Fibromyalgia and arthritides

Abstract

Fibromyalgia (FM) is a chronic pain syndrome that affects at least 2% of the adult population. It is characterised by widespread pain, fatigue, sleep alterations and distress, and emerging evidence suggests a central nervous system (CNS) malfunction that increases pain transmission and perception. FM is often associated with other diseases that act as confounding and aggravating factors, such as rheumatoid arthritis (RA), spondyloarthritides (SpA), osteoarthritis (OA) and thyroid disease. Mechanism-based FM management should consider both peripheral and central pain, including effects due to cerebral input and that come from the descending inhibitory pathways. Rheumatologists should be able to distinguish primary and secondary FM, and need new guidelines and instruments to avoid making mistakes, bearing in mind that the diffuse pain of arthritides compromises the patients' quality of life.

Pain in rheumatic diseases: how relevant is it?

“…Peripherally based models clearly cannot explain much of the variance in pain, fatigue, sleep, memory problems and functional disability that is not accounted for by peripheral factors alone. For example, although the pathological focus in osteoarthritis (OA) is the joint and surrounding structures, patients with knee OA frequently experience multifocal pain in areas unaffected by OA (4,5). Similarly, there are other somatic symptoms that cannot be explained on the basis of a purely peripheral condition: studies have found that fatigue is a major problem in patients with knee OA as many of them find it a more functionally limiting symptom than pain (5,8).…”

“…For example, although the pathological focus in osteoarthritis (OA) is the joint and surrounding structures, patients with knee OA frequently experience multifocal pain in areas unaffected by OA (4,5). Similarly, there are other somatic symptoms that cannot be explained on the basis of a purely peripheral condition: studies have found that fatigue is a major problem in patients with knee OA as many of them find it a more functionally limiting symptom than pain (5,8). Peripherally based theories of the pathogenesis of OA, systemic lupsu erythematosus (SLE), and inflammatory arthritis simply do not explain why these other symptoms are so common and often refractory to standard therapies (1,5).…”

“…For example, the pain associated with rheumatoid arthritis (RA) is probably nociceptive in origin when the joints are inflamed, but may gradually become centralised as it spreads throughout the body, which means it may also be simultaneously nociceptive and centralised for long periods of time (4,5). Consequently, it may be necessary to treat (or prevent) the centralised aspects of pain while providing anti-nociceptive treatment.…”

The impact of pain on systemic rheumatic diseases

“…Patients with arthritis may experience recurrent acute pain mainly related to exercise related or almost continuous pain that is present even at rest, whereas unremitting pain is more a feature of chronic widespread pain (CWP); furthermore, some patients with RA and OA feel pain mainly at rest and they find that it improves with exercise [5,8]. Consequently, an all-encompassing description such as 'chronic' pain does not usually reflect individual experience accurately.…”

“Real-life” treatment of chronic pain: Targets and goals

“…Even when a patient has clear-cut evidence of the existence of an inflammatory joint disease, such as positive serological test and erosions on X-rays, this still does not mean that all pain is attributable to this diagnosis. In clinical practice, a high proportion of patients previously diagnosed as suffering from rheumatoid arthritis, ankylosing spondylitis, or systemic lupus erythematosus (SLE) will exhibit comorbid fibromyalgia at least to some extent [12]. This of course makes it highly imperative that the rheumatologist, being in charge of treating patients with pain in their joints, bones, and muscles, be highly acquainted with and feel very comfortable treating elements of centralized pain (e.g., fibromyalgia).…”