Fibromyalgia Intensifies Ankylosing Spondylitis Symptoms

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Fibromyalgia and its comorbidities

Fibromyalgia (FM) is a relatively well-known musculoskeletal disorder characterized by widespread pain, fatigue, and sleep issues. However, few are aware of its comorbidities. The frequent pain and other symptoms normally associated with FM can be further exacerbated when occurring along with ankylosing spondylitis, axial spondyloarthritis (axSpA), psoriatic arthritis (PsA) or rheumatoid arthritis (RA).

A study, published in Rheumatology sought to assess both the prevalence of FM in patients with RA, AS, axSpA or PsA as well as the extent to which comorbid FM (FM that exists simultaneously with another medical condition) affects disease activity by analyzing data obtained from various publications and research articles.

Ankylosing Spondylitis

“Ankylosing spondylitis is one type of spondyloarthritis, meaning a condition that inflames places in the body where ligaments meet bones. Spondyloarthritis conditions all have a tendency to have the same genetic marker,” says Theodore Fields, MD, a professor of clinical medicine at Weill Cornell Medical College and the director of the rheumatology faculty practice plan at the Hospital for Special Surgery in New York City.

People with psoriasis may also develop psoriatic arthritis, another type of spondyloarthritis with symptoms similar to AS. Therefore, if you have ankylosing spondylitis, Dr. Fields recommends asking your doctor to examine you for psoriasis, which is characterized by red, itchy, scaly patches on the skin.

If you are also diagnosed with psoriasis and develop back, neck, or joint pain, you should also be checked for psoriatic arthritis. Psoriasis may be treated with topical medications, phototherapy, systemic treatment, or biologic therapy or a combination approach.

Ankylosing Spondylitis and Fibromyalgia

Although their symptoms can be similar, ankylosing spondylitis and fibromyalgia are different conditions. Fibromyalgia involves pain of the muscles and soft tissues such as ligaments and tendons, and doesn’t show evidence of inflammation.


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As, on the other hand, involves significant inflammation. It also affects the spine and other joints at times. More research is needed to determine if a relationship exists between ankylosing spondylitis and fibromyalgia. So far no specific genetic marker has been established for fibromyalgia. This means that currently it’s not possible to connect the conditions genetically.

However, one possible link between AS and fibromyalgia is sleep. “Lack of sleep seems to significantly contribute to fibromyalgia’s development and worsening,” Fields says. “Any condition that causes pain, such as ankylosing spondylitis, can interfere with sleep and can predispose you to fibromyalgia.” Fibromyalgia may be treated with pain management meds or antidepressants.

Ankylosing Spondylitis and Inflammatory Bowel Disease

Inflammatory bowel diseases like Crohn’s disease and ulcerative colitis can also be associated with ankylosing spondylitis. People with inflammatory bowel disease who develop neck and spine pain typically have the same genetic marker as people who develop psoriatic arthritis do.

Inflammatory bowel disease is commonly treated with aminosalicylates, corticosteriods, immunomodulators, antibiotics, or biologic therapies. Tell your doctor if you experience signs or symptoms such as chronic diarrhea or blood in your stool, which may be signs of an inflammatory bowel disease.


In conclusion, FM is much more common in patients with RA, AS, axSpA or PsA than those without. FM also leads to higher disease activity, with substantial symptom worsening occurring in most cases. However, due to the lack of statistically significant changes in objective clinical and laboratory measures (ESR, swollen joints, and CRP), this study also reveals the potential fallibilities of using the DAS28 as a guideline for treatment and disease management as it relies heavily on patient-provided subjective data that may vary by patient. As such, this must be taken into account when establishing a treatment routine.


You can diagnose fibromyalgia in several ways. The most important thing is by discussion with the patient. At the time of the clinical encounter when you listen to the patient, how the patient describes the pain and the associated symptoms, you get a sense that the fibromyalgia may be an issue.

The most important aspects that make you think somebody has fibromyalgia are as follows. One, the pain is going on for a long period of time. Also the pain is generally widespread. It affects the back, the upper extremities, lower extremities, sometimes chest, and abdomen. And there are features of the pain that are very suggestive of fibromyalgia.

The pain occurs with rest. It’s worse after exertion but has some degree of improvement with activity. It’s also strongly associated when the patients describe the pain they use a lot of color. They describe it oftentimes in dramatic terms — stabbing, burning, unbearable, and often they use what we call neuropathic characteristics for the pain. So patients will say it’s burning, tingling, which is a little different from other conditions like rheumatoid arthritis where these kinds of neuropathic aspects are missing.


A variety of medications are available for treating AS and any other conditions that arise. Communication with your doctor is key. “Tell your doctor about all of the medications you taking for ankylosing spondylitis and other medical conditions to avoid overtreatment and alert him or her for possible drug interactions,” says Petros Efthimiou, MD, an associate professor of medicine at Weill Cornell Medical College and an associate chief of rheumatology at New York Methodist Hospital in Brooklyn.

Fields also suggests keeping a list of medications you’ve tried in the past because future treatment choices will be influenced by what you’ve taken previously. By factoring in other related health conditions, you can help to make sure you get the ankylosing spondylitis treatment that’s safest and most effective for you.


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Reference :Concurrent fibromyalgia intensifies ankylosing spondylitis symptoms By Mitchel L. Zoler via MD Edge

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