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Fibromyalgia and RA

Fibromyalgia is a chronic disorder involving pain and tenderness widespread throughout the body that can co-occur with rheumatic diseases including RA. The term fibromyalgia comes from the Latin word fibro for fibrous tissue and the Greek words myo for muscle and algia for pain. In addition to diffuse body pain and tenderness, fibromyalgia can be associated with a range of other symptoms, including fatigue, cognitive problems, headaches, sleep difficulties, restless leg, temperature sensitivity, and sensitivity to bright light and loud noises. Unlike RA, fibromyalgia is not considered a type of arthritis and is not associated with joint inflammation and damage. However, like RA, fibromyalgia is considered a rheumatic condition, causing chronic pain that affects the joints and soft tissues.

Fibromyalgia affects an estimated 3 million people in the US, mostly women (80% to 90%).1 The disorder is most often diagnosed in middle age, but it can affect young adults and children, as well. The cause or causes of fibromyalgia are not known. However, it is suspected that genetic and/or environmental factors may play a role in making a person more susceptible to the disorder.


Fibromyalgia can occur commonly with RA

Fibromyalgia can occur commonly with RA, with rates of fibromyalgia ranging from 15% to 17% in groups of patients with RA.2,3 Patients who have both conditions tend to have more severe symptoms spanning both conditions, including greater pain, joint tenderness, decreased physical and mental function, and lower overall quality of life. They tend to be in poorer health and to suffer from a greater number of comorbid diseases, including diabetes, cardiovascular disease (hypertension, heart disease), and depression. Additionally, studies show that patients with both conditions tend to have lower levels of education and to be of lower socioeconomic status. They are also more likely to be disabled and unable to work.2


Who is at risk for fibromyalgia?

Studies have shown that heredity plays a role in susceptibility for fibromyalgia. In other words, fibromyalgia is more common in people who have family members who have or have had the disease. However, similar to RA, genetics is not the whole picture when it comes to risk for fibromyalgia. Environmental and psychological factors are also thought to play a role in increasing risk for the disorder.4


Diagnosing fibromyalgia

Because the pain and symptoms associated with fibromyalgia may be similar to those seen in many other diseases, it can be particularly difficult to diagnose the disorder. However, it can be useful to determine the exact location and pattern of pain. Fibromyalgia is associated with common areas of pain, including muscles, ligaments, and tendons throughout the body. These symptoms can originate in one area, and then spread to others. For diagnosis, the widespread pain associated with fibromyalgia must have lasted for at least 3 months and include tender points in 11 out of 18 specific anatomic locations. In addition to pain, fatigue is another major problem with fibromyalgia. It is estimated that as many as 9 out of 10 patients with the disorder suffer from moderate to severe fatigue. Other associated features typically include anxiety, cognitive difficulties, headache, and disturbed sleep.


Treatment for fibromyalgia

Fibromyalgia is best treated with a combination of approaches, including medication and non-pharmacologic approaches, including exercise, cognitive-behavioral therapy, and education. In fact, the American Pain Society Fibromyalgia Panel recommends a multi-modal approach to the disorder. Medication for fibromyalgia typically includes an antidepressant treatment that can decrease pain, improve overall well-being, and help with sleep problems. Often tricyclic antidepressants (such as amitriptyline) can provide these benefits. Some modes of complementary and alternative therapy, including acupuncture and biofeedback have been shown to be effective in studies and other treatment modalities, including yoga, chiropractic therapy, massage, tai chi, magnetic therapy, and tender-point injections may be useful.4

Written by: Jonathan Simmons | Last reviewed: September 2013.
1. Lawrence RC, Felson DT, Helmick CG, et al. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Part II. Arthritis Rheum 2008;58:26-35. 2. Wolfe F, Cathey MA, Kleinheksel SM. Fibrositis (Fibromyalgia) in rheumatoid arthritis. J Rheumatol 1984;11:814-8. 3. Kapoor SR, Hider SL, Brownfield A, Mattey DL, Packham JC. Fibromyalgia in patients with rheumatoid arthritis: driven by depression or joint damage? Clin Exp Rheumatol 2011;29:3. 4. Chakrabarty S, Zoorob R. Fibromyalgia. Am Fam Physician 2007;76:247-54.