A detailed guide to Chronic Fatigue Syndrome (CFS), including its symptoms, causes, and effective treatment strategies to improve energy and well-being.
One of the main reasons people with arthritis visit the rheumatologist frequently — every three months is common among patients with inflammatory arthritis — is for doctors and patients to assess how arthritis patients are managing their disease. Typical check-ins may include a doctor’s physical exam and assessment as well as reviewing the results of blood tests and imaging tests.
What’s also critical at these visits is something arthritis researchers and doctors call PROs, or patient-reported outcomes. PROs are a patient’s own assessments of how arthritis affects daily tasks — including how you rank or define the difficulty of simple activities like getting in and out of your car or buttoning your shirt — and are a very important tool for measuring and monitoring your disease.
PROs are also important during clinical trials for medications or other treatments, as they can assess how different therapies affect patients and the symptoms that matter to them.
There are many different PRO measures and questionnaires doctors and researchers can use, but which symptoms are most important to patients? This is an important topic that the rheumatology community needs to know more about, so researchers, including those from our non-profit organization, the Global Healthy Living Foundation (GHLF), set out to study this.
“PRO measures are important indicators of disease activity, but as we learn more about the importance of their role in evaluating treatment effectiveness, we need to also learn more about the specific symptoms that patients find most important to track,” says study co-author Kelly Gavigan, MPH, manager of research and data science at GHLF.
In research presented at the 2019 American College of Rheumatology/Association of Rheumatology Professionals (ACR/ARP) Annual Meeting in Atlanta, researchers surveyed 253 patients through our ArthritisPower research registry with various self-reported conditions, including rheumatoid arthritis (RA), psoriatic arthritis (PsA), ankylosing spondylitis (AS), systemic lupus erythematosus (SLE), osteoporosis (OP), osteoarthritis (OA), and fibromyalgia syndrome (FMS).
At the start of the study, patients could select up to 10 different symptoms they wanted to track via short health assessment questionnaires. Study participants would then go on to complete the assessments once a month for the next three months. The symptoms that patients could track included:
In evaluating the PROs that were most popular among study participants at baseline, three stood out:
Fatigue: 83 percent of patients chose fatigue as a PRO they wanted to track.
Pain: 83 percent of patients chose pain as a PRO they wanted to track.
Mental health: 82 percent of patients chose mental health as a PRO they wanted to track. Within mental health, 54 percent of patients wanted to track depression and 44 percent of patients wanted to track anxiety.
Here is the percentage of patients who wanted to track other PROs in the study:
Physical Function: 72 percent
RA Flare: 70 percent (only offered to RA patients)
Study participants were also asked to share any self-reported comorbidities, or other diseases they have along with their arthritis diagnosis. The most common comorbidity was depression, reported by 51 percent of participants. This may partly explain why so many participants were interested in tracking aspects of their mental health.
National data show that depression and anxiety are common among people living with arthritis. According to a 2018 CDC report, 23 percent of people with arthritis reported symptoms of anxiety and 12 percent reported depression. These rates are likely even higher among specific populations of arthritis patients. For example, a 2019 study found that people with ankylosing spondylitis were twice as likely to have depression as people without AS. Other research has indicated that depression rates are higher among people with psoriatic arthritis than other rheumatologic conditions.
“Our research shows us that mental health is a top priority for patients and they do want to keep track of it,” says Gavigan. “But we know it can be challenging for some people to discuss mental health issues with their rheumatologist or other providers.”
In fact, other GHLF data suggest patients aren’t talking about their mental health with their rheumatologist. In a 2018 poll of ArthritisPower users, 59 percent of nearly 1,000 respondents said that their rheumatologist or primary care doctor does not ask about their mental health.
“We hope that being able to log and track mental health symptoms through ArthritisPower can facilitate these discussions and ensure that patients get the care and support they need to cope better with chronic illness,” Gavigan adds.
As many patients — 83 percent — reported wanting to track their fatigue as they did pain, which is important for rheumatology clinicians and researchers alike to know.
“We often hear from our arthritis patient community that fatigue is difficult to talk about with care providers,” says Seth Ginsberg, president and co-founder of Chronicwoman, which is part of GHLF. Patients report that doctors don’t always take their fatigue as seriously as other symptoms. What makes this even more challenging is that loved ones and caregivers also often struggle to understand the impact of fatigue on someone living with arthritis — that it’s more than just feeling tired. People who have fatigue from chronic illness are not “lazy” or “just need to get more sleep.” Fatigue is a physical manifestation of their disease, just like pain, stiffness, or swelling.
“The more patients can quantify difficult-to-discuss symptoms like fatigue, and mental health concerns, the more we as a rheumatology community can evaluate disease activity, treatment effectiveness, and overall health in a broader context that more fully takes into account patients’ complex experiences living with complicated, lifelong chronic diseases,” says W. Benjamin Nowell, PhD, director of Patient-Centered Research at GHLF.
If you are diagnosed with arthritis or another musculoskeletal condition, we encourage you to participate in future studies by joining Chronicwoman’ patient research registry, ArthritisPower. ArthritisPower is the first-ever patient-led, patient-centered research registry for joint, bone, and inflammatory skin conditions.
Fibromyalgia and lupus are both chronic diseases with no cure, can both cause some similar symptoms, and can both take a long time to get the right diagnosis. But fibromyalgia — often called fibro — and lupus are two very distinct health conditions with very different causes and treatments, despite having some features in common.
Lupus is an autoimmune disorder that involves widespread inflammation and impacts many organs throughout the body. Fibromyalgia a disorder that causes widespread chronic pain and tenderness. Unlike lupus, fibromyalgia is not an inflammatory or autoimmune disease.
Still, many signs and symptoms of fibromyalgia and lupus overlap and it’s not uncommon for fibromyalgia to be misdiagnosed as lupus, says rheumatologist George Stojan, MD, an assistant professor of medicine at Johns Hopkins University School of Medicine and co-director of the Johns Hopkins Lupus Center in Baltimore, Maryland. Both fibromyalgia and lupus can cause muscle/joint pain, brain fog, and fatigue. Both are also more likely to occur in younger and middle-aged women.
Interestingly, another factor that makes fibromyalgia and lupus difficult to differentiate from each other is that some people have both at the same time. “Having both lupus and fibromyalgia is extremely common,” says Dr. Stojan. “In our cohort here at Hopkins about 30 percent of lupus patients have fibromyalgia too.”
People with other rheumatic diseases such as rheumatoid arthritis, osteoarthritis, and axial spondyloarthritis are also at an increased risk of also having fibromyalgia.
Read more to learn about the different symptoms of fibromyalgia vs. lupus, how fibromyalgia and lupus are each diagnosed, and how treatments for fibromyalgia and lupus differ.
The U.S. Centers for Disease Control and Prevention (CDC) estimates that about 4 million American adults have fibromyalgia. While doctors don’t know what causes fibromyalgia, it is a disorder in which people often experience widespread chronic pain and sensitivity to touch, in addition to many other symptoms (more on this below).
Unlike lupus, fibromyalgia is not an autoimmune disease, which occurs when then body’s immune system mistakenly attacks your own cells and tissues. Fibromyalgia is not related to inflammation, nor is it a joint or muscle disorder caused by physical injury.
People at higher risk of fibromyalgia include women, the middle-aged, and those with certain diseases, including different types of arthritis, or a family history of fibro. While fibro can impair your quality of life, it doesn’t damage your tissues and organs, or cause medical problems like heart disease. It is not life-threatening.
Fibro’s hallmark symptom is persistent pain in soft tissues and muscles all over the body. It may involve tender points, or areas of tenderness in specific parts of body. Frequently described as a deep ache, fibro pain may move around, persist for long periods, and disappear.
More than nine in 10 fibromyalgia patients experience exhaustion. Fatigue can be especially noticeable when you first wake up in the morning, even when you’ve gotten plenty of sleep; light activity can make pain and fatigue worse.
The Lupus Foundation estimates that 1.5 million people in America have a form of lupus. Lupus is an autoimmune disease that occurs when your immune system cells — which are supposed to protect the body from different germs — start treating normal, healthy cells like invaders, attacking them and causing flare-ups that can affect the joints, skin, heart, lungs, kidneys, and almost any other system in the body.
Women of childbearing age (between 15 and 44) are at the highest risk of developing lupus, according to the CDC; some 90 percent of people with lupus are women. People of color — particularly African Americans — are at a higher risk of lupus than white people are, and the disease tends to affect populations differently. Native American and black patients tend to have higher mortality rates than white patients, while Hispanic and Asian patients have a lower risk of lupus.
There are several types of lupus, but most people refer to the most common form: systemic lupus erythematosus, also known as SLE. About 70 percent of people with lupus have SLE, according to the Lupus Foundation of America. Lupus can cause a range of complications; some, such as heart disease and kidney disease, can be severe and even life-threatening without early and proper medical treatment. Regular medical care that utilizes an integrated team of specialists is important to help lupus patients avoid life-potentially serious complications.
Unexplained weight loss — not due to dieting, other illness, or medication side effects — can be a sign of lupus. On the other hand, weight gain caused by fluid retention can also be a sign of the disease.
The characteristic rash across the cheeks and nose (called a malar rash) is one of the most recognized symptoms of lupus, although a similar-looking rash can also occur in other skin issues. Another type of lupus skin issue is a discoid rash that causes raised, red, and scaly patches.
Sun exposure can cause a lupus rash to develop or flare. People with lupus are also at risk of developing Raynaud’s, a condition in which the small blood vessels in the hands and feet suddenly constrict when exposed to cold or stress.
Other lupus symptoms include fever; neuropsychiatric issues such as depression, anxiety, seizures, or psychosis; brain fog; fatigue; headaches (including migraine-like attacks); mouth ulcers; kidney problems; and chest pain.
Despite the similarities in some of the symptoms, there are a few clear differences doctors and patients should be on the lookout for, says Dr. Stojan.
1. The nature of fatigue:Fatigue is common during a lupus flare, but it will subside once the attack is over, says Dr. Stojan. In fibromyalgia, however, exhaustion is more chronic — it’s less likely to come and go.
2. The nature of pain: Although both fibromyalgia and lupus can cause muscle and joint pain, lupus pain persists until it’s treated, says Dr. Stojan. The pain of fibromyalgia comes and goes. “The transient quality of the symptoms is a reliable sign that pain is not related to lupus,” he says.
3. Whether skin is involved: Fibromyalgia doesn’t cause nose and/or mouth ulcers or rashes like lupus does, such as the typical “butterfly” rash on the cheeks and bridge of the nose that can pop up during a lupus flare.
4. Whether there is inflammation: In lupus, a patient’s immune system starts to attack organs and other body tissues, leading to widespread inflammation that will likely show up in lab tests or imaging, says Dr. Stojan. Fibromyalgia, on the other hand, does not cause inflammation.
There are no definitive tests for either fibromyalgia or lupus, so differentiating between the two relies mostly on a thorough history of your symptoms, a physical exam, and sometimes blood tests or imaging to rule out other conditions. Read more here about how fibromyalgia is diagnosed.
Your doctor will ask you to describe your pain — and if they suspect fibromyalgia, may perform a “tenderness” test, pressing on several parts of your body to gauge where the tenderness is, and how severe it is.
Your doctor will likely also ask whether you experience fatigue, wake up tired every morning, or have trouble concentrating or experience brain fog — and for how long you’ve had these symptoms.
Your doctor may order some blood tests in order to rule out diseases that can cause fatigue, such as hypothyroidism type 2 diabetes. They may order blood tests to check for levels of inflammation in the body or for antibodies that could signal an autoimmune disease. One test ordered to help confirm or rule out lupus is the blood test for antinuclear antibodies (ANA). A positive test can be one sign of lupus, but it doesn’t necessarily mean you have it. “ANA is a very common marker people have in the blood. Almost one-third of people in the U.S. will test positive — and that alone doesn’t mean you have lupus,” Dr. Stojan says. However, most people who have lupus will have a positive test.
If you have a positive ANA test and other signs that point to lupus, your doctor may do additional antibody tests that help confirm or rule out the illness.
Your doctor may also order imaging tests like X-rays or MRIs to narrow down the cause of your symptoms. Neither fibromyalgia or lupus cause erosion in the joints (the way rheumatoid arthritis does) or visible inflammation of the lower back (the way axial spondyloarthritis does).
Neither disease has a cure, but medication can treat symptoms and help prevent serious lupus complications. The medications used to treat lupus are very different from those used to treat fibromyalgia.
For fibro patients: Some drugs commonly used to treat depression, called antidepressants, may ease pain and fatigue; these include duloxetine (Cymbalta) and milnacipran (Savella). Anti-seizure medications, frequently prescribed to people with epilepsy, can also help manage pain in fibromyalgia. Among these, the FDA has specifically approved pregabalin (Lyrica) for the treatment of fibro.
For lupus patients: Many different types of medications can be used to treat lupus, including:
Non-steroidal anti-inflammatory drugs (NSAIDs) to relieve pain and inflammation
Hydroxychloroquine or chloroquine, a malaria drug that is also useful at treating lupus flares, joint pain, and skin rashes
Glucocorticoids, or steroids, to relieve inflammation and treat flares
Immunosuppressive medications, such as azathioprine, cyclophosphamide, methotrexate, mycophenalate mofetil
Targeted biologics, such as rituximab (Rituxan) and belimumab (Benlysta), which reduce the activity of the immune system by targeting specific immune cells
Other medications to help manage complications of lupus, including those for cholesterol, blood pressure, osteoporosis, and others
Patients with lupus and fibro can also benefit from healthy lifestyle practices, too, including:
Exercise: Regular physical activity can help manage symptoms of fibro or lupus, and may improve mood, fitness and function. Swimming, walking, tai chi, and yoga are smart options. Exercise can be very important in helping people with lupus reduce their risk of cardiovascular disease complications. Consult a health care provider or physical therapist about a new exercise regimen, so it can be adapted to individual needs.
Diet: Though there is no specific diet recommended for lupus or fibro, a healthy eating plan may boost your immune system, help manage co-existing conditions, and promote overall good health. Read more about a following a healthy diet for lupus and a healthy diet for fibromyalgia.
Sleep: Getting adequate rest is vital for both conditions. It’s recommended that adults between ages 18 and 64 should aim for seven to nine hours nightly.
Complementary practices: Some patients report that activities like meditation, acupuncture, deep breathing, and massage help them relax and ease symptoms.
While lupus and fibro may have some symptoms in common, they are ultimately distinct conditions with very different causes and treatments. Visiting a health care provider can help you get to the bottom of your symptoms quickly and begin the correct therapies. The faster you start, the faster you can start feeling better.
If you’ve had a nagging sore throat, your doctor may take a swab to check for strep. If you’re suffering from a high fever and bad cough, your doctor may order a chest X-ray to look for pneumonia. But not all diagnoses are that straightforward.
Case in point: Fibromyalgia, a condition that causes widespread chronic pain — as well as fatigue, sleep disturbances, and cognitive difficulties — is often challenging for a physician to pinpoint.
“Fibromyalgia can be difficult to diagnose because there’s no gold standard test like an X-ray or blood work,” says Lenore Brancato, MD, a board-certified rheumatologist at NYU Langone Ambulatory Care in New Hyde Park, New York. “It’s a diagnosis of exclusion, which means you first have to rule out other diseases that may be causing symptoms. It’s not a cookie-cutter condition.”
Fibromyalgia is also a diagnosis that’s been subject to change. Back in 1990, when the first diagnostic criteria were set by the American College of Rheumatology (ACR), a doctor had to find the following elements in order to say their patient had fibromyalgia: pain in at least 11 of 18 designated “tender points” throughout the body, plus a history of widespread pain lasting more than three months.
In 2010, however, those diagnostic criteria for fibromyalgia were updated to eliminate the tender point requirement and instead focus on findings that a patient has widespread pain, as well as sleep disruptions, fatigue, and cognitive difficulties.
Whereas the validity of fibromyalgia as a diagnosis was once questioned in the medical community — leading to a stigma it’s still overcoming — ongoing research has led to a number of possible explanations for physical causes of fibromyalgia (ranging from genetics to physical triggers) and mechanisms (involving the central nervous system).
What we know for sure is that fibromyalgia affects approximately 2 percent of adults in the United States, and your risk of developing the condition increases if you are middle-aged or older and have been diagnosed with lupus or rheumatoid arthritis, says the Centers for Disease Control and Prevention (CDC). You may also be at a higher risk if you are female (most fibromyalgia patient are women), have suffered a trauma or repetitive injury, or if you are obese.
But statistics and risk factors can’t describe how fibromyalgia actually feels to the person living with it. What follows are the descriptions doctors hear patients use when they talk about both usual and less common symptoms of fibromyalgia.
While every fibromyalgia patient is different, their descriptions of overwhelming, debilitating pain throughout the entire body are very common. “My patients report feeling sore and stiff with an achy pain that goes from the top of their head to their toenails,” says Christopher Morris, MD, a board-certified rheumatologist with Arthritis Associates in Kingsport, Tennessee, and a fellow of the American College of Rheumatology. “They tell me the pain is in the muscles and soft tissues rather than joints.” Dr. Brancato hears similar concerns, with some of her patients saying the pain is lacerating, “like being cut by knives.”
Fibromyalgia could also make you overly sensitive to touch and temperature. “If you’re a patient with fibromyalgia, and someone brushes up against you in a crowded room it can be very painful,” says Dr. Brancato. “I’ll hear that my female patients can’t tolerate a massage.” Even though the stimulus is taken away, like removing your hand from a hot stove, the pain can continue, she explains.
If you have fibromyalgia, you may have trouble falling asleep or staying asleep. “My patients say they toss and turn, or their mind wanders,” Dr. Brancato says. “I’ll hear that my patients wake up throughout the night and end up feeling as tired as when they went to bed,” Dr. Morris adds.
One of the most common issues for fibromyalgia patients is fatigue. “It’s exhausting for them,” says Dr. Brancato. “If you ask a patient how they feel in the morning, you’ll hear they felt awful, they never feel ready to go, they feel like they can’t get their head above water.”
“My patients describe having a ‘fibro fog,’” says Dr. Morris. “They have a hard time concentrating.” For her part, Dr. Brancato sees a lot of memory problems. “If you tell a fibromyalgia patient three things during an office visit, then ask them to recall them later during the same visit, they have difficulty,” she explains. “With fibromyalgia, short-term recall can be very poor.”
For many patients, fibromyalgia may also bring feelings of sadness and other negative moods. Some researchers suspect a connection between fibromyalgia and certain types of chronic anxiety and depression.
Though less common, headaches can occur among fibromyalgia symptoms. “Stress- and tension-type headaches tend to travel with fibromyalgia,” Dr. Brancato reports, adding that they can be triggered differently than in patients without fibromyalgia. “These headaches can be induced by regular sounds, background music, or even odors like perfumes.”
Fibromyalgia can sometimes occur alongside digestive problems, such as bloating, constipation, abdominal pain, and irritable bowel syndrome (IBS), says the CDC.
Some patients with fibromyalgia might also have an increased incidence of interstitial cystitis, says Dr. Brancato. This condition can cause chronic pain or pressure in the bladder and pelvis.
It’s possible for fibromyalgia to be linked to pain in the muscles of the jaw and face (temporomandibular joint disorder) or to myofascial (skeletal muscle) pain in one part of the body. Such occurrences could be considered forms of regional or localized or incomplete fibromyalgia.
The relationship between fibromyalgia and different types of arthritis can be complicated. For one thing, there’s misdiagnosis: Depending on how your symptoms present, you could be told you have fibromyalgia when you actually have a kind of arthritis, or vice versa. Read about how ankylosing spondylitis and fibromyalgia can be mistaken for each other, for example.
At the same time, having a painful chronic disease like arthritis may in turn trigger the onset of fibromyalgia. Inflammatory diseases like arthritis can affect the way your central nervous system processes pain, creating a double-whammy of having both diseases at the same time.
If you suspect your combination of symptoms could be fibromyalgia, it’s a good idea to start with your primary care doctor. Because fibromyalgia is a diagnosis of exclusion, you’ll likely need a through physical exam, blood tests, and imaging tests to figure out what could be causing your symptoms.
When you think of arthritis, you might think of creaky knees, stiff hips, or painful, swollen fingers. Yes, arthritis commonly attacks joints in the hands, knees, and hips. But it can happen anywhere you have joints — including the toes. So, if you can’t bend your big toe or have swelling around your toes, this toe pain may be caused by arthritis too.
Toe arthritis can be caused by wear and tear of the cartilage in your toe joints, as well as inflammation of the toe joints. Arthritis most often attacks the big toe, but the other toes may be affected, too. Learn more about what causes toe arthritis and how it is treated.
With osteoarthritis, there is more bone enlargement of the toe joints as a result of bone spur formation, says podiatrist Krista A. Archer, DPM, a podiatric surgeon who is on staff at Lenox Hill Hospital in New York City. Bone spurs are bony projections that develop along bone edges, often due to joint damage from arthritis.
You have restricted range of motion due to swelling or damage to cartilage (a rubbery substance on the edges of bones that lubricates the joint) in any joints that are in the toes, midfoot, rearfoot, and ankle, says Dr. Archer. Bone spurs will often develop around the joint, restricting movement.
You may be unable to bend your big toe upward and have pain when doing so, says Chadwick Hampton, MD, an orthopedic surgeon at Palm Beach Gardens Medical Center in Palm Beach Gardens, Florida. That can make it difficult and painful to walk.
Your toe may become bent permanently downward and can’t be positioned flat on the floor.
Your pain worsens with weight-bearing activities like jogging, walking, and climbing stairs. “It depends on how severe the deformity is to predict what kind of activities will be painful,” says Dr. Archer.
You may have a bump form (a pressure sore) when the joints rub together. It resembles a callus or bunion.
You may have pitted, separated, or thick toenails.
You may have curling of the toes, such claw toe or hammertoe.
You may have pain in joints in the in the midfoot (cuboid, cuneiform, metcuneiform) and rearfoot (talonavicular, calcaneocuboid).
You may have numbness, burning, or tingling in the foot or ankle.
If you have arthritis in your toes, it’s important to understand the type of arthritis that might be causing it, because each type of arthritis has specific medications and treatments. Here are some of the more common types of arthritis that strike in toes.
Osteoarthritis (OA) is a degenerative joint disease where the cartilage that cushions the ends of a joint wears away gradually. Osteoarthritis often occurs because of typical wear and tear on a joint that happens with age; it can also occur as a result of injury to the joint. OA most commonly occurs in the joint at the bottom of the big toe, which is called the metatarsophalangeal or MTP joint.
Rheumatoid arthritis (RA) is a chronic inflammatory disease in which the body’s immune system attacks itself, causing inflammation and pain in the joints. RA can affect several small joints in the foot at the same time, including those in the toes. RA often occurs in the small joints of the hands and feet first, though it can affect other joints, such as the knees, elbows, hip, and neck. Around 90 percent of people with RA will have foot problems.
For many people, pain and swelling in the big toe, especially at the joint where the toe meets with the foot, is the first symptom of gout. Gout is a type of arthritis that occurs because elevated levels of uric acid in the blood accumulate in and aggravate joints, causing inflammation. Gout attacks can affect other joints aside from the big toe, including the ankles, foot, knees, or elbows. Lumps of uric acid, called gout tophi, may become visible underneath the skin around the toes, ankles, and other joints after you’ve had gout for years or if you have severe gout that is not well controlled.
Psoriatic arthritis is an inflammatory arthritis linked to psoriasis, an autoimmune skin disease that causes red, silver, scaly rashes on the skin. It’s characterized by pain, stiffness, and swelling in the joints. People with psoriatic arthritis might notice pain, stiffness, and swelling in the “knuckles” of the toes, says rheumatologist Arthur M. Mandelin, MD, PhD, associate professor of medicine at the Northwestern Medicine Feinberg School of Medicine in Chicago. People with PsA are likely to have problems with their toenails, such as pitting and crumbling, as well as swollen fingers and toes, a condition called dactylitis that makes them appear sausage-like. Enthesitis, or inflammation at the sites where tendons and ligaments attach to bones, is also common in PsA. This can affect the Achilles tendon at the heel or cause plantar fasciitis along the bottom of the foot.
Also called septic arthritis, this type of arthritis typically causes extreme pain and difficulty using the affected join. Septic arthritis is caused by bacteria or fungi that are carried through the bloodstream from another area of the body, usually settling in one joint. A bacterial infection from an injury or opening from a surgical procedure can also cause infectious arthritis by bringing germs directly to the joint. Pain worsens with movement and comes on rapidly in hours or days. It may include a swollen, red, and warm joint accompanied by fever, chills, fatigue/weakness, and the inability to move the affected joint.
The diagnosis of arthritis in toes begins with taking your medical history and a physical exam of your foot. The doctor will look at your entire foot, not just your toes. They’re looking for pain, deformity, and loss of function, says Dr. Archer. Your doctor will likely order an X-ray of the foot to help determine whether there is joint damage or changes in the alignment of bones in the foot.
If your doctor suspects you could have a type of inflammatory arthritis, such as RA or PsA, they may order blood tests to look for signs of inflammation (such as C-reactive protein or erythrocyte sedimentation rate) as well as antibodies (such as rheumatoid factor or anti-CCP). If your doctor suspects you could have gout, they may give you a blood test to look for elevated levels of uric acid and draw fluid from the joint to look for uric acid crystals.
Over-the-counter medications like ibuprofen (Advil) and naproxen (Aleve), as well as prescription NSAIDs, can help relieve pain and swelling in the joints. However, even though many NSAIDs are available over the counter, they can have side effects (such as causing stomach ulcers, increased heart attack risk, and kidney problems) especially when taken for the long term and/or in high doses. NSAIDs are a first-line of treatment in OA to reduce pain and stiffness. In inflammatory arthritis and gout, they can be used along with other kinds of medication to treat inflammation, pain, and swelling.
A topical gel like diclofenac (Voltaren) may be prescribed for toe arthritis, says Dr. Hampton. Topicals are good if you can’t take oral medications or medications aren’t helping with the pain.
This medication can help treat and relieve inflammation. An occasional shot can be given in any toe and offer temporary pain relief and reduce inflammation. Injections shouldn’t be done repeatedly; frequent injections can damage cartilage. “I give a certain dose and I won’t give it more than three times a year or no more than once every four months,” says Dr. Hampton.
If you have an inflammatory arthritis like rheumatoid arthritis, disease-modifying anti-rheumatic drugs (DMARDs) such as methotrexate are used as a first-line therapy to help reduce the immune system activity that triggers inflammation and pain. DMARDs are not used for osteoarthritis.
Biologics are a newer class of DMARDs that target specific immune system pathways to reduce immune system activity that is causing inflammation and pain. They’re used to treat inflammatory types of arthritis, such as rheumatoid arthritis and psoriatic arthritis, and are typically offered after patients haven’t responded to conventional DMARDs like methotrexate.
There are two main kinds of drugs used to treat gout: those used during a flare to reduce inflammation and pain and those used preventively to lower uric acid levels and prevent future flares from occurring. Medications used to treat inflammation in an acute gout flare include NSAIDs, oral corticosteroids or steroid injections, or a drug called colchicine. Medications called xanthine oxidase inhibitors limit the amount of uric acid your body produces. These include allopurinol (Zyloprim and Aloprim) and febuxostat (Uloric). Another class of drugs called uricosurics help your kidneys remove uric acid from the body. These include probenecid (Probalan) and lesinurad (Zurampic). An infused drug called pegloticase (Krystexxa) can help the body eliminate uric acid in people whose gout hasn’t been well controlled with other medication.
If your gout attack is limited to one or two joints and your pain is mild to moderate, you may only need one of these medications to control the inflammation. However, if your pain is severe, and if one or more of your larger joints (not just a toe) are involved, you may need a combination of treatments to get it under control. Also, if one drug doesn’t work well enough to treat your gout attack symptoms, your doctor may switch you to a different medication or try a combination of medications.
Your doctor may send you for physical therapy to help improve your range of motion and strengthen the muscles around your foot. “Physical therapy can increase pain-free range of motion and strengthen the muscles of the foot to take pressure off the painful joint,” says David Geier, MD, an orthopedic surgeon, sports medicine specialist, and author of That’s Gotta Hurt: The Injuries That Changed Sports Forever. These exercises relieve stiffness and increase your ability to move your joints through their full range of motion.
You want to wear shoes that take pressure of your toe joints to relieve some of the stress from arthritis of the toes. Look for footwear with a more rigid, stiff sole (which will provide support) and wide toe box to help prevent excessive stress and bending forces on the toe joints. Ditch high heels; they put your foot in an unnatural position that takes a toll over time.
Cold therapy can provide relief for inflamed joints in the wrist. Cold constricts the blood vessels in the muscles, which decreases blood flow to the joint area to help reduce swelling and inflammation. Heat therapy warms the skin and the joints, which causes blood vessels to dilate, and sends more oxygen and nutrients to the joints and muscles. Try both and see which makes you feel best.
Control your weight with regular, low-impact aerobic exercise that doesn’t hurt your toes. Cycling on a recumbent bike or swimming are good options. Keeping your weight close to your ideal body mass index (BMI) is one of the best things you can do to control your toe pain. Being at a healthy weight “balances the pathomechanics [the mechanics of damaged bones, tendons] of the entire foot and relieves stress on toes,” says Dr. Archer. It’s also a good idea to do specific exercises that strengthen your Achilles tendon (the cord at the back of your heel) as well as the tendons in the balls of your feet and toes. You can even simply wiggle your toes.
Maintaining a healthy weight helps reduce stress on the joints. Feet are a weight-bearing joint, so obesity makes arthritis worse. Losing excess pounds can lead to less pain and better function. You especially want to eat healthfully since your exercise abilities may be limited if you have a lot of pain in your toes. Aim to eat foods that may help reduce inflammation, called anti-inflammatory foods.
Surgery isn’t usually necessary for arthritis of the toes. It’s usually a last resort since you may still have discomfort and have an increased risk of infection after surgery. But several surgical procedures outlined below can be done if other treatments for toe arthritis have not helped.
The most common surgery, cheilectomy, involves removing bone spurs that have formed around joints that have become arthritic. It’s typically done when arthritis is in the big toe. It can help relieve discomfort around the joint and improve the movement of the joint. The toe may stay swollen for several months, but you’ll likely experience long-term relief. However, removing bone spurs doesn’t address the worn-out cartilage within the joint. So bone spurs often return in the future. “This surgery has a high revision rate because you’re treating the arthritis as it’s in progression. So [the condition] continues to progress.” says Dr. Hampton. “You’ve removed the bad parts of the bone but you don’t actually replace the joint.”
This surgical procedure stimulates bone growth across the joint. The joint is fused together permanently with pins, screws, or a plate. When bone grows across the toe joint, it won’t bend anymore. But since the joint is fused, pain is also relieved. Dr. Archer says that she rarely does this type of surgery. “It’s usually done in active laborers, like carpenters and mechanics, to give them a stable joint with no pain,” says Dr. Geier.
Fibromyalgia — a disorder that causes widespread chronic pain and tenderness — affects 2 to 4 percent of women and men in the United States (women ages 20 to 50 are the most affected) and impacts patients in many different ways.
Thus, fibromylagia remains mysterious, and questions still linger — like why are more women affected by fibromyalgia than men? And why is fibromyalgia so hard to diagnose and treat? Why do some patients with fibromyalgia have more back pain than others?
“What causes fibromyalgia has puzzled many scientists for a long time,” says Elena Schiopu, MD, a rheumatologist and internist at Michigan Medicine in Ann Arbor. While the exact cause of fibromyalgia isn’t certain, doctors do know that the disorder can be triggered by an injury, surgery, infection, psychologicaltrauma (like an extremely stressful period), or even just from an accumulation of symptoms that leads to the eventual classification of fibromyalgia.
The reason for the heightened pain? Fibromyalgia may affect the way your brain interprets pain signals. “Fibromyalgia is basically a miscommunication between the central, peripheral, and autonomic [vegetative] nervous system, which results in abnormal or amplified sensations,” says Dr. Schiopu. This is known as central pain sensitization. It causes your nervous system to become “wound up” and in a constant state of hyperactivity, which creates a lower threshold for experiencing pain.
When you poke someone without fibromyalgia, for example, it might be no big deal, but for someone with fibro, that same level of touch can cause significant pain or discomfort.
Unlike arthritis, in which pain occurs in specific joints, the pain that fibro patients experience is more in the muscles. It’s a widespread pain, which means you feel pain all over you body. According to the latest diagnostic criteria for fibromyalgia, patients must experience pain in four out of five general regions of the body. These include left upper, right upper, left lower, right lower, and low back.
People with fibromyalgia may experience long-term back pain along with a number of other symptoms. “Back pain that’s patient-reported and physician-observed — called paraspinal lumbar tenderness — is very common,” says Dr. Schiopu. “All the areas of the body that are being ‘used’ on a regular basis could hurt, like your hands, neck, or upper or lower back.”
“The back is a common area to have pain in fibromyalgia because muscles in general are often painful in fibromyalgia, and the human back has a large quantity of muscle fibers to support posture,” says Amanda Sammut, MD, a rheumatologist and assistant clinical professor of medicine at Columbia University Medical Center in New York City.
Also, says Dr. Schiopu, patients with fibromyalgia could have a degree of wear-and-tear arthritis of the lumbar spine, which is amplified by fibro. In fact, it’s common to have fibro at the same time as other diseases, such as inflammatory arthritis or osteoarthritis.
Lower back pain is an extremely common medical complaint — some 80 percent of Americans experience it at some point in their lives. So if you have lower back pain, how do you know if it could be from fibromyalgia or something else?
The answer is complicated. If you’re experiencing back pain as well as other symptoms, it’s possible you could have a different health problem entirely — or a health problem plus fibromyalgia at the same time.
Misdiagnoses are common with fibromyalgia — both in terms of not being diagnosed with fibro when you really have it, or in terms of being diagnosed with fibro when you actually have a different health problem.
“Fibromyalgia is technically an exclusion diagnosis,” says Dr. Schiopu. This means you shouldn’t be diagnosed with fibromyalgia until a doctor has fully ruled out the possibility of having other diseases.
That’s why a thorough visit with a rheumatologist is critical. If you’ve already been diagnosed with fibromyalgia but find that your current treatment plan isn’t helping your back pain, you could have a different or additional diagnosis, such as one of the following:
Maybe you lifted a heavy box, strained to reach something in a high cabinet, or picked up your child or grandchild, which could have triggered a back muscle strain. A sudden movement can cause a strain, as well as constant use of your back (like doing repetitive motions), especially if you’re not in good physical shape.
If you have lower back pain as well as pain in other places — say, your knees, jaw, neck, or shoulders — it could be from the widespread aches of fibromyalgia, or it could be another condition you may not be familiar with: axial spondyloarthritis (AxSpA), which is an inflammatory type of arthritis in your spine and the area where your spine meets the pelvis (sacroiliac joints). Back pain is a primary symptom of AxSpA, though it can also affect other joints and areas around your body.
AxSpA is often divided into two categories. Radiographic AxSpA (which is often called ankylosing spondylitis), means that evidence of joint damage is visible on X-rays. Non-radiographic AxSpA (nr-AxSpA) is essentially the same condition, but without joint damage being visible on X-rays.
Fibromyalgia and axial spondyloarthritis are caused by very different things (AxSpA is inflammatory and due to an overactive immune system that’s attacking the joints) and thus have very different treatments. It’s important to get the right diagnosis so you can get on the right treatment and start feeling better.
You may have never realized it, but your spine could curve to the side, a condition known as scoliosis. The physical changes of scoliosis often start in childhood but the condition might not start causing back pain until middle age.
The cushiony discs between your vertebrae may bulge or rupture, which can then put pressure on a nerve in your spine. While some people may not feel any pain when this happens, others may find it excruciating.
A frustrating part about aging: The vertebrae in your spine may develop compression fractures if your bones become too brittle (a condition known as osteoporosis). These fractures can then lead to back pain.
While you may experience back pain if you have fibromyalgia, if you’re experiencing back pain alone, and not other fibromyalgia symptoms, then your pain is likely not due to fibromyalgia, says Dr. Schiopu.
In addition to pain, sleep problems are a big part of patients’ experience with fibromyalgia. Even if fibro patients sleep for hours, they still may wake up feeling unrefreshed. That could be due to pain waking people up at night, or they may experience other sleep issues, like restless leg syndrome or sleep apnea. This troubled sleep, in turn, can contribute to debilitating daytime fatigue.
Many patients with fibromyalgia complain of fibro fog, in which people feel like they can’t concentrate, hold conversations, or even remember certain things, like plans or where they placed objects. One reason for the fibro fog could be lack of sleep. Another explanation is that there is potentially something happening in the brain that’s unique to people with fibromyalgia.
Fibromyalgia often co-exists with other ailments, like irritable bowel syndrome, migraine, interstitial cystitis (a painful bladder syndrome), and TMJ (a jaw disorder). “That’s all followed by a slew of hypersensitivity to cold, light, noises, smells,” adds Dr. Schiopu. Thus, it can seem like fibromyalgia patients have a laundry list of health woes, which can be incredibly frustrating.
If you have fibromyalgia and are experiencing back pain as a symptom, then you’ll want to come up with a treatment game plan with your doctor. “Gentle stretching, warm pool exercises, and even a supportive belt would help,” says Dr. Schiopu. “Daily strengthening of the lumbar musculature [muscles in the lower back] is key as well,” she adds.
Fibromyalgia medications may help relieve back pain. Some antidepressant drugs are prescribed to help ease pain and fatigue; these include duloxetine (Cymbalta) and milnacipran (Savella). Anti-seizure medications can also help manage pain in fibromyalgia. Among these, the FDA has specifically approved pregabalin (Lyrica) for the treatment of fibro.
If you have back pain — especially back pain that’s lasting more than three months and doesn’t improve with your current treatment — it’s important to talk to your doctor about your symptoms and medical history. Your back pain could be due to fibromyalgia, but it could also stem from various other health issues.
“If your back pain continues despite medical therapy and despite physical therapy, patients should then consider seeing a rheumatologist or a pain management specialist,” says Dr. Sammut.
If you have ankylosing spondylitis or psoriatic arthritis, you may be familiar with the pain of enthesitis, an inflammation where tendons and ligaments attach to the bone — even if you aren’t aware it has a name. “I didn’t know what it was called!” Monica D. told us on Facebook. “I have pain all the time. Makes it difficult to walk very far.”
“Enthesitis is inflammation of the ‘enthesis,’ which is where a tendon or ligament attaches to bone,” says Joan Appleyard, MD, a rheumatologist at Baylor College of Medicine in Houston, Texas. “Symptoms are pain sometimes accompanied by swelling.”
There’s a reason the enthesis is susceptible to this problem. “The enthesis has a lot of blood flow and [thus] is subject to both infection and inflammation,” says Theodore R. Fields, MD, a professor of clinical medicine at Weill Cornell Medical College and an attending rheumatologist at Hospital for Special Surgery in New York City. “Two of the most common entheses are the area where the Achilles’ tendon inserts on the back of the heel, which causes Achilles’ tendonitis, and where the sheet of connective tissue, or fascia, inserts on the bottom of the heel, which causes plantar fasciitis.”
If you have rheumatoid arthritis or osteoarthritis, chances are you won’t experience enthesitis, because it generally only occurs with certain types of arthritis called spondyloarthropathies (SpA), which include non-radiographic axial spondyloarthritis, ankylosing spondylitis, psoriatic arthritis, enteropathic arthritis (a type that occurs in people with inflammatory bowel disease), and reactive arthritis (which can occur after infection, formerly called Reiter’s syndrome).
Enthesitis is actually one of the hallmark traits of SpA. “It is not a feature of rheumatoid arthritis — this is one of the ways in which SpA differs from RA,” Dr. Appleyard says.
Doctors aren’t exactly sure why SpA targets the enthesis, but it may be that a specific inflammatory response occurs in areas under biomechanical stress (stress on the joint from movement).
“About half of people with psoriatic arthritis and ankylosing spondylitis have enthesitis,” says Dr. Fields. “In both psoriatic arthritis and ankylosing spondylitis, the back and under portions of the heel are common sites of enthesitis.”
There are many other areas where enthesitis can occur, he says, including the inner and outer sides of the elbows, the area where the ribs meet the breastbone, the back of the head where it meets the neck, and in the spine in the area closest to the skin.
The main symptom of enthesis is pain, which Chronicwoman patients described as “horrible” or “burning.”
“Quite a bit of my PsA pain is due to enthesitis,” Ruth O. shared on Facebook. “It moves around from ball of my foot, to left shoulder, hands, wrists and left hip.”
Marcia G. told us, “I have [enthesitis] in my right ankle and heel mostly. My feet hurt randomly and the right toes and top of foot swell up.” Although many patients noted that enthesitis occurs in their feet, Kelly C. says it hurts “especially around my rib cage.”
Enthesitis might not mean your disease is progressing. “Enthesitis can be part of both severe and relatively mild cases of psoriatic arthritis or ankylosing spondylitis,” Dr. Fields says. It may indicate active disease, but not necessarily worsening disease, says Dr. Appleyard.
Your doctor will diagnose enthesitis based on a physical exam, in which they’ll note the location of pain, tenderness, or swelling. “Ultrasound can also be helpful in diagnosing enthesitis, and at times MRI can also be used,” Dr. Fields says.
“Managing enthesitis is important since it can cause a lot of discomforts,” Dr. Fields says. Some specific biologic therapies used to treat SpA seem to improve symptoms of enthesitis. “Treating the underlying disease with anti-TNF agents [a type of biologic] often helps with enthesitis, but traditional DMARDs such as sulfasalazine don’t treat enthesitis,” Dr. Appleyard says. Non-steroidal anti-inflammatory agents (NSAIDs) can be used for mild cases.
When deciding on a treatment regimen for SpA, Dr. Fields says it’s important to take into account all the affected areas. “In patients where enthesitis is the major issue, and more severe than the arthritis, we may skip the non-biologic agents and go directly to biologic therapies, since they tend to be more effective for enthesitis,” he says.
In addition to TNF blockers, other biologic options include blockers of the proteins IL-17, IL-12, or IL-23. “One exception is the non-biologic agent apremilast, which does not appear to cause infection and can be used in psoriatic arthritis, and which has been shown to have effectiveness in some people with enthesitis,” says Dr. Fields.
In addition, “local injection of corticosteroids can be used in enthesitis at times, but needs to be used carefully to avoid weakening of the surrounding tendons and ligaments,” Dr. Fields says.
Talk to your doctor about which medications are right for your individual case. (Here’s what one study found about picking the right treatment for enthesitis in PsA.)
A physical therapist can give you gentle stretches to do at home to help relieve the pain of enthesitis, Dr. Fields says. In addition, the doctors and patients we talked to suggested:
Apply heat or ice to affected areas
Maintain a healthy weight. “Weight loss can take pressure off the involved areas,” Dr. Fields says.
Rest and elevate the affected foot. “I try to keep the swelling down by icing it, and keeping my leg and foot elevated,” Lesley P. told us on Facebook.
Wear special shoes. “People with plantar fasciitis can benefit from shoe inserts to cushion the heel and may be helped by a consultation with a podiatrist,” Dr. Fields says.
Wear compression socks, braces, wraps, or even a medical boot.
Watch salt intake to control swelling. “Salt intake does make a difference,” Ruth says.
Over-the-counter remedies (check with your doctor first). “I love using Biofreeze on the bone in my foot — it helps!” Caroline P. told us on Facebook. Other Chronicwoman members recommended Epsom salt soaks, diclofenac gel, magnesium, or CBD products.
Fibromyalgia and multiple sclerosis are both chronic diseases with no cure. Fibromyalgia and multiple sclerosis can both cause some of the same symptoms. They can both take a long time to get the right diagnosis. They’re both more common in women. But fibromyalgia — often called “fibro” — and multiple sclerosis (MS) are two very distinct health conditions with very different causes and treatments, despite having some features in common. Read on to find out the differences and similarities of fibromyalgia vs. MS.
Fibromyalgia and MS may have some more vague symptoms in common, such as problems with focus and concentration, fatigue, and depression. If you’re Googling potential causes of these symptoms, you may find yourself researching both diseases to see if your symptoms match up. But despite some similarities, “for the most part, there is no mistaking symptoms of MS with fibromyalgia,” says Philip Cohen, MD, a rheumatologist, professor of medicine and professor of microbiology and immunology at the Lewis Katz School of Medicine at Temple University in Philadelphia.
This is especially true once you see a health care provider and start the process of seeking a diagnosis. Fibromyalgia is often diagnosed and managed by a rheumatologist, which is an internal medicine doctor who has specialized training in joint and musculoskeletal diseases. Multiple sclerosis is diagnosed and managed by a neurologist, which is a doctor who specializes in treating disorders of the brain and nervous system.
Read more to learn about the different symptoms of fibromyalgia vs. multiple sclerosis, how fibromyalgia and multiple sclerosis are each diagnosed, and how treatments for fibromyalgia and multiple sclerosis differ.
The Centers for Disease Control and Prevention estimates that about 4 million American adults have fibromyalgia. While doctors don’t know what causes fibromyalgia, it is a disorder in which people often experience widespread chronic pain and sensitivity to touch, in addition to many other symptoms (more on this below).
“Fibromyalgia is poorly understood,” says Dr. Cohen. “But it’s thought by many to be a disorder of pain perception, perhaps due to abnormalities in parts of the brain.”
Unlike MS, fibromyalgia is not an autoimmune disease, which occurs when then body’s immune system mistakenly attacks your own cells and tissues. Fibromyalgia is not related to inflammation, nor is it a joint or muscle disorder caused by physical injury.
People at higher risk of fibromyalgia include women, the middle-aged, and those with certain diseases, including different types of arthritis, or a family history of fibro. While fibro can impair your quality of life, it doesn’t damage your tissues and organs, or cause medical problems like heart disease and cancer. It is not life-threatening.
Though someone with fibro may experience a range of symptoms, the condition’s hallmark symptom is persistent pain in soft tissues and muscles all over the body. “Fibromyalgia pain is diffuse [all over], with particular involvement of what are called ‘tender points,’ or areas of tenderness elicited by pressing in specific parts of the neck, trunk, and extremities,” says Dr. Cohen. Frequently described as a deep ache, the pain may move around, persist for long periods, and disappear.
More than nine in 10 fibromyalgia patients experience unrelenting exhaustion. The sleep problems that often accompany fibro, including light sleep and repeated awakenings, can contribute to fatigue, but treating fatigue in fibromyalgia isn’t just about getting more sleep.
“Fibromyalgia patients often have headaches, irritable bowel symptoms, and depression,” adds Dr. Cohen. “Although these problems may occur in MS, they are less commonly seen.”
About 1 million Americans are thought to have multiple sclerosis. Unlike fibro, MS is considered an autoimmune disease in which the immune system is attacking part of the central nervous system. Specifically, MS affects the protective sheath (myelin) that covers nerve fibers throughout your body, which can cause a wide range of symptoms depending on which nerves are affected. Over time, multiple sclerosis can permanently damage your brain and spinal cord.
Doctors don’t know what causes MS but believe that it’s due to a combination of genes and environmental factors. Women, Caucasians, people between the ages of 20 and 50, and those who live farther from the Equator have a higher risk of developing MS.
There are four main kinds of MS; symptoms and disease progression depend on what type you have. While many people with MS develop relatively mild issues (especially with newer treatments that can help prevent MS flares and disease progression), those with severe illness can lose mobility and speech and experience other complications.
MS symptoms vary among patients, depending on which parts of the nervous system are affected. The most common type of MS — called relapsing-remitting MS, which is what 85 percent of patients are first diagnosed with — is characterized by attacks, or flares, of new symptoms followed by periods of remission. Among the more common symptoms of MS are:
Numbness and tingling in the limbs often occur with MS, as do muscle spasms. Frequently, someone with MS will feel an electric impulse sensation when they move their neck a particular way; this is called the Lhermitte sign.
Dizziness and weakness can contribute to balance and coordination troubles. People with MS often complain of feeling suddenly clumsy or report tripping, stumbling, or falling more than usual.
When MS affects the optic nerve in your eye, it can cause eye problems such as blurry eyesight, double vision, and vision loss, and may involve eye pain and unexpected movement of the eye. You may find yourself partially color blind and have issues such as picking out clothes that don’t match.
People with MS may experience eye pain or pain elsewhere in the body. It can be acute or mild, and may be related to neurological issues or musculoskeletal problems. Occasionally, some MS patients do not develop pain. For fibro patients, pain is a defining aspect of the disease. Without its presence, you cannot get a fibromyalgia diagnosis.
Constant weariness is widespread in both MS and fibro. The vast majority of people with either condition often feel physically exhausted, and may find it interrupts their lives at home, school and work.
“Fibro fog” is common in fibromyalgia. About half of MS patients report brain fog-like symptoms as well.
When considering your symptoms, it is important to keep in mind that people with multiple sclerosis may experience a wide variety of other issues not common to people with fibromyalgia, such as mobility problems and speech troubles. What’s more, many unusual symptoms may be caused by a condition unrelated to either disease. As a result, it’s crucial to get an an accurate diagnosis.
If you suspect you might have either fibromyalgia or MS, says Dr. Cohen, “begin with [your] internist or general practitioner.” They can assess your symptoms and medical history and refer you to the right specialist for further testing.
Both fibromyalgia and multiple sclerosis can be difficult to diagnose. There’s no single test that confirms you have either disease, and doctors must rule out other conditions that can have similar symptoms. Read more about diseases that can mimic fibromyalgia.
When diagnosing fibromyalgia vs MS, providers must eliminate the possibility of those other illnesses, which include rheumatoid arthritis, lupus, spondyloarthritis, thyroid disorders, and others. To do this, they’ll typically use a combination of patient history, physical exam, and laboratory tests to narrow the field. At the same time, they can look for three diagnostic criteria:
Diagnosing MS is different from diagnosing fibromyalgia since clinicians can rely on certain tests in addition to symptoms, medical history, and a physical exam. Magnetic resonance imaging (MRI), for example, takes pictures of your brain and helps detect damaged nerves. Other tests may include spinal taps, optical coherence tomography — which scans your eyes for symptoms of MS — and evoked response tests, which look at how your nerves respond to certain stimulation.
According to the National MS Society, an official MS diagnosis requires the following:
The discovery of damage in two or more separate parts of the central nervous system
While neither illness has a cure, medication can be used to relieve fibromyalgia or MS symptoms. In the case of MS, drugs can also greatly modify the course of the disease. That’s why — though taking medication as prescribed is often key to the treatment of any chronic illness — medication adherence is especially crucial for MS patients.
For fibro patients:Some drugs commonly used to treat depression, called antidepressants, may ease pain and fatigue; these include duloxetine (Cymbalta) and milnacipran (Savella). Anti-seizure medications, frequently prescribed to people with epilepsy, can also help manage pain in fibromyalgia. Among these, the FDA has specifically approved pregabalin (Lyrica) for the treatment of fibro.
For MS patients:There’s been a lot of innovation in recent years to develop different kinds of medications that can help limit damage to the nervous system, reduce relapses, and slow disease progression. These include oral medications as well as medications that are injected or infused. Each medication works differently, but they generally affect immune system activity to prevent it from attacking the nervous system.
People with MS may need additional medication to treat flares, such as corticosteroids, as well as medications to target specific MS symptoms, such as drugs for bladder issues, sexual dysfunction, and muscle stiffness and spasms.
Patients with MS and fibro can also benefit from healthy lifestyle practices, too, including:
Exercise: Regular physical activity can help manage symptoms of fibro or mild MS, and may improve mood, fitness and function. Swimming, walking, tai chi, and yoga are smart options. Consult a health care provider or physical therapist about a new exercise regimen, so it can be adapted to individual needs.
Diet: Though there is no specific diet recommended for MS or fibro, a healthy eating plan may boost your immune system, help manage co-existing conditions, and promote overall good health.
Sleep: Getting adequate rest is vital for both conditions. It’s recommended that adults between ages 18 and 64 should aim for seven to nine hours nightly.
Complementary practices: Some patients report that activities like meditation, acupuncture, deep breathing and massage help them relax and ease symptoms.
Keeping a consistent daily routine is often suggested for both fibro and MS, as is leaning on family, friends, and professionals for emotional support. “If there is depression or anxiety, referral to a psychiatrist or counselor is often helpful,” says Dr. Cohen.
While MS and fibro may have some symptoms in common, they are ultimately distinct conditions with very different causes and treatments. Visiting a health care provider can help you get to the bottom of your symptoms quickly and begin the correct therapies. The faster you start, the faster you can start feeling better.
When you think of arthritis, you might think of creaky knees or painful, swollen fingers. But if your wrist is feeling swollen and stiff, this wrist pain may be caused by arthritis too.
The wrist is a complex joint that connects the hand to the forearm. It is formed by the two bones of the forearm — the radius and the ulna — and eight small carpal bones that sit between your fingers and your arm. The carpal bones are arranged in two rows at the base of the hand, with four bones in each row. The joint surface of each bone is covered with articular cartilage, which is a slippery substance that protects and cushions the bones as you move your hand and wrist.
Arthritis in the wrist is often the cause of wrist pain. According to one estimate, one in seven people, or 13.6 percent, in the United States has wrist arthritis. But the kind of arthritis that affects your wrist might not be so obvious. Two of the most common forms of arthritis — osteoarthritis (OA, or degenerative arthritis caused by wear and tear on the joints) and rheumatoid arthritis (RA, an inflammatory type of arthritis caused by inflammation in the joint) — share many symptoms in common. Plus, other, less common forms of inflammatory arthritis affect the wrist that your doctor will need to consider as well.
“Besides pain, loss of flexibility in the wrist may affect your ability to use your hands to dress, eat, and do many work tasks,” says Steven Eyanson, MD, a retired rheumatologist who was in private practice at Physicians Clinic of Iowa in Cedar Rapids and a clinical assistant professor at the University of Iowa in Iowa City.
Learn more about what causes arthritis in the wrist and how arthritis in the wrist is treated.
Not everyone with arthritis in the wrist will experience symptoms. When symptoms do occur, the severity can vary greatly from person to person. For some patients, wrist arthritis symptoms aren’t constant, but may come and go depending on their level of activity and other factors. You may have done something to the wrist — such as repeated overuse, lifting, carrying, or bending — that aggravates it and causes a flare. Then it returns to its baseline.
“The number one symptom of wrist arthritis is pain,” says Chadwick Hampton, MD, an orthopedic surgeon at Palm Beach Gardens Medical Center in Palm Beach Gardens, Florida. The pain may be sharp, depending on the motion, says Dr. Eyanson. Or it may be dull and deep if it’s an inflammatory type of arthritis like rheumatoid arthritis.
The other main symptom of wrist arthritis is a change in your grip strength, such as an inability to open jars, use keys, or turn doorknobs.
About 30 million Americans have osteoarthritis, which makes it the most common type of arthritis. It’s more common with older age, but it can occur in younger people too, depending on such factors as injuries and genetic risk. In osteoarthritis of the wrist, the smooth, slippery articular cartilage that covers the ends of the bones gradually wears away over time. Since cartilage has little to no blood supply, it has little ability to heal or regenerate when it gets injured or worn down.
Osteoarthritis in the wrist can also develop from a condition called Kienböck’s disease. Here, the blood supply to one of the carpal bones — the lunate — is disrupted. That causes the bone to deteriorate. Over time, this can lead to structural changes and arthritis in the joints around the lunate.
Post-traumatic arthritis is a common form of osteoarthritis that happens as a result of physical injury to a joint such as from sports, a car accident, a fall, or other trauma. Injuries can damage the bone and/or cartilage, which changes the joint mechanics and makes it wear out more quickly. Post-traumatic arthritis symptoms in the wrist may appear within a few years, or it can take decades for joint damage from an injury to cause pain.
About 1.5 million people in the U.S. have rheumatoid arthritis (RA). RA is a chronic inflammatory disease that causes pain, stiffness, swelling, and loss of function in joints throughout the body.
Rheumatoid arthritis is caused by autoimmunity, which is a malfunction in your immune system. Normally, your immune system reacts to any external threats (such as viruses, bacteria, or parasites that could cause disease) by releasing antibodies, white blood cells of various types, and other defense systems. But in autoimmune diseases like RA, your body’s immune system is confused for some reason. It attacks your own healthy tissue when there’s no reason to.
RA often starts in smaller joints, such as those found in the fingers and wrist. RA is often symmetrical, which means it affects the same joint on both sides of the body. OA, for example, might affect only your right wrist, but RA is more likely to affect both your wrists.
As RA progresses, it can affect the range of motion and flexibility of the wrist joints. Because RA causes widespread inflammation in your body, it’s not common that wrist pain would be your only symptom. You’re also likely to experience pain in other joints, especially your fingers or toes, as well as fatigue, low-grade fever, and these other rheumatoid arthritis symptoms.
Psoriatic arthritis (PsA) is another kind of inflammatory arthritis linked to psoriasis (a disease that causes red, scaly rashes on the skin). Psoriatic arthritis in the wrist might cause similar symptoms to those of RA — pain, stiffness, swelling, and loss of function — but there may be additional PsA symptoms that occur that are more unique to PsA. People with PsA are likely to have problems with their nails, such as pitting and crumbling, as well as swollen fingers and toes, a condition called dactylitis that makes them appear sausage-like. PsA joint pain is also less likely to be symmetrical than that of RA.
Carpal tunnel occurs when a major nerve in the hand — the median nerve — becomes compressed in the carpal tunnel, a narrow passageway on the palm side of your wrist that also houses the tendons that bend the fingers. Interestingly, having arthritis raises your risk of developing carpal tunnel, so you could have both conditions at the same time. The nature of the pain in carpal tunnel usually sets it apart from arthritis, though: It often causes numbness and tingling in the first three fingers (thumb, index, and middle finger), as well as these other carpal tunnel symptoms.
Tendons are thick cords that join your muscles to your bones. When tendons become irritated or inflamed, that’s called tendinitis. Tendinitis causes acute pain and tenderness that makes it difficult to move the affected joint. Any tendon can develop tendonitis, but you’re more likely to develop it in your shoulder, knee, elbow, heel, or wrist. The most common cause of tendonitis is a repetitive action. You may develop tendinitis if you make the same motion frequently while playing sports, for example.
First, your doctor will ask about your symptoms and medical history and perform a physical exam. During your physical exam, your doctor will examine your wrist for swelling and pain.
Next, your doctor will examine the range of motion of the wrist itself. Your doctor may have you twist and flex both wrists in every direction to assess your range of motion. They will manipulate your wrist and thumb joints and ask if you feel pain in your wrists and thumbs. This exam can show how mild or severe the arthritis is, or if another condition is causing symptoms, such as carpal tunnel syndrome or tendinitis.
If your doctor suspects inflammatory arthritis, they will order blood tests to detect the presence of certain antibodies, such as rheumatoid factor or anti-CCP, which help identify RA and other types of inflammatory arthritis. They may also order blood tests that look for levels of inflammation, such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR).
Your doctor may order imaging tests, such as X-rays or MRIs, to assess whether you have joint damage in the wrist.
Nonsteroidal anti-inflammatory medications (NSAIDs) like aspirin, naproxen, and ibuprofen (all available over the counter) can help relieve pain and inflammation. They’re commonly used to treat pain and stiffness in OA and inflammatory arthritis. NSAIDS don’t slow the progression of arthritis. But they do help treat acute symptoms like pain and inflammation. NSAIDs are also available by prescription at stronger doses for shorter-term use. All NSAIDs, both OTC and prescription, can have significant side effects, including gastrointestinal complications and an increased risk of heart disease, so talk to your doctor about the right dosage and duration for you. Your doctor might also prescribe a topical gel NSAID, which can be helpful if oral medications aren’t helping with the pain. A common one is diclofenac (Voltaren), says Dr. Hampton.
If you have an inflammatory arthritis like rheumatoid arthritis, disease-modifying anti-rheumatic drugs (DMARDs) such as methotrexate are used as a first-line therapy to help reduce the immune system activity that triggers inflammation and pain. DMARDs are not used for osteoarthritis.
Corticosteroids like prednisone are powerful anti-inflammatory agents that can quickly relieve pain and swelling. “This type of therapy is often employed as a temporary or ‘bridge’ therapy [for inflammatory arthritis] while patients wait for DMARDs to take effect,” says Brian Golden, MD, a rheumatologist and clinical associate professor in the department of medicine at NYU Langone Health in New York City. It’s best to use corticosteroids in the lowest possible does for short periods of time, as they can cause a range of serious side effects, including bone thinning and high blood sugar.
An occasional steroid shot in the wrist can offer temporary pain relief and reduce inflammation. Shots shouldn’t be done repeatedly, as frequent injections can damage cartilage. Many doctors limit cortisone injections in a joint to no more than three or four times a year.
Biologics are a newer class of DMARD that targets specific immune system pathways to reduce immune system activity that is causing inflammation and pain. They’re used to treat inflammatory types of arthritis, such as rheumatoid arthritis and psoriatic arthritis, and are typically offered after patients haven’t responded to “conventional” DMARDs like methotrexate.
It’s important to exercise your wrist joints to promote range of motion, improve flexibility, and prevent additional damage. Your doctor will likely send you for physical therapy so you can do these exercises under supervision and then repeat them at home. Your physical therapist can develop a program that’s right for you. “The stronger the muscles are around the joint, the better you’ll feel,” says Dr. Hampton. Here are some range-of-motion exercises, including some for your wrist, which you can try at home.
In addition to physical therapy, it’s a good idea to do regular cardiovascular and strength training exercises that don’t put too much pressure on your wrist joints. Swimming and water exercises, for example, places less pressure on the joints since water helps supports the body. Tai chi and yoga involve gentle, flowing movements. (Be sure to ask your yoga teacher for modifications that don’t stress your wrist.) Walking is low-impact exercise that’s well-suited to people with arthritis. Avoid any exercises with a pushing movement or that put weight on the wrist (such as a handstand or a bench press) as that could exacerbate your wrist pain, says Dr. Hampton. “You want to stay active,” he says. “Keep the muscles and tendons around the joint strong. That will help with pain.”
Support braces can help support wrist movements and ease physical stress. They can’t prevent severe injuries, but they can help you do daily activities with less discomfort. You can get a custom-made or over-the-counter splint to cover your wrist or forearm. Dr. Hampton suggests to his patients that they wear the splint at night while they sleep. He says its compression offers pain relief.
Some people have found that their symptoms improve when wearing special arthritis gloves. They’re tight, often fingerless, gloves that may improve symptoms.
Cold therapy can provide relief for inflamed joints in the wrist. Cold constricts the blood vessels in the muscles, which decreases blood flow to the joint area to help reduce swelling and inflammation. Heat therapy warms the skin and the joints, which causes blood vessels to dilate, and sends more oxygen and nutrients to the joints and muscles. Try both and see which makes you feel best.
Surgery isn’t often needed to treat arthritis in the wrist. But surgery is considered when other treatments don’t relieve pain, wrist arthritis symptoms are severe, or when you can’t use your wrist or hand well. Surgical procedures include the following.
This is the least invasive of the three kinds of wrist surgery, says Dr. Hampton. The arthritic bones of the wrist joint are removed, which diminishes pain. Motion is preserved because there is no fusion. Proximal row carpectomy is only an option for some types of wrist arthritis. “Not everybody is a candidate,” says Dr. Hampton. It depends on where the arthritis is located. You have two rows of four bones in the wrist. If your arthritis is in the proximal row (the one closer to your arm), then you’re a candidate. If it’s in your distal row (the one closer to your hand), then you’re not a candidate. If your arthritis is in both the distal and proximal rows, then you’ll need a wrist fusion. This surgery can provide pain relief while preserving motion.
This procedure eliminates all movement at the wrist joint. Wrist fusion secures the bones of the forearm to the bones in the wrist and hand. “You’re trying to fuse all the bones together so they don’t move anymore,” says Dr. Hampton. “Fusions heal, but you lose movement in the wrist. If you’re at the point of getting this surgery, you’re in debilitating pain and you have no other choice. Either you keep living like this or you get rid of the pain and lose your motion.” The surgery provides pain relief, but the loss of motion can prevent you from doing some daily activities like lifting and manual work that involves your hands like carpentry, says David Geier, MD, an orthopedic surgeon, sports medicine specialist, and author of That’s Gotta Hurt: The Injuries That Changed Sports Forever.
This is the most invasive of the three surgeries, says Dr. Hampton. Here, damaged bone is removed and replaced with a metal and plastic implant. Dr. Hampton says this surgery isn’t done often as the implant in the wrist joint hasn’t been perfected like it has been in hip or knee joint replacements. It was done more in the past and not found to always be successful. “The rare circumstances where this procedure is performed involves older, less active patients who are in excruciating pain that’s not relieved by less invasive treatments,” says Dr. Geier.
Say study authors: ‘Patient–reported joint assessment may aid in capturing flares between routine clinical visits.’
No one knows how you’re feeling better than you, but do your symptoms actually correlate to objective measures of disease activity? A new study points to yes.
In the study, which was published in the journal Rheumatology, researchers followed 80 rheumatoid arthritis (RA) patients for one year. At the beginning of the study, all participants were either in remission or had low levels of disease activity (DAS28-CRP <3.2). Throughout the year, 36 percent of patients reported a hand flare — and clinical exams and ultrasounds confirmed that what the patients were sensing was accurately reflecting what was happening inside their bodies.
“Self-reported flares were associated with increased disease activity as determined by clinical examination and [ultrasound],” the authors wrote. “Patient-reported joint assessment may aid in capturing flares between routine clinical visits.”
Doctors and patients need to be on the lookout for these additional symptoms.
Axial spondyloarthritis (axSpA) is often described as an inflammatory form of arthritis that causes low back pain. While chronic back pain is usually the major feature of axSpA, this condition may cause symptoms in other areas of the body as well. In fact, many patients end up developing arthritis in one or more peripheral joints, according to a new study published in the journal Arthritis Research & Therapy.
Researchers recruited 708 patients from a group of French arthritis patients who had been diagnosed with early inflammatory back pain that suggested they probably had axSpA and followed them for five years. During that time, 36 percent of patients developed arthritis in at least one peripheral joint — most often in the lower limbs.
Peripheral arthritis appeared to strike more often in axSpA patients who were older (at least 33 years old), non-smokers, and negative for HLA-B27 antigen (a protein that’s sometimes associated with axSpA).
Those who developed peripheral arthritis were also more likely to develop an inflamed toe or finger and enthesitis (an inflammation of the spot where tendons or ligaments attach to bone).
While non-steroidal anti-inflammatory drugs (NSAIDs) are considered the first-line treatment for axSpA, patients who went on to develop peripheral arthritis were more apt than those who did not to require stronger medications, such as TNF inhibitor biologics. Not surprisingly, they also missed more work and reported worse quality of life.
The authors suggested that rheumatologists should be routinely monitoring axSpA patients for peripheral arthritis so they can treat those who develop it accordingly.
