Wednesday, May 16, 2018

Wisdom Wednesday: Fibromyalgia vs Rheumatoid Arthritis

Fibromyalgia and rheumatoid arthritis share some symptoms, such as pain and exhaustion. If a person has both conditions, the symptoms may be difficult to distinguish. However, fibromyalgia and rheumatoid arthritis (RA) are unrelated and have different causes.

Fibromyalgia usually causes pain, stiffness, and tenderness in muscles and connective tissues throughout the body. RA tends to cause pain, swelling, and tenderness in certain joints. Other shared symptoms include pain mirrored on both sides of the body, stiffness that is worse in the morning, chronic exhaustion, reduced mobility and range of motion in muscles and joints, depression and anxiety.

While the effects may be similar, these conditions have different causes. Fibromyalgia changes the way the brain and nervous system process and interpret pain. People with the condition tend to feel amplified pain when they experience everyday injuries, such as strains.

RA is an autoimmune condition. It causes the immune system to harm the synovial tissues, which line the joints. This leads to inflammation and pain. Over time, RA can cause permanent damage to the bones and connective tissues in the joints. Inflammation may also spread to the lungs, skin, and eyes.

The medical community currently does not believe that fibromyalgia causes inflammation. However, recent research indicates that fibromyalgia may induce a type of inflammation that is not detected by routine blood tests. No evidence suggests that this inflammation causes joint or muscle damage like RA, and there may be no visible signs.

Though the conditions are unrelated, having RA may increase a person’s likelihood of developing fibromyalgia. An estimated 20-30% of people with RA also have fibromyalgia. Researchers suggest that the chronic inflammation and pain associated with RA may make the nervous system hypersensitive over time, leading to fibromyalgia.

Fibromyalgia is more difficult to diagnose than RA because fibromyalgia is diagnosed by exclusion. A doctor will test for many other conditions that cause widespread pain, and if none are present, they may diagnose fibromyalgia. Currently, no blood or laboratory tests are used to diagnose fibromyalgia. However, most doctors will order tests, to rule out other conditions, such as arthritis or infection.

There is no single way to diagnose RA, but a rheumatologist will likely use personal and family medical history, blood tests, and imaging tests. An estimated 80% of people with RA test positive for an antibody called rheumatoid factor.

My Take:
The article goes on to describe the various drugs used to treat both conditions. In fibromyalgia Lyrica (anti-seizure), Cymbalta (antidepressant), and Savella (alters neurotransmitters) are the drugs of choice. The side effects all of these drugs share are constipation, dizziness, ataxia, headache, insomnia, and nausea. Of course each drug has additional side effects not shared by the others.
Drugs used for RA include chemotherapy (used in cancer), NSAIDs, corticosteroids and biologics. The side effects for these drugs are much more serious.

As I have noted in previous blogs, the best physicians are correct in their diagnosis only about a third of the time. Most of the time patients are being treated with the wrong drugs for the wrong condition. Fibromyalgia and RA are no exception.

The Bottom Line:
It’s much more important to treat the patient then the diagnosis. You must start by modulating inflammation, regardless of cause. Reducing inflammation typically will resolve 80% of symptoms. RA responds well to reduction of cytokine and leukotriene inflammation. With fibromyalgia addressing inflammation of the nervous system is generally more effective. However, due to the overlap of these two conditions (and many others), overlapping therapies are the most effective. Don’t get hung up on your diagnosis rather concentrate on natural remedies to alleviate symptoms.

Source: April 30, 2018 National Institutes of Health

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