Minor aches and pains are an unavoidable part of life. But when soreness lingers for weeks on end or comes paired with swelling or stiffness, it may be time to look for an underlying medical concern. Psoriatic arthritis (PsA) and fibromyalgia are two conditions that a doctor might consider while figuring out the root cause of a person’s chronic aches. Both can cause persistent musculoskeletal pain and can make engaging in daily activities difficult. However, beyond their basic similarities, the two have distinctly different symptoms, causes, and treatments.
This article will compare and contrast PsA and fibromyalgia and help you determine which condition is more in line with your symptoms. Talk to your doctor as soon as possible if you’ve started to experience chronic pain. They can help you diagnose and manage your condition.
Fibromyalgia is a condition that causes chronic musculoskeletal pain, fatigue, sleep issues, and emotional distress. Unlike PsA, fibromyalgia doesn’t physically damage the joints or tissues. Instead, it causes dysfunction in how the brain and spinal cord process pain signals (referred to as abnormal pain perception processing). In other words, people with fibromyalgia tend to be significantly more sensitive to pain than those who don’t have fibromyalgia.
Researchers estimate that fibromyalgia affects about 2 percent of the adult population, although it is more common among women than men. There is currently no cure for fibromyalgia. However, those who have fibromyalgia can manage their symptoms through medication, exercise, and stress-relief strategies.
Psoriatic arthritis and fibromyalgia share one major similarity: both cause chronic musculoskeletal pain. Beyond that, however, people with the two conditions present very differently.
Psoriatic arthritis is known for its impact on the joints. It’s an inflammatory disease that affects the spinal and peripheral joints. Doctors classify cases of PsA as being oligoarticular (affecting four or fewer joints) or polyarticular (affecting four or more joints).
Prolonged joint inflammation due to PsA can also lead to several related conditions, including:
Other major symptoms of PsA include:
Symptoms often occur in flares and may periodically go into remission.
Unlike PsA, fibromyalgia doesn’t have visible effects and does not cause physical deformity as it progresses. People with fibromyalgia also tend to experience more widespread pain. Instead of being limited to a few joints, as is often the case with PsA, fibromyalgia affects the entire body. In fact, to be diagnosed with fibromyalgia, a person must experience pain above and below the waist, as well as on both sides of their body, for more than three months.
Pain isn’t the only symptom associated with fibromyalgia. Those with the condition often experience:
Having “fibro fog” — a condition characterized by an inability to concentrate on mental tasks — is also common.
As with PsA, those with fibromyalgia may see their disease activity improve or intensify over time. Sudden stress and environmental changes can lead to sudden flare-ups for both conditions.
Both psoriatic arthritis and fibromyalgia are known for having comorbidities, or common co-occurring conditions. When you talk to your doctor, they may ask you if you experience seemingly unrelated symptoms to help clarify their diagnosis.
For example, people with PsA often have comorbidities such as:
Experiencing one or more of these common comorbidities might strengthen a doctor’s early hypothesis, although further testing will be needed to confirm a diagnosis.
Psoriatic arthritis and fibromyalgia may have distinct causes, but they overlap in one notable way — doctors aren’t entirely sure why certain people develop either condition. That said, researchers do have theories regarding how these diseases develop.
Experts believe that several factors — including genes, environmental factors, issues with the immune system, infection, and obesity — can all contribute to the likelihood that a person will develop PsA. That said, having psoriasis is the biggest risk factor associated with the development of psoriatic arthritis.
Those who have PsA also tend to show an increased level of tumor necrosis factor (TNF) — a cytokine secreted by inflammatory cells that plays a role in cell proliferation and development. Elevated TNF levels can make it difficult for the immune system to deal with inflammation like that caused by PsA.
As with psoriatic arthritis, researchers believe that genetics can play a role in whether a person develops fibromyalgia. However, unlike PsA, fibromyalgia is not the result of an autoimmune or inflammatory problem.
Researchers believe that in people who are predisposed to fibromyalgia, repeated nerve stimulation can lead to changes in the brain and spinal cord. These changes increase the concentration of the brain chemicals and proteins that signal pain in the body. They also boost the sensitivity of the brain’s pain receptors, causing an overreaction to painful and nonpainful signals.
Fibromyalgia often comes on after a triggering event, such as a car crash or emotional trauma. It tends to appear more often during middle age and among those who have rheumatoid arthritis or lupus (an autoimmune disease). Other potential risk factors for fibromyalgia might include post-traumatic stress disorder (PTSD), obesity, viral infections, family history of fibromyalgia, and physical injury.
Yes — the two conditions are not mutually exclusive. Fibromyalgia is a recognized comorbidity for psoriatic arthritis. As one MyPsoriasisTeam member confirmed of their own experience, “I have fibromyalgia and PsA, so I see a rheumatologist and pain management specialist.”
Talk to your doctor if you think you might have one or both conditions. The doctor will be able to diagnose the cause of your symptoms and work with you to find the right treatment plan.
Diagnosing both PsA and fibromyalgia can be a complicated process because there is no definitive test used to confirm either condition. Instead, doctors must use a person’s medical history, symptoms, blood tests, and imaging tests to rule out other conditions as the cause of a person’s symptoms.
Of these two diseases, psoriatic arthritis is generally easier to diagnose — especially if a person is already known to have psoriasis symptoms. A doctor may be able to make their initial diagnosis after a simple physical exam and medical history review.
These tests help rule out or confirm a diagnosis of another type of arthritis, called rheumatoid arthritis.
This blood test looks for the presence of a certain gene called HLA-B27 that’s common in people with PsA. Your doctor may order this test after confirming the presence of psoriasis symptoms or a family history of PsA.
Both sedimentation rate and C-reactive protein tests are conducted on blood samples and can help detect inflammation. They are often used to gauge whether someone has active rheumatoid arthritis or PsA.
A joint fluid test involves removing a fluid sample from an affected joint and screening it for the presence of uric acid crystals. If these crystals are present, it may indicate that a person has gout (another type of arthritis) rather than PsA.
People with fibromyalgia may undergo similar testing to rule out inflammatory conditions such as rheumatoid arthritis, PsA, or lupus. However, the first step most doctors will take to diagnose fibromyalgia will be to conduct a physical exam.
Because fibromyalgia occurs due to an issue with pain processing (not physical damage), swelling or inflammation around the joints would point to arthritis rather than fibromyalgia. If there is no swelling to immediately indicate another condition, doctors may ask you to describe the intensity and location of your pain.
In the past, the American College of Rheumatology required doctors to conduct a tender point exam — a review of 18 points on the body — to diagnose fibromyalgia. Today, doctors can generally diagnose the condition if a person has widespread pain, as long as the pain has been consistent for three or more months and no other underlying condition has been found.
Once your doctor has made their diagnosis, they will work with you to develop a treatment plan. In some cases, they may also refer you to a specialist like a rheumatologist for more specialized care.
Although treatments for psoriatic arthritis and fibromyalgia are distinct, they both involve medical and lifestyle-based components.
Medical therapies for PsA may include nonsteroidal anti-inflammatory drugs (NSAIDs), such as Advil (ibuprofen), for pain relief. In more severe cases, doctors might recommend a corticosteroid injection, or, if that approach fails to produce results, a disease-modifying antirheumatic drug (DMARD) like Otrexup (methotrexate). Alternatively, the doctor may prescribe biologics — strong drugs that target the immune system.
Because fibromyalgia is not an autoimmune disease, the medications used in its treatment are very different. Usually, doctors suggest over-the-counter pain relievers like Tylenol (acetaminophen) to manage day-to-day aches and pains. They may also recommend antidepressants, such as Cymbalta (duloxetine), to manage mood irregularities and alleviate pain and fatigue. Given the sleep problems associated with fibromyalgia, muscle relaxants like cyclobenzaprine may also be prescribed to increase nighttime restfulness.
PsA and fibromyalgia may also be managed by making certain lifestyle changes. For example, physical therapy and regular exercise are often recommended to people with both conditions to reduce flare-causing stress and to manage daily pain. Those with fibromyalgia may also be referred to a counselor to address the psychological components of their condition. Talk to your doctor to chart the right treatment course for you.
Psoriatic arthritis can be a challenging diagnosis to deal with — especially if you’re already managing psoriasis symptoms — but you don’t have to do so alone. MyPsoriasisTeam is the social network for people with psoriasis and their loved ones. On MyPsoriasisTeam, more than 94,000 members come together to ask questions, give advice, and share their stories with others who understand life with psoriasis.
Do you have psoriatic arthritis or fibromyalgia? Leave a comment below or start a discussion by posting on MyPsoriasisTeam.