Fibromyalgia hindering RA gains

More than a third of patients with rheumatoid arthritis are also dealing with additional symptoms of fibromyalgia, new Australian research has shown.

A study of 117 rheumatoid arthritis patients found 33% met 1990 American College of Rheumatology (ACR) criteria for a diagnosis of fibromyalgia and 42% met the 2011 criteria.

Dr Emma Guymer, from the department of rheumatology at Monash Medical Centre, said the findings were consistent with overseas studies but disappointing for both patients and clinicians.

“We have made such fantastic inroads into rheumatoid arthritis management and yet a significant group of people still feel unwell,” she said

“Patients are taking their arthritis medications so their inflammatory markers are down and symptoms like joint swelling are reducing. If their rheumatoid arthritis is under control, there is not an expectation that they will still feel unwell.”

The study found the presence of fibromyalgia was associated with poorer physical and emotional outcomes according to the SF-36 health survey.

Patients with fibromyalgia had more symptoms of chronic sensitivity syndromes such as headache, temporomandibular joint dysfunction, irritable bladder, restless legs and chronic fatigue syndrome.

They also had a higher use of prescription medications despite no significant difference in rheumatoid arthritis disease activity.

“It’s concerning that people are looking for ways to control their symptoms and taking more medications such as painkillers and rheumatoid arthritis drugs and not those specific to fibromyalgia,’ she said.

Dr Guymer said the best way to manage fibromyalgia was with a multidisciplinary approach combining psychological therapies and gentle aerobic activity with fibromyalgia medications such as duloxetine or pregabalin.

The study also found a significant association between high BMI and fibromyalgia although it was not able to determine whether the association was cause or effect.

Physical activity and a healthy BMI could have a positive impact on central pain levels or conversely, patients with worse fibromyalgia symptoms may be less active and as a consequence have a higher BMI.

“Adipose tissue is very inflammatory and increases production of cytokines but in reality, chronic sensitivity syndrome pain is multifactorial. As well as an inflammatory component, there is deconditioning from inactivity and the mechanical pain of unstable joints,” she said.

“In general, a healthy BMI is a target for everyone but it will be very interesting to see if weight loss can help reduce fibromyalgia symptoms.”

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