Eileen was feeling depressed. It seemed her arthritis was getting worse, but her regular treatments weren’t working very well. The pain used to be mostly in her knee and hip on her right side but, lately, she was noticing a more widespread pain affecting her shoulders and lower back too.
On top of that, she couldn’t seem to get past feeling tired all the time. She tried getting more sleep, but it didn’t seem to help. Lifting her body out of bed in the morning felt like a monumental task.
She talked to her doctor about it, and he asked her about other symptoms like brain fog and muscle pain. At the end of their consultation, he suggested something Eileen had never considered: that she may be suffering from fibromyalgia as well as arthritis.
What Is Fibromyalgia?
Fibromyalgia is a complex chronic pain disorder that causes widespread musculoskeletal pain along with other symptoms like chronic fatigue, trouble sleeping, mood swings, brain fog, and memory problems. The word “fibromyalgia” is derived from the Latin “fibro” meaning fibrous tissues, “my” meaning muscles and “algia” meaning pain.
The National Fibromyalgia Association estimates that the disorder affects about 10 million people in the United States, with about 70 to 90 percent of those being women, although it can occur in men and children as well.
Scientists don’t yet know what causes fibromyalgia, but they believe that a number of factors are involved:
- Gender: Fibromyalgia is much more common in women than in men. The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) states that women are eight to nine times more likely to suffer from the disorder than men.
- Genetics: Fibromyalgia tends to run in families, so if your mother had it, you are more at risk for it, too. Researchers have identified some genetic markers called human leukocyte antigens (HLA) that may be linked with the disorder.
- Joint diseases: Other joint diseases, including rheumatoid arthritis, lupus, and osteoarthritis, seem to increase the risk of fibromyalgia. About 20 to 30 percent of people with rheumatoid arthritis also develop fibromyalgia.
- Overweight: Those who are overweight and inactive have an increased risk of developing fibromyalgia.
- Infections: There is some evidence that certain types of infections, including the flu, hepatitis C, HIV, and Lyme disease, may increase the risk.
- Trauma: Past traumas, whether physical or emotional, including post-traumatic stress disorder (PTSD), repeated injuries, some surgeries, childhood abuse and a traumatic loss in life, may trigger the development of fibromyalgia.
- Hormones: Lower-than-normal levels of some hormones, including serotonin, norepinephrine, and dopamine, may be involved in intensifying pain signals, leading to fibromyalgia.
- Central sensitization: An overactive central nervous system can also produce excessive hormones that sensitize pain receptors, leading to an increased feeling of pain.
- Muscle abnormalities: People with fibromyalgia sometimes have abnormalities in the muscles themselves. They may have low levels of chemicals that help muscles relax or thick capillaries that rob the muscles of oxygen.
- Abnormal blood flow: Some studies have found that too much or too little blood flow in certain areas of the brain that interpret pain intensity could be the root cause of chronic pain.
- Sleep problems: Although insomnia is often a symptom of fibromyalgia, there is some evidence that it may be a cause as well. Abnormal sleep patterns can change the levels of some chemicals in the brain, which could increase the risk of the disorder.
- Inflammation in the brain: A recent study suggested that fibromyalgia may stem from inflammation in the brain. Researchers conducted imaging scans on the brains of 31 patients with fibromyalgia and 27 control subjects. They found that the people with fibromyalgia had higher levels of an inflammatory chemical thought to sensitize pain pathways and contribute to fatigue.
The more researchers study the issue, the more they believe that a number of factors, rather than just one, are probably involved in developing fibromyalgia.
Symptoms of the disorder usually flare up or become worse during certain periods, often triggered by hormonal changes, such as those that occur during the menstrual cycle or pregnancy or during periods of stress. Weather changes can also lead to an increased sensation of pain. In addition to the symptoms listed above, patients may suffer from endometriosis, irritable bowel syndrome, interstitial cystitis or joint pain.
The main symptom associated with fibromyalgia is widespread pain, which can be felt anywhere in the body, including the joints. Many sources list persistent muscle and joint pain and tenderness as hallmarks of the disorder.
This can make it difficult, however, to diagnose fibromyalgia as it can mimic the symptoms of arthritis and often accompanies an arthritis diagnosis. Fibromyalgia and arthritis are very different conditions, but they can occur in the body simultaneously.
Several studies have indicated that those who have rheumatoid arthritis (RA) are at a higher risk for fibromyalgia. Research published in 2002 noted that in some cases, RA is associated with fibromyalgia and that when a patient has both, it can be difficult to determine the degree of RA activity because patients have higher scores for both pain and disability.
A more recent 2016 study also found a strong link between seronegative RA, which doesn’t produce the blood antibodies normally associated with RA, and fibromyalgia, finding that patients with seronegative RA were twice as likely to have signs of the chronic pain disorder than those with seropositive RA.
The Arthritis Foundation states that fibromyalgia “affects a disproportionate number of people with rheumatoid arthritis,” and that fibromyalgia makes arthritis symptoms worse while creating other issues like chronic fatigue and sleep problems.
Dr. Stanford Shoor, clinical professor of medicine and rheumatology at Stanford University, told U.S. News & World Report that chronic pain in people with RA “may be caused by fibromyalgia in 35 to 50 percent of cases.”
Although there isn’t as clear a relationship between osteoarthritis and fibromyalgia as there is between RA and fibromyalgia, the two can still occur together. Other types of arthritis, as well, including spondyloarthritis and psoriatic arthritis, may occur together with symptoms of fibromyalgia, such as chronic pain and fatigue.
There are clear differences between arthritis and fibromyalgia, however. These include the following:
|Caused by an autoimmune disorder or long-term wear and tear on the joints||Caused by abnormal processing of pain signals|
|Causes joint deterioration over time||Does not affect joint health — just causes pain|
|Involves inflammation in the joints||Typically does not involve inflammation in the joints|
|Pain tends to flare up and then subside||Pain is often consistent or constant|
|Symptoms mainly include joint pain and stiffness||Symptoms include pain, fatigue, sleep problems, mood changes, brain fog, digestive problems and more|
|Feel pain during exercise||Pain is worse while resting|
|Pain is localized to certain joints||Pain is widespread and occurring in many joints and tender areas|
|May affect the range of motion, limiting how far patients can move a joint||Does not affect the range of motion|
In looking at this table, you can see if you might have symptoms of both conditions. If so, it’s possible that both are occurring simultaneously. You may also see, however, that your symptoms tend to line up more with one side or the other, which can also help you and your doctor zero in on the treatments that are most likely to help.
If you and your doctor determine that fibromyalgia is causing at least a portion of your joint pain, there are treatments that can help. The U.S. Food and Drug Administration has approved a few medications made specifically for managing fibromyalgia. Doctors may also prescribe antidepressants or antiseizure drugs to ease pain and fatigue or may recommend over-the-counter pain relievers.
Patients who have both arthritis and fibromyalgia can benefit from treating arthritis to help slow its progression and prevent permanent joint damage. These treatments should also help reduce pain.
In addition, you can try these remedies:
- Get more vitamin B12: Research has shown that this vitamin can help regenerate nerves and brain cells, improve communication between nerve cells, and help protect existing nerve cells. It’s also been found to help reduce chronic pain in both fibromyalgia and RA.
- Tai chi: A recent study showed that tai chi was more effective at reducing the symptoms of fibromyalgia than aerobic exercise. The gentle movements and deep breathing helped lessen pain and improve physical and mental health.
- Yoga: Studies have also found that yoga can help combat chronic pain caused by fibromyalgia. After an eight-week yoga program, participants in one study experienced relief of pain, fatigue, stiffness, poor sleep, depression, anxiety, and poor balance.
- Massage: A 2014 review of nine studies involving about 400 patients with fibromyalgia showed that message during a five-week period significantly improved pain, anxiety, and depression. Look for a massage therapist who has experience with fibromyalgia patients and who can apply a gentle touch where needed.
- Try vitamin D: If you’re low in vitamin D, increasing your levels may help ease fibromyalgia pain. In a 2017 meta-analysis of 12 studies, researchers found that vitamin D levels in patients with the disorder were significantly lower than those in the control group. Other studies have found that vitamin D supplements helped improve fibromyalgia pain and depression.
- Use SAM-e: S-adenosylmethionine (SAM-e) occurs naturally in the body and is necessary for many daily functions, including regulating various hormones and neurotransmitters. Some small studies have suggested it may help reduce pain, fatigue, and depression associated with fibromyalgia.
- Meditation: The perception of pain comes from the brain, and meditation can help alter how the brain responds to pain stimuli. Studies have found that when people meditate, activity in regions of the brain associated with pain perception can be altered, resulting in a reduction in pain. In a 2017 review, researchers found that mindfulness-based meditation could alleviate fibromyalgia-related symptoms.
Adler-Neal, A. L., & Zeidan, F. (2017). Mindfulness Meditation for Fibromyalgia: Mechanistic and Clinical Considerations. Current Rheumatology Reports, 19(9). doi:10.1007/s11926-017-0686-0
Albrecht, D. S., Forsberg, A., Sandström, A., Bergan, C., Kadetoff, D., Protsenko, E., … Loggia, M. L. (2019). Brain glial activation in fibromyalgia – A multi-site positron emission tomography investigation. Brain, Behavior, and Immunity, 75, 72-83. doi:10.1016/j.bbi.2018.09.018
Arthritis Foundation. (n.d.). What is Fibromyalgia? | Arthritis Foundation. Retrieved from https://www.arthritis.org/about-arthritis/types/fibromyalgia/what-is-fibromyalgia.php
Creaky Joints. (2019, January 2). Scientists May Have Found a New Explanation for Fibromyalgia Pain and Fatigue. Retrieved from https://creakyjoints.org/news/brain-inflammation-fibromyalgia-pain/
Donohue, M. (2017, October 18). Fibromyalgia and Rheumatoid Arthritis Often Go Hand in Hand. Retrieved from https://health.usnews.com/health-care/patient-advice/articles/2017-10-18/fibromyalgia-and-rheumatoid-arthritis-often-go-hand-in-hand
Doss, J., Mo, H., Carroll, R. J., Crofford, L. J., & Denny, J. C. (2017). Phenome-Wide Association Study of Rheumatoid Arthritis Subgroups Identifies Association Between Seronegative Disease and Fibromyalgia. Arthritis & Rheumatology, 69(2), 291-300. doi:10.1002/art.39851
Kelley, J. C. (2016, September 23). Seronegative RA and Fibromyalgia May Be Linked. Retrieved from https://www.medscape.com/viewarticle/869178
Li, Y., Wang, F., Feng, C., Yang, X., & Sun, Y. (2014). Massage Therapy for Fibromyalgia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. PLoS ONE, 9(2), e89304. doi:10.1371/journal.pone.0089304
Makrani, A. H., Afshari, M., Ghajar, M., Forooghi, Z., & Moosazadeh, M. (2017). Vitamin D and fibromyalgia: a meta-analysis. The Korean Journal of Pain, 30(4), 250. doi:10.3344/kjp.2017.30.4.250
Naranjo, A. (2002). Fibromyalgia in patients with rheumatoid arthritis is associated with higher scores of disability. Annals of the Rheumatic Diseases, 61(7), 660-661. doi:10.1136/ard.61.7.660
The National Fibromyalgia Association. (2017, March 8). New Research – Pain Relief from Vitamin D – National Fibromyalgia Association (NFA). Retrieved from http://www.fmaware.org/fibromyalgia-resources/new-research-pain-relief-vitamin-d/
National Fibromyalgia Association. (n.d.). Prevalence – National Fibromyalgia Association (NFA). Retrieved from http://www.fmaware.org/about-fibromyalgia/prevalence/
National Institute of Arthritis and Musculoskeletal and Skin Diseases. (2019, January 14). Fibromyalgia. Retrieved from https://www.niams.nih.gov/health-topics/fibromyalgia
ScienceDaily. (2019, January 22). Yoga can counteract fibromyalgia, study suggests. Retrieved from https://www.sciencedaily.com/releases/2010/10/101014083119.htm
UHN Staff. (2018, July 2). A Natural Treatment for Fibromyalgia and Rheumatoid Arthritis – University Health News. Retrieved from https://universityhealthnews.com/daily/pain/a-natural-treatment-for-fibromyalgia-and-rheumatoid-arthritis/
Wang, C., Schmid, C. H., Fielding, R. A., Harvey, W. F., Reid, K. F., Price, L. L., … McAlindon, T. (2018). Effect of tai chi versus aerobic exercise for fibromyalgia: comparative effectiveness randomized controlled trial. BMJ, k851. doi:10.1136/bmj.k851