After waking up in the morning, you notice feeling exhausted despite getting a good night of rest. You also notice your joints are feeling more swollen and stiffer. Even your muscles feel a little achier than usual.
These symptoms may be related, or they could be completely separate. Rheumatoid arthritis (RA) and fibromyalgia (FM) both present with similar symptoms, such as pain, stiffness, and fatigue. But they are two different conditions. These are easy to confuse because they have many similarities, but each condition has different causes and a unique set of symptoms that differentiates one from the other.
What Are the Symptoms of RA and Fibromyalgia?
Rheumatoid arthritis and fibromyalgia are two different conditions, but with some similar symptoms. Symptoms that are common to both conditions include:
- Chronic pain
- Sleep disturbances
- Fatigue and tiredness
- Depression and anxiety
While these symptoms are the same, the causes and the way people experience them often differ.
Pain is a common symptom of many conditions, especially ones like rheumatoid arthritis and fibromyalgia. However, the cause of pain for each condition is different. RA is an inflammatory autoimmune disease that manifests in joints of the hands, wrists, and knees. Joint pain often occurs on both sides of the body, meaning if you feel pain in the right wrist then you will likely feel pain in the left wrist, too.
The pain felt in fibromyalgia is a widespread pain that often begins in the neck, shoulders, or back. As the condition progresses, the pain usually spreads to other areas of the body. People with FM tend to experience other types of pain such as:
- Headaches and migraines
- Abdominal pain and pelvic cramping
- Facial and jaw pain
Sleep Disturbances and Fatigue
RA and FM can cause sleep disturbances like difficulty falling or staying asleep. Sleep problems can increase levels of stress hormones and trigger flare-ups. This can make symptoms worse and more difficult to manage. Poor sleep can also cause mental health problems, such as depression and anxiety.
Studies show that up to 70% of patients with RA suffer from sleep problems. While researchers don’t know the exact correlation between the two, they have found that pain caused by RA makes sleep more difficult and sleep deprivation makes the pain worse. One hypothesis is that during the deepest stages of sleep, the body releases growth hormones that help repair little tears in the muscles that happen throughout the course of the day. Without enough sleep, the body isn’t able to release enough hormones to make repairs causing increased feelings of pain and muscle soreness.
Sleep disturbances in people with FM have been shown to be greater compared to those with RA. One study found that women with FM have similar nighttime sleep problems as those with RA, but patients with FM reported greater daytime sleepiness and fatigue than RA patients. Fatigue is a constant feeling of tiredness or lack of energy that’s more severe than feeling sleepy.
One reason researchers believe fibromyalgia causes fatigue is that fatigue is the body’s natural response to coping with pain. When the body feels pain, it sends a signal to the nerves that can make you feel lethargic and exhausted. Because pain in FM isn’t localized and spreads to many areas of the body, it’s likely that pain signals are being sent to more nerves throughout the body, increasing feelings of fatigue.
Depression and Anxiety
Depression and anxiety are common symptoms of many chronic conditions, especially rheumatoid arthritis and fibromyalgia. Depression is marked by constant feelings of hopelessness that interferes with daily life, while anxiety is characterized by excessive worry or fear about everyday situations. These feelings can impact the quality of life and make other symptoms worse.
A 2016 study investigated the prevalence of mental health conditions in patients with fibromyalgia. They found that of the 305 FM patients in the study, 88% had moderate to severe depression and 41.6% had anxiety. The study showed that the severity of depression was significantly associated with increased prevalence and severity of FM symptoms.
There is also a link between depression and increased risk of rheumatoid arthritis, as well as a more difficult disease course. It’s known that inflammation is a key feature of depression. Researchers believe the increased levels of pro-inflammatory cytokines like those found in RA patients, increase the risk of depression. Of those who have RA, about 14.8-22.5% also have depression.
What Symptoms are Different Between Rheumatoid Arthritis and Fibromyalgia?
RA and FM are commonly mistaken for one another because of these overlapping symptoms. However, there are some symptoms that are unique to each condition. Symptoms specific to rheumatoid arthritis include:
- Joint tenderness and swelling
- Loss in appetite and weight
- Fatigue and tiredness
Symptoms specific to fibromyalgia are:
- Headaches and migraines
- Memory problems
- Irritable bowel syndrome (IBS) or other digestive issues
- Tingling or numbness in hands and feet
- Sensitivity to extreme temperature
Symptoms differ between the two conditions because they are different types of conditions. Rheumatoid arthritis is an autoimmune disorder, whereas fibromyalgia is a neurological condition.
What Causes Rheumatoid Arthritis and Fibromyalgia?
Rheumatoid arthritis is an autoimmune disease that causes inflammation in different parts of the body. An autoimmune disease means the immune system mistakenly attacks healthy cells in the body instead of foreign invaders. In RA, the immune system primarily attacks joints in the hands, wrists, and knees. When joints are affected by RA, the lining of the joint becomes inflamed and causes damage to joint tissue.
The exact cause of RA is unknown, but it is believed to be a combination of:
- Environmental and lifestyle factors
Unlike RA, fibromyalgia doesn’t involve inflammation nor cause damage to joints. Fibromyalgia is a neurological disease driven by the central nervous system. It impacts a person’s sensory processing system, changing how people process pain signals, making them more sensitive to pain. Other sensory reactions, like a response to light and noise, are also amplified which can make things like heat and pressure feel more intense.
Similar to RA, the exact cause of FM is unknown, but some factors include:
- Illnesses or other chronic conditions
- Traumatic events
- Repeat injuries
There is no single test to diagnose either condition. Instead, a doctor will ask for a detailed medical history, discuss present symptoms and perform a physical exam. If your doctor thinks you have RA, they may order lab tests like:
- Rheumatoid factor: a blood test that measures levels of autoantibodies
- Complete blood count (CBC): a measurement of red and white blood cells, and platelets
- Anti-cyclic citrullinated peptide antibody (anti-CCP): a blood test that looks for another autoimmune condition that also attacks the joints
- C-reactive protein: an inflammatory marker
- Erythrocyte sedimentation rate: a secondary measure of inflammation
Unfortunately, there are no lab or imaging tests that can help diagnose fibromyalgia. Instead, your doctor will rule out other conditions that are similar to FM before providing an official diagnosis.
How are Rheumatoid Arthritis and Fibromyalgia Treated?
Living with rheumatoid arthritis and fibromyalgia means dealing with unpredictable flare-ups. You may feel symptom-free one day and experience debilitating pain the next. Though there isn’t a cure for either condition, they can be managed with a variety of treatment strategies.
Medications are usually the first line of treatment for both RA and FM. Only non-steroidal anti-inflammatory drugs (NSAIDs) are used to treat both conditions. These over-the-counter medications can help relieve pain, swelling, and inflammation. Because NSAIDs can cause liver damage and increase the risk of heart attack and stroke if used too much, providers will often use other medications to help manage these conditions.
Medications used to treat rheumatoid arthritis include:
- Corticosteroids: These are a group of medications used to help control inflammation and aid in metabolism, stress, and immune responses in the body. They can be injected, taken orally, or used as a cream.
- Disease-modifying anti-rheumatic drugs (DMARDs): This class of medications slows the progression of joint damage caused by RA. They work by targeting the disease, rather than the symptoms by suppressing the immune system to reduce inflammation.
- Biologic drugs: These are genetically engineered proteins that target specific parts of the immune system that promote inflammation. Like DMARDs, they work by slowing the progression of the disease.
Medications commonly used to treat fibromyalgia are:
- Antidepressants: They help by easing the pain and fatigue associated with fibromyalgia. They can also help treat any depression that accompanies the condition.
- Anti-seizure drugs: Medications used to treat epilepsy are often used to help reduce pain. Gabapentin has been shown to be helpful in reducing fibromyalgia symptoms. Pregabalin was the first drug approved by the FDA to treat FM. This medication works by inhibiting pain signals sent out by neurotransmitters, thus reducing feelings of pain associated with FM.
- Muscle relaxants: Studies show that low doses of muscle relaxants taken at bedtime have been shown to help people with fibromyalgia sleep better and experience less pain.
In addition to medications, different types of therapies and lifestyle modifications are often used to help manage RA and fibromyalgia. Some other techniques used for both conditions include:
- Physical therapy
- Occupational therapy
- Message therapy
- Modified diets
- Gentle exercise
- Improved Sleep
- Stress regulation
Get the Support You Need
Whether you have rheumatoid arthritis or fibromyalgia, finding the level of care and support you need can be difficult. With symptoms frequently changing in severity or new symptoms developing, it can feel like you are in this alone. Remember, you are not alone. There are thousands of members at PatientsLikeMe who have one or both of these conditions and understand what you are going through. Join the conversation to connect with others to learn how they were able to receive their diagnosis and manage their condition.