Fibromyalgia and Arthritis Pain

Most experts don’t consider fibromyalgia — a chronic pain disorder that also causes fatigue, memory issues, and other symptoms — to be a type of arthritis, though it’s not uncommon for inflammatory arthritis patients to also have fibromyalgia. Now new research suggest that also having fibromyalgia might make arthritis harder to control.

Fibromyalgia is often treated with NSAIDs (non-steroidal anti-inflammatory drugs), anti-seizure drugs, or antidepressants that have been shown to help relieve pain. People with inflammatory arthritis may use pain medication as well, but they also rely on drugs that slow or stop the progression of arthritis. These include traditional disease-modifying anti-rheumatic drugs (DMARDs) like methotrexate, as well as biologic DMARDs like etanercept or infliximab.

DMARDs are often very effective and help many patients reach low disease activity or remission, but not everyone benefits from these medications equally. While many factors may explain why DMARDs don’t work well in some people, a new study published in the journal Rheumatology International finds that a co-existing diagnosis of fibromyalgia might have something to do with it.

This study was a literature review that analyzed several smaller studies that had previously examined the connection between fibromyalgia and inflammatory rheumatic conditions. The authors identified eight relevant studies and found that “fibromyalgia was a significant predictor of not achieving remission” with a traditional DMARD. They also found that arthritis patients who also had fibromyalgia were more apt to be given a biologic drug.

Although it is possible that many patients who were given a biologic really needed it, the authors expressed some concern that fibromyalgia symptoms (which DMARDs are not specifically designed to address) might be spiking arthritis disease activity scores and leading to extra use of biologics.

“Comorbid fibromyalgia interferes not only with the [arthritis] disease activity scores but also with the treatment outcomes and management plan,” they wrote. “Further evidence is warranted in order to determine the potential benefits of biological disease-modifying anti-rheumatic drugs on fibromyalgia-related symptoms in patients with inflammatory rheumatic diseases.”

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Coskun Benlidayi, I. Fibromyalgia interferes with disease activity and biological therapy response in inflammatory rheumatic diseases. Rheumatology International. January 2020. doi: https://doi.org/10.1007/s00296-019-04506-2.