New data from the Centers for Disease Control and Prevention (CDC) suggests that arthritis might be a leading cause of chronic pain in the U.S.
Chronic pain can occur for many reasons: migraines, reproductive-related health issues (such as endometriosis or fibroids), advanced cancer, an injury, and so on. But if you had to place a bet on the root cause for the most chronic pain patients, arthritis would be a pretty good guess.
That’s the key takeaway from a new study, presented at the 2019 American College of Rheumatology/Association of Rheumatology Health Professionals Annual Meeting in Atlanta, which aimed to compare the prevalence of chronic pain among arthritis patients to the U.S. population at large.
To conduct the study, researchers from the U.S. Centers for Disease Control and Prevention (CDC) analyzed data on nearly 60,000 respondents to the 2016-2017 U.S. National Health Interview survey. They determined that 48 percent of those with arthritis lived with chronic pain, which was substantially higher compared to those without arthritis.
They also found that 22% of adults with arthritis had what was called “high impact chronic pain,” which is defined as pain that has lasted at least three months and is severe enough to interfere with a major life activities (like being unable to leave the house for work).
“Despite unknown temporality, our study results combined with clinical evidence suggests that arthritis may be a leading cause of [chronic pain] and [high impact chronic pain] among U.S. adults,” the authors concluded.
The authors called for “integrated approaches to pain management that include evidence-based non-pharmacologic strategies” — including cognitive behavioral therapy, physical activity, and self-management education) — to “reduce chronic pain and its adverse effects, such as psychological distress, and may help reduce prescribed opioid use.”
For more information on science-based treatment for chronic pain, sign up for an upcoming webinar from the Global Healthy Living Foundation.
“This may have implications for management decisions beyond treating to disease activity targets alone.”
Pain and inflammation often go hand in hand, especially for people with inflammatory conditions like rheumatoid arthritis (RA). So it logically follows that when inflammatory markers decrease, less pain would follow. But according to a new study that isn’t always the case.
The study, which was presented at the 2019 2019 American College of Rheumatology/Association ofRheumatology Health Professionals Annual Meeting in Atlanta, used data from three earlier trials. The authors, led by Mart A.F.J. van de Laar, MD, PhD, from Arthritis Center Twente in the Netherlands, aimed to separate patient reports of pain from objective measures of inflammation (including swollen joint counts and C-reactive protein).
In each of the three trials, a sizeable portion of RA patients being treated with baricitinib (Olumiant) achieved inflammation control by week 24, yet not everyone who had less inflammation reported corresponding improvements in pain. Not surprisingly, patients who said they had less pain in addition to low inflammation as indicated by swollen joint count and C-reactive protein level were more likely to report better physical functioning, less fatigue, and overall better quality of life compared to those whose inflammation (but not pain) was brought under control.
“Despite apparently well-controlled inflammation [swollen joint count ≤1 and CRP ≤1 mg/dL], residual pain may persist,” the authors concluded. “This may have implications for management decisions beyond treating to disease activity targets alone.”
Baricitinib is a JAK inhibitor, an oral medication that is not a first-line treatment for RA. Whether a similar number of patients taking difference types of RA medications, such as TNF inhibitors, experience improvements in inflammation but not pain is unclear as it was not part of this research.
And a few factors seemed to be responsible, including being obese and also having fibromyalgia.
When most people think about rheumatoid arthritis (RA), they focus on joint pain, swelling, and stiffness. While those issues are certainly common, they tend to co-exist with another symptom — overwhelming fatigue — that can be harder for friends and family to understand.
Fatigue is more than being a little tired. Earlier this year, a Chronicwoman/Chronicillness poll found that 89 percent of people with arthritis (including but not limited to RA) said that fatigue interfered with their ability to go about their everyday activities. An important question for treating RA, then, is this: Does severe fatigue resolve when patients receive proper RA treatment?
Fortunately, a new study says yes: 70 percent of newly diagnosed patients who initially presented with high levels of fatigue “reported significant improvements in fatigue” within a year.
These findings, which were presented at the 2019 American College of Rheumatology/Association of Rheumatology Health Professionals Annual Meeting in Atlanta, focused on more than 1,000 Canadian patients who had been recently diagnosed with RA and started on a disease-modifying antirheumatic drug (DMARD), such as methotrexate or sulfasalazine. They suggest that treating RA with these drugs also leads to less fatigue, though whether the medication is directly responsible is unclear. It’s equally likely that patients become more energized as a result of their joint pain and stiffness improving.
Although this is mostly good news, the researchers, led by Susan J. Barlett, PhD, from McGill University in Montreal, found that a substantial portion of participants — 30 percent — did not experience a major improvement in their level of fatigue. Those in this camp were typically more likely to be obese or have fibromyalgia in addition to RA. Some had simply reported less fatigue to begin with, so there was less room for improvement.
“Debilitating fatigue is common around the time of RA diagnosis and is associated with more active disease, worse pain and disability, and [osteoarthritis]/back pain, obesity, depression, poor sleep, and major stressors in the previous year,” the authors wrote. “Early [methotrexate] use and optimizing weight, sleep, and mood may help address persistent fatigue when RA inflammation is well controlled.”
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’re dealing with knee pain that won’t go away, you might blame it on overuse or age-related wear and tear. But in some cases, knee pain can come from a form of inflammatory arthritis such as ankylosing spondylitis (AS).
AS is known for causing inflammation, pain, and stiffness predominantly in the spine and sacroiliac joints (where the spine meets the pelvis). People often equate ankylosing spondylitis with lower back pain, but it can affect other joints, including the knees.
What’s behind the inflammation in ankylosing spondylitis? Your body’s immune system is releasing chemicals into your blood and joints that cause pain, stiffness, and eventually joint damage.
Compared with many other forms of arthritis, AS symptoms usually begin young — before age 45 — and often as early as the teens and twenties. Lower back pain is worse after inactivity or when you wake up; it often strikes in the middle of the night and prevents you from getting a good night’s sleep. AS can present as an ongoing, dull pain that feels like it is coming from deep within the lower back or buttocks. Because back pain is incredibly common, it’s easy for people with inflammatory back pain from AS to chalk up their symptoms to other issues, such as athletic or overuse injuries.
Ankylosing spondylitis (AS) is a type of spondyloarthritis (SpA), which is an umbrella term for different types of arthritis — including psoriatic arthritis — that have some traits and symptoms in common. There are two main types of SpA:
Axial spondyloarthritis (AxSpA)
Peripheral spondyloarthritis
In axial spondyloarthritis, “the inflammation is more confined to the spine, and occasionally the shoulders and hips,” says Konstantinos Loupasakis, MD, a rheumatologist at MedStar Washington Hospital Center in Washington, D.C. “More distal joints, such as the knees, may also be affected although this is more commonly seen in peripheral spondyloarthritis.”
Ankylosing spondylitis is considered radiographic AxSpA, which means that evidence of joint damage is visible on X-rays.
Non-radiographic axial spondyloarthritis (nr-AxSpA) is essentially the same condition, but without joint damage being visible on X-rays.
A non-radiographic axial spondyloarthritis diagnosis can be made if the patient has sacroiliac changes on an MRI or is positive for the HLA-B27 gene (this gene gives instructions for making a protein that plays an important role in the immune system) with symptoms of inflammatory back pain (such as nighttime pain and morning stiffness, and improvement with physical activity), says Neal Birnbaum, MD, a rheumatologist, former president of the American College of Rheumatology, and founder of Pacific Rheumatology Associated Medical Group in San Francisco.
Peripheral spondyloarthritis means that inflammation and joint pain affects the limbs more than the spine. Sites include the knees, as well as the hands, wrists, elbows, shoulders, and ankles.
Despite formal classification of the spondyloarthropathies as above, in reality, people may have features of both axial and peripheral involvement, says Dr. Loupasakis. One recent study found that more than one-third of patients with axial spondyloarthritis also develop peripheral spondyloarthritis. Researchers studied more than 700 French patients from a group who had been diagnosed with early inflammatory back pain suggestive of AxSpA and followed them for five years. During that time, 36 percent developed arthritis in at least one peripheral joint — most often in the lower limbs.
Although AS is most common in the spine, any large joint can be affected — usually in an asymmetric distribution. This means that only one knee might hurt, as opposed to both knees. The pain is usually dull, often described by patients as soreness. It’s associated with stiffness that is worse in the morning and usually more intense after inactivity, he says. Pain and stiffness tend to improve with physical activity over an hour or more, Dr. Loupasakis says. The knee may feel warm to the touch and look swollen.
Still, how knee pain in AS feels is subjective and varies from patient to patient, says Erika Di Porto, DPT, MSPT, CI, department chairperson for the School of Health Sciences at Miami Dade College Medical Campus in Miami. “The joint hurts. The pain envelops the muscles, tendons, and the joints,” says Dr. Di Porto.
The pain in peripheral joints like the knee can be caused by arthritis (inflammation in the joint itself) or enthesitis (inflammation that occurs where tendons and ligaments attach to the bone), says Dr. Loupasakis. In arthritis, the knee can be swollen, warm, and tender. Enthesitis typically involves the Achilles tendons and the heels. But it can involve almost any part of the body at sites where tendons and ligaments attach to bones (front of the knees, pelvis, side of the hips or front of chest), he says. With enthesitis, the knee is not swollen but is tender to pressure, mostly at the front part around and below the kneecap.
Keep in mind that it’s rare to have knee pain due to AS without any other AS symptoms. If you or your doctor suspects you could have AS or peripheral spondyloarthritis, they will do more testing. This includes a blood test to see if you have the HLA-B27 gene, as well as blood tests to look for signs of systemic inflammation. The doctor may conduct different tests during a physical exam to assess your range of motion and flexibility in the spine and other joints. They may send you for imaging tests such as X-rays or MRIs. Read more here about how doctors diagnose AS and what to expect at the rheumatologist.
If you already have an AS diagnosis, it’s possible that your knee pain could be due to AS, but it could also be due to a different health issue.
For example, someone in their twenties or thirties who is physically active may have an injury-related pain syndrome like tendinitis (inflammation or irritation of a tendon) or bursitis (a painful condition that affects the bursae, which are the small, fluid-filled sacs that cushion the bones, tendons, and muscles near your joints). Someone middle-aged is more likely to start to develop osteoarthritis in their joints — from age-related wear and tear — even if they also have a type of inflammatory arthritis.
A thorough physical exam, medical history, and various imaging tests as needed may be necessary to determine whether your knee pain is due to AS or a different health issue.
There is no cure for AS, but you can ease its symptoms and slow its progression. Symptoms of AS knee pain are treated in a similar way to AS-related back pain.
Patients with peripheral spondyloarthritis are usually first given a combination of nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce pain and inflammation along with oral disease-modifying anti-rheumatic drugs (DMARDs) like methotrexate or sulfasalazine, says Dr. Loupasakis. Though NSAIDs are available over the counter, they can cause side effects such as stomach ulcers and kidney dysfunction, especially when taken for the long term and/or in high doses. You may also be prescribed topical NSAID creams or gels like diclofenac or salicylate cream that may be effective for enthesitis.
These conventional DMARDs are only recommended for peripheral spondyloarthritis. If you have axial spondyloarthritis and are not responding to NSAIDs, biologic drugs are the next step rather than conventional DMARDs, says Brett Smith, DO, a rheumatologist with Blount Memorial Physicians in Alcoa, Tennessee.
If you have axial disease, the biologics will usually help the peripheral disease, too, he says.
Biologics are medications — either given by IV infusion or injection — that target certain immune system proteins and pathways to reduce inflammation.
The first-line biologic drugs recommended for axial spondyloarthritis are called tumor necrosis factor (TNF) inhibitors, which block certain proteins made by the immune system. These include adalimumab (Humira), certolizumab (Cimzia), etanercept (Enbrel), infliximab (Remicade), and golimumab (Simponi).
Newer biologics for axial spondyloarthritis block other immune system proteins called interleukins. These include secukinumab (Cosentyx) and ixekizumab (Taltz).
Steroid injections may occasionally be given in inflamed large joints in the knees to alleviate pain. “Steroid injections are not to be used more than three to four times a year in the same joint since excessive steroid use may accelerate cartilage thinning and be harmful to the joint,” says Dr. Loupasakis.
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. Ice the joint and area for 15 minutes at a time to reduce inflammation, says Dr. Di Porto. 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.
Hydrotherapy can also benefit patients with knee pain from AS, says Dr. Di Porto. Hydrotherapy uses water at varying temperatures for health purposes at a health center, spa, or at home. “It increases your flexibility and blood flow and loosens the tightness in your muscles,” says Dr. Di Porto.
Exercise, especially with help from a physical therapist, can also be key in keeping pain at bay. “Physical therapy is crucial to maintaining range of motion and preventing the development of contractures, where the joint gets stiff permanently,” says Dr. Loupasakis. Stretching exercises are also shown to be effective, he says. Check out these daily stretches for AS.
He recommends swimming or water exercises since the water makes it easier to exercise with less strain on your joints. He also suggests postural training, where you learn how to maintain proper posture to help prevent you from developing stiff joints.
Surgery is a rarely used in the management of ankylosing spondylitis in the knee. It’s a last resort if knee joints are damaged to the point where daily activities become compromised, if your disease worsens, or you develop less motion and more pain. “You wouldn’t do a knee replacement until you’re at the point where symptoms are severe, your quality of life has been decreased significantly, and your activities of daily living are diminished,” says Dr. Di Porto.
The most common surgery if surgery is done is total knee arthroplasty, also known as knee replacement. Knee surgeries typically have successful and lasting outcomes. A study in the Journal of Bone and Joint Surgery evaluated the results in a group of patients with ankylosing spondylitis who underwent total knee arthroplasty. The surgery was found to give excellent pain relief and a durable fix at an average of 11.2 years postoperatively. However, since people typically have this surgery at a relatively young age, Dr. Di Porto says they’ll likely need a revision (another) procedure done.
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.
