How to Manage Fibromyalgia and Rheumatoid Arthritis Together

Fibromyalgia and rheumatoid arthritis are both chronic pain conditions. With two conditions contributing to your pain level, it is difficult to know how to best manage it.

How can people with both fibromyalgia and rheumatoid arthritis know which condition is actually causing more of their pain? What factors or characteristics distinguish between the two conditions? What is the best course of treatment for people who have both fibromyalgia and rheumatoid arthritis? We asked Scott J. Zashin, MD, clinical assistant professor at University of Texas Southwestern Medical School, Division of Rheumatology, in Dallas, Texas. 

According to Dr. Zashin, "When people complain of hand pain among other symptoms, for example, it may be difficult to distinguish rheumatoid arthritis from fibromyalgia. There are several ways to distinguish. First, rheumatoid arthritis does not typically involve the DIP joint (distal interphalangeal joint or end joints closest to the nails) so if there is tenderness there, a diagnosis of fibromyalgia would be favored or possibly osteoarthritis. Secondly, fibromyalgia is not associated with joint swelling which commonly occurs with rheumatoid arthritis, although fibromyalgia patients often complain that their joints "feel" swollen. The complaint of widespread body pain associated with typical fibromyalgia tender points would also be consistent with fibromyalgia and not rheumatoid arthritis."

Dr. Zashin continued "The best course of treatment for patients who have both fibromyalgia and rheumatoid arthritis is to first treat the rheumatoid arthritis, since rheumatoid arthritis is commonly associated with joint deformity and disability. Slowing progression of rheumatoid arthritis and preventing permanent joint damage is the priority."

"If rheumatoid arthritis is well-controlled based on a joint examination, as well as measures of inflammation such as the sedimentation rate and C-reactive protein (CRP), but a patient still complains of pain and fatigue, fibromyalgia activity should be considered. Treatment, in this case, should focus on improving quality of sleep through increased rest and aerobic exercise. Sleep apnea should be ruled out, if symptoms of fatigue are clinically significant. Medications used for fibromyalgia should be considered, including tricyclic antidepressants, selective serotonin reuptake inhibitors (SSRI), and gabanergic medications like Neurontin (gabapentin) or Lyrica (pregabalin)," according to Dr. Zashin.

Among other drugs which can be used, Cymbalta (duloxetine HCl) was the first serotonin-norepinephrine reuptake inhibitor that was proven to reduce pain in fibromyalgia patients. Savella (milnacipran), a selective serotonin and norepinephrine dual reuptake inhibitor, increases norepinephrine and serotonin activity in the brain.

According to NIAMS (National Institute of Arthritis and Musculoskeletal and Skin Diseases), it is estimated that fibromyalgia affects 5 million Americans age 18 or older. While anyone can be affected by fibromyalgia, 80 to 90 percent of those diagnosed with the condition are women. Rheumatoid arthritis affects about 1.5 million US adults. While anyone can develop rheumatoid arthritis, it affects two to three times more women than men.

NIAMS also points out that people with certain rheumatic diseases, such as rheumatoid arthritis, systemic lupus erythematosus, or ankylosing spondylitis appear to be more likely to have fibromyalgia as well. Also, while the prevalence of rheumatoid arthritis seems to be going up in older people, researchers have observed that it is going down in younger people.

While pain medications are used to treat both fibromyalgia and rheumatoid arthritis, other medications will differ. That said, lifestyle modifications that include exercise and good sleep habits will surely help both. There is no specific dietary recommendation for the two conditions, but eating a healthy, balanced diet can't hurt. An anti-inflammatory diet may be something for you to try.