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Fibromyalgia further worsens function in patients with RA: rheumatoid arthritis patients with fibromyalgia suffer doubly.

Fully 20 percent of rheumatoid arthritis (RA) patients also are afflicted with fibromyalgia (FM), compared to 2.5 percent in the general population who suffer from FM alone, according to a new study by researchers at Brigham and Women's Hospital, Boston. Participants were involved in the Brigham and Women's Hospital Rheumatoid Arthritis Sequential Study.

A greater number of fibromyalgia symptoms predict a decline in functional status in RA, according to the study, leading researchers to call FM a "spectrum disorder," that is, with a range of severity. Heretofore, the combination of FM and RA were considered two branches of one disorder, or, a "dichotomous entity."

What Is Fibromyalgia? Fibromyalgia is characterized by widespread muscle pain and multiple tender points on the body, specifically, on the neck, shoulders, back, hips, and upper and lower extremities. These tender spots vary in severity from day to day. Unlike RA, FM does not inflame or damage joints, muscles, or other tissues. Other symptoms of fibromyalgia include:

* Headaches

* Irritable bowel syndrome

* Memory problems

* Morning stiffness

* Sleep disturbances

* Numbness or tingling in the extremities

* Painful menstrual periods

* Restless legs syndrome

* Temperature sensitivity

Determining Functional Status. Four different questionnaires/tests were used to assess participants' conditions, covering functional status, disease activity, psychological stress, and FM status. The RA patients who were found to have fibromyalgia (16.7 percent) scored higher (worse) on three of the four tests. Baseline corticosteroid use was higher among patients with FM than those without the disorder, indicating higher pain levels in those with FM.

Treatment. Earlier intervention might lead to prevention or mitigation of some symptoms. Researchers suggested that RA patients who are identified as most likely to have worsening function might benefit from physical and occupational therapy programs; they recommended also that health care providers, specifically rheumatologists, consider using medications such as tricyclic antidepressants, serotonin norepinephrine reuptake inhibitors and anti-convulsants, as well as interventions such as aerobic exercise and cognitive behavioral therapy.

Currently, the U.S. Food and Drug Administration has approved only three medications to treat fibromyalgia: duloxetine (Cymbalta), milnacipran (Savella), and pregabalin (Lyrica).

Other drugs often recommended for fibromyalgia include analgesics, nonsteroidal anti-inflammatory drugs (NSAIDs), and benzodiazepines (such as Valium). Complementary and alternative therapies, such as massage, chiropractic techniques, acupuncture, and dietary supplements, produce varying degrees of success. Getting adequate, quality sleep can sometimes improve the symptoms of pain and fatigue, as well.

The study was published in Arthritis Care and Research, Feb. 9, 2017.

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Title Annotation:BONES & JOINTS
Publication:Duke Medicine Health News
Date:May 1, 2017
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