with your doctor, you should be able to find treatments that work for both of your conditions.

Arthritis Curehow to Arthritis Cure for Manage FMS and RA Together

Arthritis Curehow to Arthritis Cure for A Word From Verywell

Arthritis Curehow to Arthritis Cure for Both RA and FMS can make your life extremely difficult and limit how functional you can be. By finding and following a treatment/management regimen, you may be able to preserve your functionality and independence.

Because both conditions can lead to depression and isolation, it's important for you to have a support system. Keep lines of communication open with your doctor and the people you're close to, and get early help if you think you're becoming depressed. Support groups—both online and in your community—may be a big help to you, too.

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