How common is it to get Fibromyalgia if I have been diagnosed with RA?
I am starting to get other symptoms that are more consistent with FM and not my RA. Is this common to have both diseases?
Answers from our Doctors
Dr. Brian Walitt says:
Bothersome sensations such as widespread pain, fatigue, and non-refreshing sleep are the defining features of fibromyalgia. These are also common complaints in other active rheumatic diseases. In fact, a person with active rheumatoid arthritis with multiple active joints will often meet the American College of Rheumatology criteria (both 1990 and 2010) for fibromyalgia. Adding to the confusion, the development of concomitant fibromyalgia symptoms is greater in people with rheumatic disease than in the general population. The prevalence of concomitant fibromyalgia in rheumatoid arthritis patients has been estimated in several papers to be somewhere around 15%. The most recent paper on the subject in Pain by Wolfe, et al. showed that 7.4% of 9739 rheumatoid arthritis patients met fibromyalgia criteria at their most recent evaluation but 19.8% met fibromyalgia criteria at some point during follow-up. In summary, it is not uncommon to have both problems.
In practice, a person with symptoms of both disorders will typically be treated aggressively for their rheumatoid arthritis by their rheumatologist. This is because there are objective markers that can be measured in rheumatoid arthritis, such as joint swelling, joint tenderness, and inflammatory markers in the blood (such as erythrocyte sedimentation rate and C-reactive protein). If aggressive therapy leads to improvements in the signs of rheumatoid arthritis but do not alleviate diffuse body pain, fatigue, non-refreshing sleep, and other bothersome symptoms, then therapies directed at fibromyalgia symptoms should be considered.
Answered on: Wednesday, April 20, 2011 - 13:31
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Dr. Frederick Wolfe
Dr. Wolfe is the founder and director of the National Data Bank for Rheumatic Diseases, and a specialist in fibromyalgia and rheumatoid arthritis research.
Comments
I was diagnosed with upper body fibromyalgia in 2005. At the time, I had the multiple joint pain symptoms of RA, but lacked the joint swelling and positive blood tests. In 2009 the joint swelling started, confirming what my first internal medicine doctor thought in 2006 (that I really had RA, but lacked the positive blood work to allow treatment). My second internal medicine doctor in 2009 did not diagnose the RA, nor refer me, because he solely based his decision on blood tests! Though I still lack positive blood tests (20% of RA patients do), since January of 2011 I am being treated for my RA, but because my rheumotologist knows I have had it for "some time now", she thinks it will be harder for me to go into remission. I continue to have the symptoms of fibromyalgia in my upper body, and continue those medications as well as starting on meds for the RA. The most important thing I can do is get a good nights sleep, without which my symptoms of both are much worse.
I was diagnosed with Fibromyalgia in 1996 after spending 5 years trying to get answers for the widespread pain. The sleep disturbance finally was the deciding factor as to disability. I totally was unable to go into REM sleep and had no choice but to retire before my time. I was put on Ultram and Serzone as part of a research study, which I stayed on for 6 years. Most of that time I felt like a zombie and the meds only took the edge off the pain. I weaned myself off the meds in 2003 to see where I was at pain wise and a year later had a rheumatoid nodule removed from my foot. The necessary labs were done for RA which confirmed the high inflammation in my body and other positive factors. I have been on Methotrexate since 2005 and Hydroxychloroquine since then. I manage the pain with walking everyday and yoga for stiffness. It is not perfect but at age 67 I consider myself doing as well as expected.
Being on medications when there is no positive diagnosis to me makes no sense, as your liver has to metabolize these drugs. Why would you do that to your body not being sure of a diagnosis. I have done the best I can through diet and exercise and realize there is a necessity for pharmeceuticals for this disease but I prefer to take minimal drugs to keep the labs stable.
Taking pills is not going to magically make your pain and stiffness go away. Try a regimen of diet, exercise and positive thinking....it works for me.
good luck.
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