Many people who are living with chronic pain and are seeking diagnosis learn that they may have fibromyalgia, arthritis, or both. The conditions can cause similar symptoms, making it difficult to determine the true cause. So what’s the connection between fibromyalgia and arthritis? Are fibromyalgia and arthritis the same thing?
In this article, we’ll explore why these two conditions so often occur together. We’ll look at how they are different and how they can overlap, and what you can do to determine a diagnosis and find the best treatment options. With the right diagnosis, you’ll be on your way to effective treatment – and to feeling better.
What Is Arthritis?
Arthritis simply means inflammation or swelling in the joints. It’s a general term that includes a number of different conditions affecting the joints and connective tissues. Most kinds of arthritis cause pain and stiffness in the joints, but different kinds of arthritis have different causes. Some are autoimmune conditions, while others are not.
Let’s take a closer look at three common types of arthritis.
Rheumatoid Arthritis
Rheumatoid arthritis (RA) is an autoimmune condition that involves inflammation in the lining of the joints. This inflammation causes joint pain, swelling, stiffness, and eventually tissue damage. Typically, small joints such as those in the hands and feet are affected first; joints closer to the center of the body, such as the hips and shoulders, may be affected later.
With RA, it’s common to feel pain in the same joints on both sides of your body – for instance, in both wrists. The joint pain may come with fatigue, occasional fever, loss of appetite, and weight loss. Over time, joint damage can worsen if rheumatoid arthritis isn’t treated, or if the treatment isn’t effective. RA may also cause problems with the heart, blood vessels, lungs, skin, and eyes.
RA affects about 1.3 million adults in the United States, or approximately 0.6% to 1% of the population.¹
Psoriatic Arthritis
Like rheumatoid arthritis, psoriatic arthritis is an autoimmune condition that causes pain, swelling, and a sensation of warmth in the joints. The symptoms may occur on one or both sides of the body. It can also cause swelling in hands and feet, as well as changes in the eyes and nails.
But unlike RA, psoriatic arthritis usually occurs in people who have psoriasis, a condition that causes red, scaly patches on the skin. The joint symptoms of psoriatic arthritis may appear at the same time as the skin symptoms, or they may come on later.
About 1 million people in the United States live with psoriatic arthritis.²
Osteoarthritis
Osteoarthritis (OA) occurs when the cartilage (cushioning tissue) within a joint breaks down; it is typically due to age-related wear and tear and generally not autoimmune.Typically, It also involves changes in the bones; these can happen for a number of reasons, including wear and tear, injury, and infection. Overuse can increase the risk that you’ll develop OA in that joint.
OA also seems to have a genetic component, and age is a risk factor. Researchers do not fully understand the mechanisms of cartilage loss and bone changes, but they may be due to changes in signaling processes during inflammation and repair after injury.
Like RA and psoriatic arthritis, OA causes joint pain, stiffness, and swelling. Symptoms usually come on slowly and get worse over time. The hands, knees, and hips are the parts of the body most often affected.
OA is quite common, affecting over 32 million adults in the United States, or about 10% of the population.
What Is Fibromyalgia?
Fibromyalgia is a complex condition that can cause several different categories of symptoms. Some of these symptoms overlap with those of other conditions, like arthritis or chronic fatigue syndrome. That can make it tricky to diagnose, so let’s dive into the details.
Symptoms
The main symptom of fibromyalgia is pain throughout the musculoskeletal system: in the muscles, joints, tendons, and ligaments. It’s most often described as a dull and constant achy feeling, but it can also involve pain flares, muscle spasms, twitches, knots, or tightness. The pain tends to occur on both sides of the body, in both the upper and lower body.
Many people with fibro also experience difficulty focusing, concentrating, paying attention, or remembering things that happened recently. This is sometimes called “fibro fog.” In addition, fibromyalgia can cause a profound feeling of fatigue, or tiredness that doesn’t go away no matter how much you sleep. You may also wake up feeling tired even when you’ve gotten several hours of sleep.
Diagnostic Criteria
With such a range of symptoms, how do you know if you have fibromyalgia? Since 2016, the American College of Rheumatology has recommended diagnosing fibromyalgia based on the Widespread Pain Index plus the Symptom Severity Scale.³ According to these criteria, a person is diagnosed with fibromyalgia when:
- they have “significant and widespread pain”
- they have severe symptoms (like fatigue)
- the pain and other symptoms have been “generally present” at least three months
The Widespread Pain Index is a questionnaire that asks whether you have experienced pain in a certain region of your body in the past week. To evaluate the other symptoms, doctors use the Symptom Severity Scale. The first part of the SSS focuses on cognitive symptoms, fatigue, and waking unrefreshed. It asks how severe and bothersome each of these has been over the past week. The second part asks whether you’ve had other body symptoms like headache, depression, nervousness, nausea, diarrhea, shortness of breath, and bladder issues in the past seven days.
Your doctor considers your answers to the questions about pain alongside the other symptoms to determine whether fibromyalgia is the best explanation for what you’re experiencing.
Is Fibromyalgia a Form of Arthritis?
There are many types of arthritis, and fibromyalgia causes many of the same symptoms as the kinds of arthritis we’ve discussed, including widespread pain in the joints and connective tissues. So, is fibromyalgia another kind of arthritis?
The short answer is no, because fibromyalgia and arthritis involve different underlying processes. Arthritis is an inflammatory condition. The pain that characterizes arthritis is caused by inflammation in the joints. Fibromyalgia pain, on the other hand, is believed to be caused by changes in how the brain responds to pain signals from the body, in a process called central sensitization.⁴
Fibromyalgia versus Rheumatoid Arthritis
Although fibro and RA are not the same thing, it can be difficult to tell them apart because they share many of the same symptoms. Both conditions cause fatigue, stiffness, and pain that may be felt on both sides of the body, but it’s typically not the same kind of pain. With RA, the discomfort is felt mainly in the joints, usually in the hands and feet, and it can come and go. With fibromyalgia, there is a nearly constant dull or achy feeling that’s typically experienced as muscle pain, though it may also show up as joint pain. It occurs throughout the body, and it goes on for at least three months.
Both conditions can involve depression, fatigue, and sleep problems, but only fibromyalgia causes brain fog.
RA is an autoimmune condition, meaning that your immune system attacks your own healthy tissues – in this case, the lining of your joints. Fibromyalgia is not an autoimmune condition, though it can involve chronic inflammation.
Fibromyalgia versus Psoriatic Arthritis
Both fibromyalgia and psoriatic arthritis cause pain, fatigue, and brain fog. Psoriatic arthritis may also cause anxiety, depression, and problems with sleep, all of which can also be symptoms of fibromyalgia. This can make it hard to tell the two conditions apart.
However, there are some key differences. With fibromyalgia, the pain occurs throughout the body, often in the same place on both sides of the body. With psoriatic arthritis, the pain may be on one side only. Fibromyalgia pain involves the muscles and tendons, while psoriatic arthritis pain is felt in the joints, and there is often swelling of whole fingers and toes. Finally, psoriatic arthritis typically comes along with a red skin rash with silvery scales.
Fibromyalgia versus Osteoarthritis
With osteoarthritis, the main symptoms are joint pain and stiffness, especially after you’ve been inactive for a while. The pain may be on only one side of the body. OA does not typically involve systemic symptoms like fatigue or cognitive difficulties, though pain can interfere with sleep. Fibromyalgia may cause joint pain, but it is more often experienced as muscle pain that occurs on both sides of the body.
While there are a number of differences between fibromyalgia and the three types of arthritis we’ve discussed, the symptoms may still overlap in confusing ways. To get an accurate diagnosis, you may wish to see a rheumatologist.
Can You Have Both Fibromyalgia and Arthritis?
Getting the right diagnosis isn’t always a matter of distinguishing between two different conditions. Sometimes the answer is that you have both. It is possible to have fibromyalgia plus any of the three types of arthritis we’ve discussed in this article: rheumatoid arthritis, psoriatic arthritis, or osteoarthritis.
People who have rheumatoid arthritis are more likely to develop fibromyalgia. In fact, 10 to 20% of people who have RA also have fibro. However, the influence doesn’t go in the other direction: if you have fibromyalgia, you are no more likely than anyone else to develop RA.
RA and fibro share many of the same risk factors. Both have a genetic component. Women are more likely to get either condition than men. Obesity, stress, and prior infection can also increase your risk for both.
How about psoriatic arthritis? About 20% of people with this condition will also develop fibromyalgia.⁵ Unfortunately, people who have both conditions tend to develop more severe psoriatic arthritis symptoms over time.
Osteoarthritis is the most common kind of arthritis, and it is certainly possible to have both OA and fibromyalgia. According to one study, 17% of people with osteoarthritis also have fibromyalgia.⁶
Why is it so common to develop fibromyalgia when you have arthritis? The answer may lie in the cause of fibromyalgia. Researchers believe that fibro develops through a process called central sensitization, meaning that the brain becomes increasingly sensitive to pain signals from the body. Arthritis typically causes chronic pain, and the joint pain caused by rheumatoid arthritis, psoriatic arthritis, and osteoarthritis may set off this process of central sensitization, eventually leading to fibromyalgia.
If you have both osteoarthritis and fibromyalgia, it’s possible that the fibromyalgia came first. The pain and fatigue of fibro can make you want to avoid movement, and inactivity can lead to weight gain, which increases your risk of osteoarthritis. The pain of fibromyalgia can also make you move your body differently to compensate, causing extra wear and tear on certain joints, and eventually osteoarthritis.
Can You Get Disability for Arthritis and Fibromyalgia?
Whether you have fibromyalgia, arthritis, or both, you may be living with chronic pain. You may also have fatigue or other problems that affect your ability to stand, walk, bend, drive, lift, carry, or use a computer. If you are employed, your workplace will most likely be required to accommodate your needs if possible. For example, you could be provided with a hands-free headset or an ergonomic desk.
However, depending on the kind of work and the severity of your symptoms, there may not be adequate accommodations that can reasonably be made. Some people ultimately find that their condition limits their ability to work. If that is the case for you, or if you are not currently employed, you may be eligible for disability benefits.
Social Security Disability Insurance (SSDI) is a federal program that provides monthly payments for as long as you remain disabled. To qualify for SSDI, your condition must be expected to last for a year or longer, and it must prevent you from doing your current job (if you have one), the kinds of work you have done in the past, and other kinds of work for which you could be trained.
The Social Security Administration maintains a list of conditions that qualify for disability, and this list includes rheumatoid arthritis and psoriatic arthritis. Fibromyalgia and osteoarthritis may qualify if your symptoms are severe enough. To make that determination, the SSA will contact your doctors for their opinion about whether you are able to meet the physical demands of work (such as standing, sitting, lifting, or carrying) as well as the mental demands (including the ability to concentrate and remember).
The application process can be challenging if you have fibromyalgia, because diagnosis is not based on a scan or blood test; instead, you will need to work with your doctor to provide documentation of your diagnosis and self-assessment results. It’s essential that you and your doctors are on the same page about what symptoms you’re experiencing and how severe they are. Seeing a fibromyalgia specialist may help you prepare better documentation, as they can be more familiar with this process from their experience with the condition.
It’s fairly common for an initial application for SSDI to be denied. If this happens, you can appeal.
If you have chronic pain, you may also be eligible for other disability benefits besides SSDI. Five states (California, Hawaii, New Jersey, New York, and Rhode Island) have short-term disability insurance programs, usually extending six months to a year. Some employers also offer disability insurance coverage.
Applying for disability typically requires a lot of paperwork, and the process can be slow. Not every application is approved. However, if your symptoms are severe, it can be worth a try for the peace of mind it can provide. No one should have to worry about financial security on top of disabling chronic pain or fatigue. With the right diagnosis, effective treatment, and the support of disability insurance if you need it, you can enjoy family, friends, and everything else that makes life truly worthwhile.
Medically Reviewed by Dr. Andrea Chadwick, MD
Sources
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² Al Hammadi, A. Psoriatic Arthritis: Epidemiology. Medscape. Available at https://emedicine.medscape.com/article/2196539-overview#a5.
³ Wolfe, F., Clauw, D. J., FitzCharles, M., Goldenerberg, D., Häuser, W., Katz, R. S., Russell, I. J., Mease, P. J., Russell, A., & Walitt, B. (2016). 2016 Revisions to the 2010/2011 Fibromyalgia Diagnostic Criteria [abstract]. Arthritis Rheumatol. 68 (suppl 10). https://acrabstracts.org/abstract/2016-revisions-to-the-20102011-fibromyalgia-diagnostic-criteria/.
⁴ Harte, S. E., Harris, R. E., & Clauw, D. J. (2018). The neurobiology of central sensitization. Journal of applied biobehavioral research 23(2). https://doi.org/10.1111/jabr.12137.
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⁶ Wolfe, F., Clauw, D.J., Fitzcharles, M.A., Goldenberg, D.L., Hauser, W. et al. (2011). Fibromyalgia criteria and severity scales for clinical and epidemiological studies: A modification of the ACR Preliminary Diagnostic Criteria for Fibromyalgia. J Rheumatol 38, 1113–1122.
