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Minor aches and pains are unavoidable in life, but when soreness lingers or is accompanied by 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.
This article will compare and contrast PsA and fibromyalgia, including the symptoms, causes, and treatments.
Fibromyalgia is a condition that causes chronic musculoskeletal pain — that is, pain affecting the bones, muscles, tendons, ligaments, and soft tissues — along with symptoms including 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, which is called abnormal pain perception processing or central nervous system altered pain processing. This means that 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 adults in the United States, and the condition is more common among women than men, according to the Centers for Disease Control and Prevention (CDC). There is currently no cure for fibromyalgia, but the symptoms can be managed through medication, exercise, and stress-relief strategies.
Psoriatic arthritis and fibromyalgia share one major similarity: Both cause chronic musculoskeletal pain. Beyond that, however, there are big differences between the two.
Psoriatic arthritis is known for its impact on the joints. It’s an inflammatory rheumatic disease that primarily affects the peripheral joints like your hands, wrists, elbows, and knees, though it also can affect the spine.
PsA can cause the following symptoms:
Other major symptoms of PsA include:
PsA symptoms often flare up, and a person may later go into remission — a period when disease activity is reduced.
Unlike PsA, fibromyalgia doesn’t have visible effects and doesn’t 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.
Symptoms other than pain associated with fibromyalgia include:
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.
Doctors aren’t entirely sure why certain people develop fibromyalgia or PsA. However, researchers do have theories regarding how these diseases develop.
Health experts believe that genes and environmental factors may contribute to a person’s likelihood for developing PsA. That said, having psoriasis is the biggest risk factor associated with developing psoriatic arthritis.
As with psoriatic arthritis, genetics may play a role in whether a person develops fibromyalgia. However, unlike PsA, fibromyalgia is not the result of an autoimmune or inflammatory problem.
Fibromyalgia sometimes 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 (RA) or lupus (an autoimmune disease). Other potential risk factors for fibromyalgia might include:
It is possible to have both PsA and fibromyalgia. As one MyPsoriasisTeam member wrote, “I have fibromyalgia and PsA, so I see a rheumatologist and a pain management specialist.”
Talk to your doctor if you think you might have one or both conditions. They can pinpoint the cause of your symptoms and work with you on a treatment plan.
No definitive test exists to confirm either PsA or fibromyalgia. Instead, doctors must use a person’s medical history, symptoms, blood tests, and imaging tests to rule out other conditions first.
Of these two diseases, psoriatic arthritis is generally easier to diagnose, particularly in people who have a history of psoriasis. A doctor may be able to make their initial diagnosis after a simple physical exam and medical history review.
If a person doesn’t have symptoms of psoriasis, however, other tests might be necessary. Your doctor may order various blood tests that can rule out conditions like RA.
People with fibromyalgia may undergo similar testing to rule out inflammatory conditions such as RA, PsA, or lupus. However, the first step most doctors will take to diagnose fibromyalgia will be to conduct a physical exam.
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, a person must experience pain in several areas of their body — along with some cognitive and physical symptoms — to receive a fibromyalgia diagnosis. These symptoms should last at least three months, and a doctor must rule out other potential causes for the pain.
Once your doctor has made their diagnosis, they will work with you to develop a treatment plan. Treatments for psoriatic arthritis and fibromyalgia both involve medical and lifestyle-based components.
Medical therapies for PsA may include nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil), for pain relief. In more severe cases, doctors might recommend a corticosteroid injection or a disease-modifying antirheumatic drug (DMARD) like methotrexate. Alternatively, the doctor may prescribe biologics — medications that target specific parts of the immune system. Biologics are also used to treat psoriasis.
Because fibromyalgia is not an autoimmune disease, the medications used to treat it are very different from those for PsA. Usually, doctors suggest over-the-counter pain relievers like acetaminophen to manage day-to-day aches and pains. They may also recommend antidepressants, such as duloxetine (Cymbalta), 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, health care providers often recommend physical therapy and regular exercise to people with both conditions to reduce stress and manage daily pain. People with these conditions may also be referred to a counselor to address related emotional and psychological difficulties. Talk to your doctor to chart the right treatment course for you.
MyPsoriasisTeam is the social network for people with psoriatic disease and their loved ones. On MyPsoriasisTeam, more than 124,000 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 conversation on your Activities page.
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Maria Lolou, M.D., M.S. graduated from Aristotle University of Thessaloniki, Greece, where she completed her medical school training. Learn more about her here.
Sage Salvo is a content creator who specializes in developing savvy, SEO-aware content strategies and top notch ghostwritten articles for a wide variety of industry niches. Learn more about her here.
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