In my previous post, Can I have Rheumatoid Arthritis and Lupus?, I introduced the topic of comorbidity. Diseases are called comorbid when they exist at the same time and independently within the same patient. With the increasing interest in the field of comorbidity and rheumatic diseases, it becomes even more important for us as patients to discuss our experiences in living with more than one disease as awareness leads to empowerment.
How Common are Rheumatic Diseases?
According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), a division of the National Institutes of Health, an estimated 43 million people in the United States have arthritis or other rheumatic conditions. By the year 2020, this number is expected to reach 60 million. The more than 100 rheumatic diseases, characterized by inflammation and of loss of function in supporting or connecting structures of the body, are a more frequent cause of activity limitation than heart disease, cancer, or diabetes.
Rheumatic diseases affect people of all races and ages. Some rheumatic conditions are more common among certain populations. For example:
* Rheumatoid arthritis occurs two to three times more often in women than in men.
* Scleroderma is more common in women than in men.
* Nine out of 10 people who have fibromyalgia are women.
Rheumatoid arthritis is an inflammatory disease of the immune system which first targets the synovium, or lining of the joint, resulting in pain, stiffness, swelling, joint damage, and loss of function. Inflammation most often affects joints of the hands and feet and tends to occur symmetrically which helps to distinguish it from other diseases. The Arthritis Foundation estimates that 1.3 million Americans, or about 0.6 percent of the U.S. adult population, live with rheumatoid arthritis.
Fibromyalgia is a chronic disorder that causes pain throughout the tissues that support and move the bones and joints of the body. Pain, stiffness, and localized tender points occurs in the muscles and tendons, particularly those of the neck, spine, shoulders, and hips. Patients often experience fatigue and sleep disturbances. The National Center for Chronic Disease Prevention and Health Promotion (CDC) adds that other symptoms may include tingling or numbness in hands and feet, headaches (including migraines), irritable bowel syndrome, and cognitive difficulties.
It is estimated that fibromyalgia affects 5 million Americans, or about 2 percent of the U.S. adult population. For unknown reasons 80 to 90 percent of those diagnosed with fibromyalgia are women, although men and children can be affected. People with certain rheumatic diseases, such as rheumatoid arthritis, lupus, and ankylosing spondylitis (spinal arthritis), may be more likely to have fibromyalgia, too.
How is Fibromyalgia Diagnosed?
Below is an excerpt from the fibromyalgia handout prepared by NIAMS:
"Research shows that people with fibromyalgia typically see many doctors before receiving the diagnosis. One reason for this may be that pain and fatigue, the main symptoms of fibromyalgia, overlap with those of many other conditions. Therefore, doctors often have to rule out other potential causes of these symptoms before amking a diagnosis of fibromyalgia. Another reason is that there are currently no diagnostic laboratory tests for fibromyalgia; standard laboratory tests fail to reveal a physiologic reason for pain. Because there is no generally accepted, objective test for fibromyalgia, some doctors unfortunately may conclude a patient’s pain is not real, or they may tell the patient there is little they can do.
"A doctor familiar with fibromyalgia, however, can make a diagnosis based on criteria established by the American College of Rheumatology (ACR) [in 1990]: a history of widespread pain lasting more than 3 months, and the presence of diffuse tenderness. Pain is considered to be widespread when it affects all four quadrants of the body, meaning it must be felt on both the left and right sides of the body as well as above and below the waist. ACR also has designated 18 sites on the body as possible tender points. To meet the strict criteria for a fibromyalgia diagnosis, a person must have 11 or more tender points, but often patients with fibromyalgia will not always be this tender, especially men (see illustration of tender points here). People who have fibromyalgia certainly may feel pain at other sites, too, but those 18 standard possible sites on the body are the criteria used for classification."
How does Fibromyalgia affect RA?
In January 2009, the Journal of Rheumatology published a study Rheumatoid Arthritis and Fibromyalgia: A Frequent Unrelated Association Complicating Disease Management, which examines the value of the 28-joint Disease Activity Score (DAS28) in evaluating disease activity in rheumatoid arthritis (RA) associated with fibromyalgia (FM). The authors analyze the relationship between RA and FM and discuss whether the association is random or caused by the rheumatic disease itself.
According to the background information in the study, 10-20% of patients with rheumatoid arthritis also have fibromyalgia, whereas the frequency of FM in the general population is broadly estimated at 2-14%. The authors conclude that the low threshold of pain sensitivity in fibromyalgia leads to a subjective overestimation of disease activity in those patients who have both diseases and for an unknown reason seems to provide these patients with some level of protection against joint destruction.
Complications of the RA/FM Comorbidity
Not having fibromyalgia myself, I can only draw upon what other patients tell me and what I read in blogs, websites, and journal articles. The National Fibromyalgia Association discusses the comorbidity issue and long-term outcome for fibromyalgia.
"There is often concern on the part of patients, and sometimes physicians, that FM is the early phase of some more severe disease, such as multiple sclerosis, lupus , etc. Long-term follow-up of fibromyalgia patients has shown that it is very unusual for them to develop another rheumatic disease or neurological condition.
However, it is quite common for patients with “well-established” rheumatic diseases, such as rheumatoid arthritis, systemic lupus, and Sjogren’s syndrome, to have fibromyalgia also. It is important for these patients’ doctors to realize they have such a combination of problems, as specific therapy for rheumatoid arthritis and lupus, etc. does not have any effect on FM symptoms.
What should I do if I have both RA and Fibromyalgia?
There is currently no cure for rheumatoid arthritis nor fibromyalgia. Patients with fibromyalgia do not become crippled by the disease, nor does it affect their lifespan. However, rheumatoid arthritis can be crippling. Both diseases can have a great impact on a person’s quality of life.
Since rheumatoid arthritis and fibromyalgia respond to different treatment regimens, you need to work with your rheumatologist to maximize pain relief and minimize joint damage. Much of what you should do is the same as if you had any autoimmune disease. Take care of your body. Get plenty of rest. Exercise as you can. Eat nutritious food. Reduce stress, both mental and physical. Protect your joints. Protect your skin and organs. Reduce weight if obese. Stay compliant and attend follow-up appointments. Learn as much as you can about your disease. Be proactive and enjoy life.
Lisa Emrich is a patient advocate, accomplished speaker, author of the award-winning blog Brass and Ivory: Life with MS and RA, and founder of the Carnival of MS Bloggers. Lisa uses her experience to educate patients, raise disease awareness, encourage self-advocacy, and support patient-centered research. Lisa frequently works with non-profit organizations and has brought the patient voice to health care conferences and meetings worldwide. Follow Lisa on Facebook, Twitter, and Pinterest.