Rheumatoid arthritis (RA) and fibromyalgia are two different conditions with some similar symptoms. These include:
- sleep disturbances
- feelings of depression and anxiety
The causes of these conditions are very different:
- RA is an autoimmune disease that causes the body’s immune system to attack the joints.
- Fibromyalgia is a central pain disorder marked by musculoskeletal pain and symptoms of fatigue, trouble sleeping, and problems with memory and mood.
RA and fibromyalgia progress very differently. Fibromyalgia usually causes constant pain that may worsen with poor sleep and stress. On the other hand, RA can flare up and grow progressively worse without treatment.
Below, we’ll take a closer look at the differences between RA and fibromyalgia, including how the symptoms of each condition differ and how they’re diagnosed and treated.
While both RA and fibromyalgia have similar symptoms, the causes of each symptom — as well as the way people with each condition experience them — can be different.
Experiencing pain is common in each condition, but the triggers aren’t the same. One of the most significant differences between RA and fibromyalgia is inflammation. Fibromyalgia pain isn’t from inflammation.
In RA, joint inflammation is one of the key symptoms. People with RA often notice that their joint pain appears on both sides of their body. For example, if you have a painful joint in your right wrist, you also may have corresponding pain in your left wrist.
Many people with fibromyalgia initially report pain that’s localized to one place, such as the neck and shoulders or the back. However, pain often spreads to other locations as time passes. It’s also not uncommon for people with fibromyalgia to experience other pain symptoms, such as:
- frequent headaches, which can include migraine
- numbness and tingling
- abdominal cramping or pelvic pain
- face and jaw pain
People with RA or fibromyalgia can also have problems with attention and concentration. One of the reasons for this may be that the pain associated with these conditions can make it more difficult to focus your attention or concentrate on things.
This effect appears to be more pronounced in individuals with fibromyalgia. A
Sleep disturbances and fatigue
Both of these conditions can cause sleep disturbances and fatigue. However, sleep problems in people with fibromyalgia tend to be more draining.
A preliminary 2013 study found that women with fibromyalgia reported greater daytime sleepiness and fatigue than women with RA. However, based on the results of a multiple sleep latency test, women with fibromyalgia actually had less objective daytime sleepiness compared with women with RA.
A 2015 study found that reduced sleep affected women with fibromyalgia more than it affected women with RA. Women with fibromyalgia reported feeling more daytime sleepiness and needed a longer recovery time.
Depression and anxiety
Still, addressing mental health concerns in RA and fibromyalgia is very important. In fact, a
While RA and fibromyalgia can have many symptoms in common, each condition also has its own unique set of symptoms.
Distinct symptoms of rheumatoid arthritis
With RA, symptoms will often flare up periodically. Common RA symptoms include:
- joint pain and tenderness
- joint stiffness, particularly in the morning
- red, swollen joints
- firm lumps, called nodules, that appear under the skin
- low grade fever
- loss of appetite
- eyes: dryness, sensitivity to light, and impaired vision
- mouth: dryness, irritation, or infection of the gums
- lungs: shortness of breath
- heart: cardiovascular disease and stroke
- blood vessels: organ, skin, or nerve damage
- blood: anemia
Distinct symptoms of fibromyalgia
These points are located in symmetrical pairs in the following areas:
- back of the head
- collarbone area
- upper back
You may also have:
- trouble with memory, often called “fibro fog“
- joint stiffness
- pelvic pain
- restless legs syndrome
- overactive bladder
- irritable bowel syndrome (IBS)
- temporomandibular disorder (TMJ)
Fibromyalgia pain can appear in the joints and muscles, but fibromyalgia doesn’t damage your joints the way that arthritis can. It also doesn’t damage your muscles or other soft tissues. The pain of fibromyalgia can worsen arthritis pain.
Doctors use different techniques to diagnose RA and fibromyalgia. In each case, you’ll want to give a doctor or other healthcare professional as much information as possible about your medical history and the symptoms you’re experiencing.
Diagnosing rheumatoid arthritis
There’s no single test for RA, so a doctor will first need to take a detailed medical history and a do a complete physical examination. They’ll also conduct several tests to help confirm an RA diagnosis.
These tests may include:
- a review of you and your family’s medical history
- a physical exam to look for joint tenderness, swelling, and pain
- blood tests to look for signs of inflammation in the body, such as tests for C-reactive protein and your erythrocyte sedimentation rate
- auto-antibody tests for the rheumatoid factor antibody, which in combination with an anti-cyclic citrullinated peptide (anti-CCP) test increases the chances of an accurate RA diagnosis
- imaging tests, such ultrasound or X-ray, to look for joint damage or inflammation
A doctor will immediately initiate treatment if you have RA. This is because, if left untreated, RA symptoms can lead to long-term joint damage. Serious cases of RA can even cause damage to major organs, including your heart.
If your tests are negative for some of the common markers for RA, it’s still possible RA may present. These tests can sometimes come back negative for people who have RA.
A fibromyalgia diagnosis can be difficult to confirm. While there may be clear signs and symptoms, there isn’t one test or examination to determine whether you have fibromyalgia.
One of the best ways for a doctor to diagnose fibromyalgia is to rule out other conditions.
A doctor will also use diagnostic tools such as the widespread pain index (WPI) and the symptom severity score. According to criteria published by the American College of Rheumatology in 2010, you have fibromyalgia if you:
- have a WPI score of 7 or more and a symptom severity score of 5 or more or you have a WPI score of 3 to 6 and a symptom severity score of nine or more
- have had symptoms at a similar severity for at least 3 months
- don’t have another health condition that can explain your symptoms
The WPI includes a list of 19 areas where individuals with fibromyalgia typically experience pain. The score is based on how many areas you’ve had pain in during the past 7 days. One point is given for each area you’ve had pain in, for a maximum of 19 points.
Your symptom severity score includes information about your symptoms and how severe they are. The maximum number of points is 12. Your symptom severity score is determined by:
- the severity of each of the following symptoms over the past 7 days, scored on a scale of 0 points (no problem) to 3 points (severe):
- having difficulty with thinking or remembering
- waking up tired
- whether or not you’ve experienced any additional symptoms over the past 6 months, such as headache, abdominal or pelvic pain, or depression
- the number of additional symptoms in general, scored from 0 points (no additional symptoms) to 3 points (a great number of additional symptoms)
Neither RA nor fibromyalgia has a cure. Overall, treatment focuses on easing symptoms and improving quality of life. In the case of RA, timely treatment can also prevent the progression of the disease and additional complications.
Treating rheumatoid arthritis
RA is primarily treated using medications. These focus on calming the inflammation associated with RA, easing symptoms, and preventing your condition from getting worse. Which medication is recommended for you will depend on the severity of your symptoms.
Typically, medications called disease-modifying antirheumatic drugs (DMARDs) are used in RA treatment. There are a few types of DMARDs:
- Traditional DMARDs: These work by dampening your body’s immune response, helping to reduce inflammation. Examples of these drugs are methotrexate, hydroxychloroquine, sulfasalazine, and leflunomide.
- Biologics: These target a specific part of the immune response that’s involved in RA. There are different classes of biologics that can be used for RA treatment:
- IL-6 inhibitors such as tocilizumab (Actemra) and sarilumab (Kevzara)
- CD80/CD86 inhibitors such as abatacept (Orencia)
- CD20 inhibitors such as rituximab (Rituxan)
- Janus kinase (JAK) inhibitors: These inhibitors help to reduce the activity of molecules that are important for inflammation (cytokines) and include drugs such as tofacitinib (Xeljanz) and baricitinib (Olumiant)
Other medications may also be used for RA in some cases. For example, nonsteroidal anti-inflammatory drugs (NSAIDs) may alleviate mild pain and inflammation. Additionally, corticosteroids can also be used on a short-term basis to reduce inflammation in the body.
Other types of treatment that may be recommended include:
- physical or occupational therapy to aid in improving flexibility, range of motion, and the ease of performing your daily activities
- home remedies such as getting regular exercise, applying hot and cold to affected areas, and finding ways to reduce stress
- trying out complementary therapies such as acupuncture, massage, or omega-3 fatty acid supplements
- surgery to repair damaged joints
The treatment of fibromyalgia includes several options that can make a big difference in your quality of life. A few different medications have been approved to treat fibromyalgia. These act on certain chemicals in your brain and help reduce the amount of pain you experience.
These medications include:
- duloxetine (Cymbalta)
- milnacipran (Savella)
- pregabalin (Lyrica)
It’s also possible that other types of medications may be recommended for you, depending on the types of symptoms you’re experiencing. Some examples include:
- medications to treat symptoms of depression or anxiety
- medications to help you sleep better
Cognitive-behavioral therapy (CBT) may also be a part of your fibromyalgia treatment. CBT can help you evaluate and change negative thought patterns that may be contributing to your symptoms. It can also teach you valuable coping strategies for emotional and mental health.
Specific lifestyle changes may also be part of your fibromyalgia treatment plan. This may include:
- taking steps to get good sleep, such as setting regular times to go to bed and wake up, or doing a relaxing activity prior to bed
- getting regular exercise to help reduce pain and promote improved sleep
- trying out strategies to reduce stress in your daily life, such as yoga, breathing techniques, meditation, or focusing on a hobby that you enjoy
- considering complementary therapies like massage, mindfulness meditation, or acupuncture
Joint pain, fatigue, and muscle pain can also be symptoms of other conditions. Some of these include:
- lupus, an autoimmune disease that causes damage to any part of the body
- Sjögren’s disease, an immune system disorder that also has symptoms of dry eyes and mouth
- hypothyroidism, in which low levels of thyroid hormone cause fatigue and aches and pains
- multiple sclerosis, an immune system disorder that attacks the central nervous system
- chronic fatigue syndrome, a condition that causes extreme fatigue and may also lead to physical symptoms such as muscle and joint pain
- Lyme disease, a bacterial infection that’s transmitted by ticks and can cause symptoms such as fever, fatigue, and muscle and joint pain
Talking with a doctor about all your symptoms can help them determine what’s causing your discomfort.
If you’re experiencing any of the symptoms associated with either RA or fibromyalgia, make an appointment with a doctor or other healthcare professional. Even though these conditions share similar symptoms, the treatment and outlook for people with RA differ from those for people with fibromyalgia.
A doctor can help diagnose the condition and recommend the right treatment. It’s also important to treat RA early because RA may lead to serious complications as it progresses.
RA and fibromyalgia share several common symptoms, such as pain, disrupted sleep, and feelings of anxiety or depression.
However, both of these conditions affect your body in different ways. They each have their own specific symptoms and are diagnosed and treated in different ways.
If you’ve developed symptoms consistent with RA or fibromyalgia, talk with a doctor about them. Be sure to give them as much detail as you can. Knowing what you’re experiencing can help the doctor make a more accurate diagnosis and begin appropriate treatment.