What Is the Difference Between Rheumatoid Arthritis vs. Fibromyalgia?

A common symptom of both rheumatoid arthritis and fibromyalgia is pain; however, RA causes joint pain while fibromyalgia causes pain all over the body.

Other symptoms of RA and fibromyalgia that are similar include: 

• Fatigue
• Tingling or numbness in hands and feet
• Sleep problems
• Anxiety and depression

Rheumatoid arthritis usually affects the same joints on both sides of the body (symmetrical). Joint pain and stiffness of rheumatoid arthritis usually begins in the small joints, such as those joints at the base of the fingers, the middle of the fingers, and the base of the toes, or it may occur in a single, large joint, such as the knee or shoulder, or it may shift from one joint to another

As the condition progresses, joint pain and inflammation become more prominent and symptoms include: 

• Joint pain and stiffness that may affect the:
  • Hands
    • Carpal tunnel syndrome
    • Finger deformities/bent fingers 
  • Wrist 
    • Difficulty bending the wrist backward
  • Elbow 
    • Numbness or tingling in the fingers
  • Shoulder 
    • Pain and limited motion
  • Foot 
    • Standing and walking with weight on the heels due to pain at the base of the toes
    • Top of the foot may be swollen and red, and the heel may be painful
• Ankle
  • Numbness and tingling in the foot
• Knee 
  • Difficulty bending the knee 
  • “Baker's cyst” (a fluid-filled cyst in the space at the back of the knee)
• Hips
  • Difficulty walking
• Neck 
  • Painful and stiff neck
  • Difficulty bending the neck and turning the head
• Cricoarytenoid joint (a joint near the windpipe) 
  • Hoarseness 
  • Difficulty breathing
• Other symptoms of rheumatoid arthritis may include:
  • Muscle pain
  • Muscle weakness 
  • Low-grade fever
  • Weight loss
  • Feeling unwell (malaise) 
  • Bone loss/decreased bone density
  • Skin problems: rheumatoid nodules (painless lumps that appear beneath the skin) 
  • Eye problems: eye redness, pain, and vision problems
  • Lung disease: shortness of breath and dry cough
  • Pericarditis: chest pain and difficulty breathing
  • Vasculitis: inflammation of the blood vessels
  • Sjögren's syndrome: dry eyes and dry mouth

Symptoms of fibromyalgia include:

• Pain and stiffness all over the body
  • Increased sensitivity to pain (compared to people without fibromyalgia), called abnormal pain perception processing
  • Morning stiffness
• Headaches/migraines
• Problems with thinking, concentration, and memory (called “fibro fog”)
• Pain in the face or jaw, including temporomandibular joint syndrome (TMJ)
• Abdominal pain
• Constipation
• Bloating
• Irritable bowel syndrome (IBS) 
• Painful menstrual periods

It is unknown what causes both rheumatoid arthritis and fibromyalgia. 

Risk factors for both rheumatoid arthritis and fibromyalgia include: 

• Age: middle-aged or older
• Being female: females are twice as likely as men to develop either condition
• Genetics: tends to run in families

Triggers that can increase the chances a susceptible person will develop rheumatoid arthritis, include:

• Infection: bacteria in the gut or mouth and gum infections (periodontitis) 
• Smoking 
• Stress 

Risk factors for developing fibromyalgia include: 

• Obesity
• Illness (such as viral infections)
• Repetitive injuries
• Stressful or traumatic events, such as car accidents or post-traumatic stress disorder (PTSD)
• Mood problems such as anxiety, panic disorder, and depression
• Certain diseases
• Lupus or rheumatoid arthritis
• Sleep disorders, such as sleep apnea

The diagnosis of rheumatoid arthritis or fibromyalgia involves a combination of clinical, laboratory, and imaging information. 

Laboratory studies used to diagnose rheumatoid arthritis include:

• Erythrocyte sedimentation rate 
• C-reactive protein level 
• Complete blood count 
• Rheumatoid factor assay 
• Antinuclear antibody assay 
• Anti-cyclic citrullinated peptide and anti−mutated citrullinated vimentin assays 

Imaging studies used to diagnose rheumatoid arthritis include:

• X-rays (first choice)
• Magnetic resonance imaging (MRI)
• Ultrasound of joints

Joint aspiration and analysis of synovial fluid may also be indicated.

Fibromyalgia is diagnosed with the patient's history and physical examination, along with tests such as: 

• Blood tests
• X-rays

Criteria used to help diagnose fibromyalgia may include:

• A history of widespread pain and symptoms lasting more than three months
• The number of areas throughout the body in which pain has occurred in the past week, based on the total number of painful areas out of 19 parts of the body, plus the level of severity of these symptoms: 
  • Fatigue
  • Waking unrefreshed
  • Cognitive (memory or thought) problems
• No other health problems that explain the pain and other symptoms

Rheumatoid arthritis is treated with medications, surgery, and other therapies such as physical therapy.  

Medications used to treat rheumatoid arthritis include:

• Nonbiologic disease-modifying antirheumatic drugs (DMARDS) 
• Biologic tumor necrosis factor (TNF)–inhibiting DMARDs 
• Biologic non-TNF DMARDs 
• Corticosteroids 
• Nonsteroidal anti-inflammatory drugs (NSAIDs) 
• Pain relievers (analgesics)
• Topical skin products

Surgical treatments for rheumatoid arthritis include:

• Synovectomy 
• Tenosynovectomy 
• Tendon realignment 
• Reconstructive surgery or arthroplasty 
• Arthrodesis 

Other therapies for rheumatoid arthritis include:

• Heat and cold therapies 
• Orthotics and splints 
• Physical therapy and exercise 
• Occupational therapy 
• Adaptive equipment 
• Joint-protection education 
• Energy-conservation education 

Treatment for fibromyalgia may include lifestyle changes, medications, therapy, and complementary therapies: 

• Self-management/lifestyle changes
  • Exercise
  • A healthy, balanced diet
  • Getting adequate sleep
  • Adjusting work demands
  • Dietary supplements, if recommended
• Medications 
  • Over-the-counter (OTC) pain medications 
  • Tramadol (Ultram) for severe pain (short-term use only)
  • Pregabalin (Lyrica) for nerve pain
  • Duloxetine (Cymbalta) and minacipran (Savella) for pain and fatigue
  • Older drugs that affect the same brain chemicals such as amitriptyline (Elavil) and cyclobenzaprine (Flexeril)
  • Cyclobenzaprine (Flexeril), amitriptyline (Elavil), gabapentin (Neurontin) or pregabalin (Lyrica) for sleep problems 
• Cognitive behavioral therapy (CBT) to treat depression
• Patient education classes, usually in primary care or community settings
• Complementary therapies 
  • Acupuncture
  • Chiropractic therapy
  • Movement therapy
• Stress management 
  • Massage
  • Meditation
  • Yoga