Conditions Often Confused for Fibromyalgia

When determining whether a person’s symptoms are related to fibromyalgia or due to another condition the process is often lengthy in some cases complex. Many illnesses often cause generalized muscle aches and even fatigue as well as many of the other common symptoms of fibromyalgia.

It’s often important to realize that fibromyalgia will occur in people suffering from rheumatoid arthritis, systemic lupus erythematosus, osteoarthritis, and other illnesses (below). When this is the case, it can be difficult to determine symptoms of chronic pain and fatigue are caused by fibromyalgia or another condition. This will require a consultation with a physician who is trained to help patients with fibromyalgia.

Conditions Confused with Fibromyalgia

Rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) – Rheumatoid arthritis is a chronic illness that often will cause inflammation of the joints, pain, swelling, and even deformity of the joints. Lupus is another chronic, inflammatory disorder of connective tissue that affects multiple organ systems.
Both rheumatoid arthritis and lupus share symptoms with fibromyalgia they will often have other features that are not seen in people with fibromyalgia, including inflammation of connective tissue that lines the spaces between bones and joints.

Hypothyroidism – The decreased activity of the thyroid gland (hypothyroidism) will often cause fatigue, disturbance of sleep, as well as generalized aches very similar to those seen in fibromyalgia. Blood tests to measure thyroid function can be conducted to help exclude hypothyroidism. However, there are many endocrine disorders especially increased activity of the parathyroid glands known as hyperparathyroidism that will often cause symptoms similar to fibromyalgia.

Osteoarthritis – Osteoarthritis causes joint stiffness, tenderness, often pain, and even potential deformity of the joint. Osteoarthritis most commonly occurs in older people. We can differentiate osteoarthritis from fibromyalgia usually based upon a person’s medical history, physical examination, and even x-ray results. For example, with osteoarthritis x-rays will often show degenerative joint changes that are will not be present in fibromyalgia.

Muscle inflammation (myositis) — this muscle disease is often due to metabolic abnormalities also known as metabolic myopathy. These are a set of conditions that can cause muscle fatigue often with weakness, but usually does not the widespread pain pattern seen in fibromyalgia. We will often test patients with myositis as they will typically have abnormal levels of muscle enzymes.

Neurologic disorders – This includes disorders of the brain and often spinal cord and of nerves outside the spine. A detailed neurologic examination will help in determining if fibromyalgia could be from a neurologic disease. Some patients with fibromyalgia will have evidence of nerve damage and these nerves should be treated and function restored.

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  • Soft tissue and Muscle pain — The most common symptom of fibromyalgia is widespread chronic and persistent pain especially of the muscle and tendons. Many times when pain is felt in muscles and soft tissues there may be no visible abnormalities in the area. Often the pain is described as a “deep” muscular “aching”, “soreness” and “stiffness.” This can occur with burning and or throbbing. Many patients may feel numbness, tingling, and “crawling” sensations of the arms and legs. Muscle pain is always present, and will often vary in the level of intensity and can be aggravated by conditions like anxiety, stress, poor sleep, mild exertion, and often exposure to cold and or damp weather. People will often describe their symptoms as feeling kind of like when they have the flu.
  • Areas of Pain — Pain may often be located in specific areas, very often the neck and shoulders, this is very common in the early part of the disease. Multiple regions will eventually be involved, with many patients describing pain in the neck, middle and lower back, arms and legs, and chest wall. The areas referred to as “tender points” will often feel painful with mild to moderate pressure. Patients suffering with fibromyalgia often feel as if their joints are swollen, however often there will be no visible inflammation of the joint — unlike forms of arthritis.
  • Headaches that occur in a repeating pattern, including migraines
  • Irritable bowel (IBS) symptoms, especially frequent abdominal pain and episodes of diarrhea, constipation, and often cycles of both.
  • Painful bladder syndrome — bladder pain and urinary urgency (feeling like you have to go right now) and frequency (having to go often) are present without an infection
  • Temporomandibular joint (TMJ) syndrome — usually presents as limited jaw movement with clicking, snapping, and or popping sounds when opening or closing the mouth. This is also associated with pain of the facial and jaw muscles in or around the ear.
  • Sleep disturbances and Fatigue — Chronic fatigue (feeling tired) occurs in about 90 percent of people later diagnosed with fibromyalgia. Most people describe having unusually unrefreshing and nonrestorative sleep. The also report having difficulty falling asleep many times waking up repeatedly during the night and this leading associated with a feeling of exhaustion upon awakening
  • Anxiety and Depression — People with fibromyalgia also often have depression with or without anxiety and are more likely to develop both later in life. This is also true of many chronic pain conditions. It is important to realize that fibromyalgia is not simply a physical manifestation of depression and the two are separate illnesses.

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The Tender Points of Fibromyalgia

Fibromyalgia is likely on of the most misused and misunderstood diagnosis in medicine. So let’s set it straight today. Fibromyalgia is a group of pain disorders that affect connective tissues, including the muscles, ligaments (tough bands of tissue that connect the ends of bones), and tendons (attach muscles to bones). It is a condition that causes widespread muscle pain (also called a “myalgia”) and extreme tenderness in many areas of the body. Patients often will also experience fatigue (feeling tired), sleep disturbances, headaches, and even mood disturbances which often show up as depression and anxiety. Research is ongoing but we are beginning to understand the cause and improvements have been made in diagnosing fibromyalgia. There are still many things about fibromyalgia that are not clear.

For the United States, fibromyalgia affects approximately 8 percent of people and is the most common cause of musculoskeletal pain in women between 20 and 55 years. Fibromyalgia is more common in women than men.