Fibromyalgia and Rheumatoid Arthritis

Living With Two Chronic Pain Conditions

A doctor checks a woman's hands for signs of rheumatoid arthritis.
ADAM GAULT/SPL/Getty Images

Rheumatoid arthritis (RA) and fibromyalgia (FMS) are chronic pain conditions that commonly go together. While they're very different, their symptoms can be remarkably similar, making diagnosis difficult. When you have both, it becomes even harder.

Women are more likely to get each of these illness, but plenty of men get them as well. Both RA and FMS can strike at any age.

In people with both, a 2017 study headed by M.S.

El-Rabbat shows that FMS is not only especially common in RA, it has a major impact on quality of life. That finding is backed by another published the same year in Rheumatology and Therapy found that FMS had a bigger impact on global assessment than any other latent factor.

Compairing FMS & RA

The 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, which means that your immune system mistakenly attacks healthy tissues as if they were foreign invaders, such as a virus. FMS isn't  currently classified as autoimmune, although research suggests that some cases may involve autoimmunity.

The course of RA is unpredictable, but after many years, about ten percent of people with it become severely disabled and have a hard time with even the most basic tasks.

It's common for people to believe that someone with RA will end up in a wheelchair, but this is a myth. With proper treatment, that's for more rare than you might expect.

FMS is also unpredictable. Experts say that about one-third of people with it will get significantly worse over time, about one-third will get significantly better, and about one-third will see no major change in symptom severity.

So far, we don't know what factors influence the course of the illness.

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

FMS often involves flares and remissions as well, but some cases involve more or less consistent symptom levels. Long-term remissions are rare but possible.

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 more common along the spine than in the extremities.

Why They're Linked

Researchers don't know what causes either condition, so we don't yet understand for sure why FMS and RA go together so often.

Studies show, however, that people with RA are more likely to develop FMS, but people with FMS are no more likely than anyone else to develop RA. Some scientists believe that chronic pain, from RA or other sources, can lead to FMS by causing changes in the ways our nervous systems perceive and process pain.

A 2017 study published in Arthritis Care & Research suggested that people with RA can develop high levels of pain sensitization, which is a known feature of FMS.

That points to a possible similarity in physiology that may help explain the frequent overlap.

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

Getting a Diagnosis

A specific blood test called the anti-CCP antibody test can usually distinguish RA from other forms of arthritis. Your doctor may also order several other tests to confirm the diagnosis and to help get an idea of how the disease may progress.

FMS is diagnosed by either a tender-point exam or scores on a specially designed evaluation, along with testing to rule out other possible causes of symptoms.

Symptoms

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

  • joint pain
  • symmetrical pattern (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:

FMS involves numerous symptoms that aren't linked to RA, including:

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.

Treatments

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

Sometimes, surgery can help people with severe joint damage.

FMS usually requires a multi-pronged approach, which may involve:

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. By working closely with your doctor, you should be able to find treatments that work for both of your conditions.

For more on how to decide on the best course of treatment for RA and FMS, read Fibromyalgia vs. Rheumatoid Arthritis Pain - What Factors Determine Treatment? 

A Word from Verywell

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.

Sources:

American College of Rheumatology. "Rheumatoid Arthritis"

Challa DNV, Crowson CS, Davis M 3rd. The patient global assessment of disease activity in rheumatoid arthritis: identification of underlying latent factors. Rheumatology and therapy. 2017 Jun;4(1):201-208. doi: 10.1007/s40744-017-0063-5.

El-Rabbat MS, Mahmoud NK, Gheita TA. Clinical significance of fibromyalgia syndrome in different rheumatic diseases; relation to disease activity and quality of life. Reumatologia clinica. 2017 Apr 11. pii: S1699-258X(17)30048-7. doi: 10.1016/j.reuma.2017.02.008.

Lee YC, Bingham CO 3rd, Edwards RR, et al. Pain sensitization is associated with disease activity in rheumatoid arthritis patients; a cross-sectional study. Arthritis care & research. 2017 Apr 24. doi: 10.1002/acr.23266.

The Johns Hopkins Arthritis Center. "Rheumatoid Arthritis Clinical Presentation"

Continue Reading