When medical conditions present similar symptoms, a diagnosis can take weeks or months of extensive testing.
This is particularly true of conditions that cause muscle and joint pain. Proper diagnosis is essential to developing an effective treatment plan.
Rheumatoid arthritis and fibromyalgia are prime examples of medical conditions that present similar symptoms.
A person with rheumatoid arthritis and a person with fibromyalgia both experience joint pain and chronic fatigue.
While there are many other overlapping symptoms, that is where the similarities end.
There are important differences between rheumatoid arthritis and fibromyalgia.
Is Rheumatoid Arthritis an Autoimmune Disease
The Arthritis Foundation notes that rheumatoid arthritis is caused by a dysfunction of the immune system.
A healthy immune system provides protection from infection. For those with rheumatoid arthritis, the immune system becomes overactive, attacking the synovial lining of the joints.
The immune system response causes pain, stiffness, inflammation and has the potential to cause joint deformity.
Rheumatoid arthritis (RA) is also a systemic condition. That means RA can also affect other organs, including the blood vessels, heart, lungs, and eyes.
If not successfully treated, rheumatoid arthritis can inflict permanent damage and disability.
Signs and Symptoms of Rheumatoid Arthritis
Rheumatoid arthritis (RA) typically affects the smaller joints of the hands and feet but can affect any joint in the body.
The pain is symmetrical. That means if the right wrist is painful, the left wrist will be affected as well.
The inflammation caused by the immune system stretches the pain receptors of the soft tissues.
This joint inflammation can also convert parts of the synovial membrane to a fibrovascular or granular tissue called pannus.
This conversion can happen anywhere there is synovial tissue. The formation of pannus in the tendon sheath can result in painful tendon ruptures.
As described by the Rheumatoid Arthritis Support Network, there are many other symptoms related to rheumatoid arthritis.
- Pain that may feel like a dull ache
- Joint swelling and redness
- Joint stiffness and warmth
- Scarring and inflammation of the lungs
- Joint deformity
- Numbness and tingling
- Loss of appetite
- Fatigue
- Fever
- Morning Stiffness
- Anemia
- Insomnia or sleep disturbances
- Rashes caused by blood vessel inflammation (vasculitis)
- Nodules under the skin (will resolve with treatment)
- Dry eyes (Sjogren’s syndrome)
- Blurred vision and/or light sensitivity
- Feelings of depression or anxiety
Symptoms will vary from person to person. Some may have many of these symptoms, while others may only have a few.
Since RA is caused by a compromised immune system, those with rheumatoid arthritis are more susceptible to contracting other infections.
How is Rheumatoid Arthritis Diagnosed
A physical examination and medical history would alert a physician to the possibility of RA. The patient may be referred to a rheumatologist for further evaluation.
Those suspicions would be confirmed through blood tests (CRP, Anti-CCP, and ESR) according to MedicineNet.
The rheumatologist may also want images, through x-ray, ultrasound or MRI, to determine the severity of the condition and to monitor the progression of the condition over time.
Treatment Options for Rheumatoid Arthritis
Early diagnosis and treatment can help prevent the organ and joint damage caused by RA.
The goal of treatment is to get the disease into remission and stop the progression. This can be accomplished through several options.
- Steroids Corticosteroids are initially prescribed to reduce inflammation and pain. Steroids are used short-term and tapered gradually
- NSAIDs (non-steroidal anti-inflammatory drugs) either over-the-counter or prescription
- DMARDs Disease-modifying antirheumatic drugs can slow the progression of RA
- Biologic agents This newer class of DMARDs also slow the progression of RA and can be used in combination with DMARDs
- Occupational or physical therapy to instruct patients how to keep joints strong and flexible
- Lifestyle modifications such as a healthy diet, low impact exercise and adequate rest
Science has not been able to pinpoint the exact cause of rheumatoid arthritis. Research shows that genetic and environmental conditions could activate this disease.
Current theories indicate that a virus, infection or trauma could trigger the onset of symptoms in those who are genetically vulnerable.
Even with medication and lifestyle modifications, rheumatoid arthritis can flare. A flare is a sudden increase in disease activity and symptoms.
If RA flares, the rheumatologist may want to increase or change medications to better control the condition.
Fibromyalgia is a Centralized Pain Condition
Fibromyalgia is a chronic condition that causes extreme fatigue and pain in the tendons, ligaments, and muscles throughout the body.
The pain can range from a dull, all-over ache to intensely sharp burning or stabbing pain.
Fibromyalgia can be a debilitating condition but does not cause inflammation or damage to the joints or organs.
Unlike rheumatoid arthritis, fibromyalgia is classified as a chronic syndrome rather than a disease because it presents a group of symptoms that affect all systems of the body.
While fibromyalgia does not cause damage, the condition can be difficult to treat successfully.
Signs and Symptoms of Fibromyalgia
According to the Mayo Clinic, fibromyalgia is now thought to be a neurological condition.
Researchers believe that fibromyalgia is caused by an increase of neurotransmitters in the brain that signal pain.
The brain then develops pain memory and becomes more sensitive to pain signals.
Fibromyalgia tends to co-exist with other chronic pain conditions such as irritable bowel syndrome, temporomandibular joint disorder, and migraines.
Like rheumatoid arthritis, genetic and environmental factors can trigger the onset of fibromyalgia.
FibroCenter lists some of the many symptoms and overlapping conditions.
- Pain that may feel like a dull ache
- Pain in muscles and tendons around the joints
- Chronic Fatigue
- Morning stiffness
- Difficulty with temperature regulation
- Fibro fog (difficulty concentrating or with memory)
- Allodynia (Pain caused by non-painful events, such as a shower or handshake)
- Numbness and tingling
- Loss of appetite
- Dry eyes (Sjogren’s syndrome)
- Migraines or headaches
- Insomnia or sleep disturbances
- Numbness and tingling
- Depression or anxiety
- Tinnitus (ringing in the ears)
- Interstitial cystitis (bladder pain)
- Sensitivity to noise or light
The symptoms of fibromyalgia vary from person to person and can change from day to day.
Since there is not a definitive test to confirm a diagnosis of fibromyalgia, It can take several years for a patient to get an accurate diagnosis of their condition.
How is Fibromyalgia Diagnosed
Diagnosing fibromyalgia can be frustrating for the doctor and the patient. Even a physician experienced with fibromyalgia needs to take time to rule out other conditions with similar symptoms.
Prior to a fibromyalgia diagnosis, the patient is typically tested for rheumatic diseases, such as lupus and rheumatoid arthritis, and for neurological disorders such as multiple sclerosis and myasthenia gravis.
Once these conditions have been ruled out, the doctor bases a fibromyalgia diagnosis on several factors.
For a fibromyalgia diagnosis, pain must persist for three months or longer. There must also be pain above and below the waist and on both sides of the body, and located in at least 11 of 18 tender points according to Mayo Clinic.
Treatment of Fibromyalgia
The goal of fibromyalgia treatment is to reduce pain and improve the quality of life. Many common pain relievers will not work on the pain caused by fibromyalgia.
Currently, there are three prescription medications approved by the FDA for fibromyalgia treatment.
- Pregabalin An anticonvulsive medication that is also known to relieve nerve pain and improve fatigue
- Duloxetine An SSNRI antidepressant (serotonin and norepinephrine reuptake inhibitor) that is also used to treat diabetic nerve pain
- Milnacipran Also an SSNRI not typically used to treat depression, but has been shown to improve physical function and reduce pain
- Exercise to increase serotonin levels and improve daily function
- Lifestyle modifications such as a healthy diet, and adequate rest
It is Possible to Have Rheumatoid Arthritis and Fibromyalgia
It may be important to note that people diagnosed with rheumatoid arthritis can also have fibromyalgia.
Having fibromyalgia does not increase the risk of developing rheumatoid arthritis, but several medical conditions often coexist with fibromyalgia.
Those conditions include irritable bowel syndrome, migraines, and interstitial cystitis.
Wrap up
Though the causes of rheumatoid arthritis and fibromyalgia are entirely different, many of the symptoms are the same.
Both conditions cause widespread pain and fatigue. Those with fibromyalgia and rheumatoid arthritis both struggle with pain, fatigue, numbness, dry eyes and sleep disturbances.
The most important distinction between rheumatoid arthritis and fibromyalgia is inflammation.
Since rheumatoid arthritis is an autoimmune disorder, the body’s own immune system attacks otherwise healthy joints and organs.
Rheumatoid arthritis has the potential to cause serious damage if not treated or appropriately managed.
Although painful, fibromyalgia does not cause inflammation and does not cause damage to otherwise healthy joints or organs.
Additional Sources:
https://www.healthline.com/health/rheumatoid-arthritis-vs-fibromyalgia#diagnosis
https://www.medicinenet.com/rheumatoid_arthritis_vs_fibromyalgia/article.htm#what_tests_do_health_care_professionals_use_to_make_a_diagnosis_of_rheumatoid_arthritis_and_fibromyalgia
https://www.fmcpaware.org/aboutfibromyalgia.html
