How to Manage Fibromyalgia and Rheumatoid Arthritis Together

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Having inflammatory forms of arthritis increases the risk of fibromyalgia.

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.”

Symptoms Which Distinguish Fibromyalgia from Rheumatoid Arthritis

According to Dr. Zashin, “When people complain of hand pain among other symptoms, for example, it may be difficult to distinguish rheumatoid arthritis from fibromyalgia, There are several ways to distinguish. First, rheumatoid arthritis does not typically involve the DIP joint (distal interphalangeal joint or end joints closest to the nails) so if there is tenderness there, a diagnosis of fibromyalgia would be favored or possibly osteoarthritis.

Secondly, fibromyalgia is not associated with joint swelling which commonly occurs with rheumatoid arthritis; although fibromyalgia patients often complain that their joints “feel” swollen. The complaint of widespread body pain associated with typical fibromyalgia tender points would also be consistent with fibromyalgia and not rheumatoid arthritis.”


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The Basics

Rheumatoid arthritis is an autoimmune disease in which the person’s immune system erroneously attacks the joints, causing inflammation inside and around the joints, leading to pain, swelling, and stiffness and compromising the joints’ ability to move normally. Approximately 1.5 million people in the United States have rheumatoid arthritis (RA).

By contrast, fibromyalgia is not an autoimmune disorder but rather a syndrome of unknown origins that causes widespread pain, mostly in the muscles, as well as fatigue, and mood changes. More than 3.7 million people in the United States have fibromyalgia, according to the Arthritis Foundation. Both conditions affect more women than men.


One of the biggest differences between RA and fibromyalgia is inflammation. In RA, joint inflammation is one of the key symptoms. People with RA often notice that their joint pain appears on both sides of their body. For example, if you have a painful joint in your right wrist, you also may have corresponding pain in your left wrist. A study showed that people with RA and those with fibromyalgia both had more trouble paying attention than those in the control group.

Both cause fatigue

Fatigue is often the most difficult FM symptom to describe to others.  It’s a pervasive, all-encompassing exhaustion that can interfere with even the most basic and simple daily activities.  It can be described as feeling like someone pulled the plug and disconnected you from your power source.

The coping mechanisms are different

RA pain can be eased by staying still you don’t want to do that too much, though, or you may lose mobility – but if you stay still with fibromyalgia pain, your body seizes up more and the pain intensifies. Another important coping tool is to stay warm and that works for both RA and fibro.

Double Trouble

When the two conditions occur together (a phenomenon called “comorbidity”), “usually rheumatoid arthritis is first then the person develops secondary fibromyalgia,” Kaplan says. “But they may or may not be diagnosed in that order.” Complicating matters, the pain from one condition can exacerbate pain from the other. “When patients have fibromyalgia, everything hurts more,” says Carmen Gota, MD, staff physician in the department of rheumatology at the Cleveland Clinic.

And “the stress of having rheumatoid arthritis that is uncontrolled can make fibromyalgia pain worse.” In fact, people who have both rheumatoid arthritis and fibromyalgia have higher perceptions of pain and significantly higher joint disease activity scores than those who have only RA, according to a study published in a 2014 issue of the Journal of the College of Physicians and Surgeons of Pakistan.

RA and FM have a connection

It’s not unusual for FM to occur with another disorder, such as RA, osteoarthritis, lupus, etc.  Researchers think that some people have a genetic predisposition to FM that may be triggered whenever they develop another illness. It’s also possible there may be an autoimmune connection between RA and FM. However, that has not been proven.

Both can be difficult to diagnose

Both illnesses can be difficult to diagnose and share a number of common symptoms such as joint pain, fatigue, and flu-like symptoms.  Since blood tests and X-rays may show up as normal in the early stages of RA, it can be hard to pinpoint whether RA or FM is responsible for the symptoms.

How to Treat Both Conditions Simultaneously

RA pain tends to come and go, while fibromyalgia pain typically sticks around (though it may wax and wane in intensity). The first step to effective treatment is to pinpoint which condition you suffer from, since an RA diagnosis calls for a quick response in order to protect against long-term joint damage.

If you do suffer from both RA and fibromyalgia, you can concentrate on a few key areas for more relief, good joint protection, and a better quality of life:

>Sleep quality – Getting enough quality sleep is vital for good health, especially if you live with a chronic condition. Sleep problems are quite common among fibromyalgia sufferers, and poor sleep can lead to greater pain sensitivity and emotional problems.

>Daily pain levels – Some experts believe that the pain of RA can trigger fibromyalgia flares and elevate all your symptoms. Therefore, managing your day-to-day joint pain with the right medication will help control both conditions.

>Emotional health – Both RA and fibromyalgia can deeply disrupt your life, and many people can become depressed as they struggle through flares or lose functionality. When you suffer from both conditions, it’s even more important to have a strong support network to lean on. Communication is key to emotional management, and support groups can important assets.


For support and Discussion join the group “Living with Fibromyalgia and Chronic Illness”

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  • Handout on Health: Rheumatoid Arthritis. NIAMS. February 2016.
  • Questions and Answers About Fibromyalgia. NIAMS. July 2014.
  • Kelley’s Textbook of Rheumatology. Ninth edition. Elsevier
  • How to Manage Fibromyalgia and Rheumatoid Arthritis Together By Carol Eustic via Verywell Health
  • Featured Image: Daily Express

Also Read:

Fibromyalgia vs RA – Do you have both ?

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