Rheumatoid Arthritis Vs Fibromyalgia: Can You Have Both?

How do you tell the difference between fibromyalgia (FM) and rheumatoid arthritis (RA)? It can be hard to know, and some people have both conditions, making it doubly tricky!

Some of the symptoms are very similar, but these two conditions have different characteristics and different causes. Here, we walk through the key differences and diagnostic criteria to help you work out whether your symptoms are fibro or arthritis.

Symptoms

FM and RA are both chronic conditions that affect the musculoskeletal system. And both can cause pain, fatigue, sleep disturbances and mood challenges such as depression and anxiety.¹

So, rheumatoid arthritis vs fibromyalgia… if you have sore joints and fatigue, which condition is to blame?

Fibromyalgia is a widespread pain disorder and that pain tends to change or is inconsistent. If the following sound familiar, then it’s likely that FM is the cause:

• Pain that spreads or moves around, for example affecting your left elbow one day but your right shoulder another day. Or back pain that comes on when you’re vacuuming in preparation for a visit from your in-laws, but doesn’t come on when you’re gardening for pleasure. Or perhaps pain that is caused by the breeze from a fan or fatigue that comes on when the lights are too bright.
• Frequent headaches or migraines, which may come with pain in the face and jaw.
• Numbness and tingling in the body.
• Pain in the pelvis, gut symptoms (such as IBS) and abdominal cramps.
• Trouble sleeping, even if you’re tired. Perhaps you struggle to fall asleep or stay asleep and wake up feeling groggy and unrested.
• Brain fog and other mental challenges, such as difficulty thinking or remembering things.

Rheumatoid arthritis usually causes joint pain in addition to systemic effects. The following are more likely to be caused by RA:

• Joint pain and stiffness that doesn’t move around and often affects joints on both sides of the body. For example, it’s always your wrists that hurt.
• Red and swollen joints, which may have nodules – firm lumps under the skin – nearby. This is often particularly noticeable in the hands, when the joints of the fingers become misshapen and hard to bend and flex.^2,3
• Fever and flu-like symptoms.⁴
• Lack of appetite, which may lead to weight loss.
• Fatigue that might be caused by anemia – a condition in which a person doesn’t have enough red blood cells (there is a simple blood test for anemia).⁵

The inflammation in RA can affect other parts of the body and cause additional symptoms such as dry, sensitive eyes and mouth, shortness of breath and cardiovascular problems.⁵

Causes

RA is an autoimmune disease. This means that the person’s own immune system is attacking their body, and especially their joints, causing physical damage and inflammation that in turn lead to pain and stiffness. This is probably caused by a mixture of genetics and immunological factors.¹

And while there is some evidence to suggest that fibro could be an autoimmune disorder in some people, FM is most likely a result of central sensitization. This is when their central nervous system becomes over sensitized and generates pain as a response to situations it deems dangerous, even if there is no physical damage.

Fibro can also be linked to a person’s genetics, but most people’s fibro pain starts with a difficult physical or emotional experience. So, if your symptoms started with an accident, surgery, illness or a challenging emotional experience, fibromyalgia might be the cause.

Diagnosis

Neither FM or RA have a clear diagnostic test. For both conditions, your doctor will want to review your medical history and it can be very helpful to track your symptoms as part of this. You’ll likely also have some physical examinations to check for pain and tenderness and to rule out other conditions. 

However, whereas a fibromyalgia diagnosis is a process of elimination, for rheumatoid arthritis a doctor can specifically look for joint swelling and nodules, and conduct blood tests to look for inflammation and auto-antibodies which are indicative of an autoimmune condition. You might also have ultrasounds or X-rays to look for joint damage or other signs of inflammation.⁶

What else could it be?

So what if you have some of these symptoms, such as pain and fatigue, but it’s not RA or FM? What else could it be?

There are several different chronic conditions that can cause similar symptoms. Always check with your doctor for individual advice and support, but some of the other conditions that could be causing your symptoms include¹:

• chronic fatigue syndrome
• hypothyroidism – low levels of thyroid hormone
• lupus – autoimmune disease⁷
• Lyme disease – bacterial infection
• multiple sclerosis – autoimmune disease
• Sjögren’s disease – immune system disorder.

Treatment

Treatments for rheumatoid arthritis and fibromyalgia aim to reduce a person’s symptoms and improve their quality of life, but they cannot cure the condition. These include physiotherapy, other movement-based therapies to loosen joint stiffness, and heat or cold packs, depending on what helps the individual more.

RA is mainly treated with medications. These are known as disease-modifying antirheumatic drugs (DMARDs) and target the body’s immune system, reducing its impact and thereby reducing inflammation in the body. There are several different kinds of these medications and its important to note that although dampening the immune system can reduce the amount of autoimmune activity, it can also make a person more susceptible to other infections and illnesses.^8-10

Nonsteroidal anti-inflammatory drugs (NSAIDs) and steroidal drugs can also be used to help reduce pain and inflammation, although steroids should only be used for short-term relief.^8-10

For people with fibromyalgia, medications can often provide some relief, but in addition to physical movement the best treatment includes pain science education and psychological approaches. This whole-of-person approach has been shown to give the greatest results.

If you think that you might have fibro and would like to learn more take our suitability quiz to see if the MoreGoodDays® multidisciplinary approach can help you on your pain-management journey.