Is It Psoriatic Arthritis or Fibromyalgia?
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Diagnosis: Fibromyalgia
Unlike psoriatic arthritis, fibromyalgia is not an autoimmune or inflammatory disease, according to the American College of Rheumatology. Research suggests that the nervous system is involved, particularly the brain and spinal cord. Mayo Clinic notes that many researchers believe repeated nerve stimulation causes the nervous system of people with fibromyalgia to change, resulting in increased levels of certain pain-signaling chemicals in the brain.
Fibromyalgia affects about four million adults in the United States, per the CDC, with women twice as likely to have the condition as men.
Certain symptoms of fibromyalgia may distinguish the condition from psoriatic arthritis:
- Pain all over the body (known as widespread pain)
- Problems with thinking, memory, and concentration, known as “brain fog” or “fibro fog”
- Sleep problems, including waking feeling unrefreshed
- Abdominal pain or bowel problems
- Dizziness
- Headache
- Numbness or tingling in the hands and feet
- Restless legs
- Frequent urination
As with psoriatic arthritis, there’s no test for fibromyalgia. It is mostly a diagnosis of exclusion, with doctors performing a physical exam, lab tests, or X-rays to rule out other problems, according to the American College of Rheumatology.
A challenge for rheumatologists is knowing when diffuse, widespread pain that appears to be enthesitis from psoriatic arthritis is actually a sign of fibromyalgia.
Doctors might consider how well a patient with widespread pain does on medications that tend to work well for people with psoriatic arthritis, such as NSAIDs (nonsteroidal anti-inflammatory drugs) like ibuprofen (Advil, Motrin), naproxen (Aleve), and etodolac (Lodine). “Most patients with fibromyalgia may not have substantial improvements with NSAIDs alone,” says Marina Magrey, MD, a professor of medicine at Case Western Reserve University School of Medicine in Cleveland.
If a patient with psoriatic arthritis is on medication that is effectively controlling their inflammation yet they’re still experiencing significant pain and fatigue, it could be a sign that they have fibromyalgia — and need the right treatment for it, notes the National Psoriasis Foundation.
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What Causes Psoriatic Arthritis and Fibromyalgia, and How Are They Linked?
It’s not entirely clear why some people develop psoriatic arthritis, but researchers believe that the cause may be a combination of genetic vulnerabilities and environmental triggers such as infection, stress, and physical trauma.
Anyone can develop psoriatic arthritis, but it most often occurs in adults between ages 30 and 50, per the National Psoriasis Foundation.
Researchers don’t know the exact cause of fibromyalgia either, but as with psoriatic arthritis, genetics seems to play a role. Fibromyalgia tends to run in families, and there may be certain genetic mutations that may make someone more susceptible.
The CDC says that age is also a risk factor for fibromyalgia: While it can affect people of all ages, most people are diagnosed during middle age, and the risk increases as you get older. People who’ve had lupus or rheumatoid arthritis are more likely to develop fibromyalgia.
Other possible risk factors for fibromyalgia, according to the CDC, include the following:
- Stressful or traumatic incidents, such as a car accident, or post-traumatic stress disorder
- Injury from repetitive stress to a joint such as knee bending
- Illness such as a viral infection
- Family history
- Obesity
Why are people with inflammatory arthritis like PsA at an increased risk for fibromyalgia? It’s not clear, but as the Arthritis Foundation notes, it may be because of the way chronic pain affects the body: The brain becomes hypersensitized to symptoms like pain and fatigue, heightening them even when the arthritis is effectively controlled.
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Treating Fibromyalgia
If you have both psoriatic arthritis and fibromyalgia, getting correctly diagnosed with both will help your doctor prescribe the right kinds and amounts of psoriatic arthritis medications. “If a doctor doesn’t recognize the presence of fibromyalgia, he or she could increase the dosage of powerful [psoriatic arthritis] drugs or switch drugs unnecessarily,” says Dr. Mease.
There is no known cure for fibromyalgia, but medication and other therapies (such as psychological and behavioral interventions) can help relieve symptoms. “The first treatment for fibromyalgia is often with a nonaddictive sleep aid, because fibromyalgia disrupts phase 4 sleep, which is the deep sleep that’s most restful and restorative,” says Dr. Magrey.
“To relieve pain associated with fibromyalgia, we usually prescribe gabapentin, pregabalin, and selective serotonin and norepinephrine reuptake inhibitors, [SNRIs]” says Magrey. SNRIs include duloxetine (Cymbalta) and milnacipran (Savella). Magrey adds that rheumatologists might also prescribe NSAIDS and muscle relaxants.
Aerobic and resistance exercise is also important for reducing pain and enhancing quality of life for people with psoriatic arthritis or fibromyalgia. Consider water exercises such as water walking, water aerobics, and swimming — low-impact activities that won’t stress joints.
It may take a few weeks before exercising doesn’t hurt, Magrey says. ”But then you’re up the hill,” she adds, “and exercising will feel much better.”
Additional reporting by Barbara Kean.
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