Fibromyalgia, which may occur throughout the body, is more likely to afflict women than men.(GETTY IMAGES)
ANYONE AFFLICTED WITH rheumatoid arthritis knows what it’s like to live with chronic pain. And if the disease isn’t bad enough in itself, it’s commonly accompanied by another painful syndrome, fibromyalgia.
According to the National Fibromyalgia and Chronic Pain Association, fibromyalgia is a common and complex chronic pain disorder that causes widespread pain and tenderness to the touch. The Mayo Clinic website says doctors don’t know the causes of fibromyalgia but that it likely involves several factors working together. Symptoms often begin after physical trauma, surgery, infection or significant psychological stress, accumulating slowly over time, with no single triggering event.
The pain may occur throughout the body, or it can migrate from place to place, and the pain can come and go. It is estimated that about 10 million Americans have fibromyalgia.
Fibromyalgia is a poorly understood disorder that is not easy to diagnose.
“Many rheumatologists believe emotional stress and sleep deprivation actually generate the widespread pain of fibromyalgia,” says Dr. Robert Hylland, a rheumatologist in Muskegon, Michigan, “and we identify at least two forms of the disorder: primary, when there is no apparent illness or condition directly influencing the development of fibromyalgia, and secondary, when the person has a condition or illness that directly influences the development of fibromyalgia.”
RA is one of the diseases most commonly associated with fibromyalgia, according to Hylland.
“Studies show that between 17 and 30 percent of people with RA will develop coexisting fibromyalgia,” he indicates.
In fact, the pain experienced by individuals with RA is often actually caused by coexisting fibromyalgia.
“Chronic pain in people with RA may be caused by fibromyalgia in 35 to 50 percent of cases,” says Dr. Stanford Shoor, a clinical professor of medicine and rheumatology at Stanford University. “The pain can be present even if the RA is in a low disease activity state,” he adds.
Because of this, “the coexistence of fibromyalgia in RA is probably underreported,” Hylland says.
The reasons why RA and fibromyalgia are so often seen together are not completely understood, but Hylland believes that sleep deprivation and stress may play a significant role.
“When RA pain interferes with sleep for extended periods, combined with the ever-present stress of enduring a chronic, potentially disabling disease [like RA], we have the elements necessary to create fibromyalgia,” he says.
Like RA, fibromyalgia is more likely to afflict women than men.
“Fibromyalgia is far more commonly diagnosed in females,” Hylland says, indicating that 80 to 90 percent of all cases occur in women.
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And although the origins of the disorder are mysterious, Hylland believes that a history of abuse may play a part in the development of some cases of fibromyalgia.
“Well over half of my female patients with primary fibromyalgia were sexually abused in childhood or adolescence, and many of the others were mentally or physically abused,” he says. “National studies also support this association.”
However, the same association does not appear to be present in individuals with RA and secondary fibromyalgia, he says.
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Fibromyalgia itself doesn’t affect RA disease activity or influence the efficacy of anti-rheumatic drugs, Hylland notes, “but stress does negatively influence both disorders, which is why we often see simultaneous worsening of both conditions” he says. “We also, however, see fibromyalgia develop in patients with well-controlled RA, when other life stresses are to blame.
“In these cases, the patient will not experience swollen joints, and [blood] tests for RA-caused inflammation will be normal,” he notes.
Patients may also complain that non-steroidal anti-inflammatory drugs do not decrease pain, which is an indication that the pain is due to fibromyalgia, and not the underlying RA.
“These medications do not help the pain of fibromyalgia,” Hylland says.
If you have RA and are suffering from coexisting fibromyalgia, Hylland stresses that it’s important to maintain good control of your RA. This step reduces the stress caused by active disease, which helps quell underlying fears of becoming disabled. It also enables restorative sleep. Taken together, these things will often eliminate the fibromyalgia, Hylland says.
“For those RA patients with lingering symptoms of fibromyalgia, it would do the patient and doctor well to look for additional stressors, improve sleep integrity and treat underlying anxiety and depression,” he says.
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Exercise can also help with both conditions, and some patients can also benefit by taking an antidepressant like Cymbalta or Lyrica.
“The prognosis is excellent for patients with RA and coexisting fibromyalgia, given the numerous breakthroughs in the treatment of RA,” Hylland says. “Effective treatments for primary fibromyalgia alone require more research into the presence and treatment of post-traumatic stress. Until those breakthroughs arrive, a team approach with psychologists, counselors, physical and occupational therapists, sleep specialists, pain specialists and rheumatologists or primary care physicians should be used,” he advises.