For years,fibromyalgiawas a mystery illness. No one knew what caused it, how to diagnose it or how best to treat it. Some people, including doctors, even questioned its existence. In the last few years, however, researchers have cleared up some of the mystery. Although much about fibromyalgia still isn’t understood completely, two things are clear: It’s very real, and it affects a disproportionate number of people withrheumatoid arthritis(RA).
What Is Fibromyalgia?
纤维肌痛是一种以广泛疼痛、疲劳、睡眠不良和记忆问题为特征的综合征。它也经常与其他症状有关，包括头痛、肠易激综合征和对温度变化、光线和声音的敏感性增加。In some respects, it can resemble RA, which is why patients with both RA and fibromyalgia sometimes go years without the fibromyalgia beingdiagnosed.
Unlike arthritis, however, fibromyalgia doesn’t affect or damage joints or other tissues. “Fibromyalgia pain tends to occur where arthritis pain doesn’t, such as the trunk, back and muscles in the thighs and arms,” explains Daniel Clauw, MD, a professor at the University of Michigan and noted fibromyalgia researcher. “Qualitatively, it’s a different kind of pain, too, more diffuse and migratory — not as constant from day to day as, say, rheumatoid arthritis in a finger joint.”
Thecauseof fibromyalgia pain is also different. Instead of resulting from inflammation, it’s thought to result from changes in the way the brain and spinal cord process and transmit pain signals.
医学博士、俄勒冈州波特兰市俄勒冈健康与科学大学名誉教授、纤维肌痛信息基金会执行董事罗伯特·贝内特解释说，在纤维肌痛中，疼痛脉冲会增强，就像把收音机的音量开到最大一样。
Dr. Clauw and colleagues first demonstrated an association between fibromyalgia and a heightened pain response in 2002. In their study, people with fibromyalgia had measurable responses to gentle finger pressure in pain-processing areas of the brain. It took twice as much pressure to create similar responses in controls.
These findings have since been corroborated by other research, including a 2013 Harvard study published inArthritis & Rheumatismsuggesting that the brains of people with fibromyalgia are less able to guard against pain signals. This hypersensitivity to pain is known as central sensitization.
Double Trouble
Having inflammatory forms of arthritis increases the risk of fibromyalgia. This may be due, at least in part, tochronic painitself, which causes the brain to become highly sensitized not only to things that hurt but also to things that normally aren’t painful. The hypersensitivity makes arthritis pain worse and can create widespread pain and other symptoms, such as fatigue, even when arthritis is well controlled.
Ann Vincent, MD, a physician-investigator specializing in fibromyalgia at the Mayo Clinic in Rochester, Minnesota, points out, “People with fibromyalgia have pain receptors firing all the time. And in fighting that pain, people become fatigued, have unrefreshing sleep and cognitive problems. It’s important to recognize that chronic pain kicks the symptom burden much higher.”
It’s not clear how many people with RA have fibromyalgia. Researchers used to think it was around 20–30%, but that number may be too low. The current thinking, based on a 2013 study inArthritis Care & Research, is that fibromyalgia is a spectrum disorder, with symptoms ranging from mild to severe. That means more people are likely to fall under the fibromyalgia umbrella.
“Once patients are diagnosed with RA or lupus, rheumatologists tend to attribute all pain and fatigue to the autoimmune disease. What can end up happening is that the RA is over-treated with disease-modifying drugs or biologics because symptoms such as fatigue and memory problems persist even after joint swelling and inflammation are reduced. Persistence of symptoms should be a blinking neon light to look for central sensitization,” Dr. Clauw says.
How Is Fibromyalgia Treated?
Dr. Clauw says one of the most common misconceptions is that there are no effective therapies for fibromyalgia.
“纤维肌痛需要药理学和非药理学治疗，”他解释道。“药物疗法处理疼痛过程，而非药物疗法处理疼痛的功能性后果。所以，例如，我们知道[体育]活动是极其重要的。Research has repeatedly shown thatregular activityis one of the most effective treatments for pain syndromes, just as it is one of the most effective treatments for arthritis. I tell people to take it slowly because if they try to do too much at first, they get frustrated.”
Deep, restorativesleepis also essential for reducing chronic pain, but for many people with fibromyalgia, that’s easier said than done. Pain interferes with normal sleep, and lack of sleep makes pain worse. Conversely, a good night’s rest can significantly improve fibromyalgia symptoms.
Relaxation techniques,meditation,massage, deep breathing and cognitive behavioral therapy — a type of therapy that can help change certain thought and behavior patterns — are also helpful for relieving pain and fatigue.
Nonpharmacologic approaches are particularly important because the three drugs approved to treat fibromyalgia — pregabalin (Lyrica), duloxetine (Cymbalta) and milnacipran (Savella) — are only moderately effective. Dr. Clauw emphasizes that most patients find relief with a combination of treatments.
He also recommends that people with RA who have ongoing pain and other symptoms ask their doctor about fibromyalgia.
“That question may cause your physician to have an ah-ha moment,” he says.
Linda Rath for the Arthritis Foundation
It was so reassuring to read that Im not being overly dramatic about my pian. I have RA but also have fibro. The pain in middle of back and back of top part of thighs, was a revolution for me.
这篇文章中的信息是否也适用于银屑病关节炎?有30多年的爸爸和纤维。我相信是这样的。
我非常欣赏这篇全面的文章。这些信息证实了我有认知问题的原因。在我的一生中，我对意外的声音(我跳，尖叫)有极端的反应，这些声音会惹恼我的丈夫。明亮的灯光使我偏头痛。我的风湿病医生不承认纤维肌代数和干燥综合征。他声称对这两个人没有有效的治疗方法。无论如何，感谢你的贡献。我觉得验证。
我在几十年前被诊断为纤维肌痛，20年前被诊断为骨关节炎，7年前被诊断为风湿性关节炎。
This is good information. I have both. BUT my RA Doc refuses to treat my fibormyalgia because he says there are not related. It appears more education needs to be provided to the doctor on this issue.
In my opinion I think they have it backwards I think most people start with the fibromyalgia and get RA. FIbromyalgia has just recently been acknowledged as a real illness and was not recognized for what is was for a long time if there was a way to go back and look at this I think that is what would be found.
Hi my name isUrsula, I have fibromyalgia for 15 years, I tried everything nothing works I’m in pain 24/7, last year I was diagnosed of RA, I also a diabetic so I have a lot on mine plate,I can’t due very much getting tied very easy need a lot of rest, I don’t sleep very good every 2-3hr I’m awake, i don’t take any mess for my fibro but I do take for my RA Leflunomide.
非常有益的。
I have fibromyalgia and RA and it is hard to find a medicine that works for me because most of them I cant take because I have an allergic reaction to them so most of the time I just hurt .
I have so much pain, I walk daily, exercise mildly, do stretches, work 8.5 hrs 5 days a week. Have tried Cymbalta, Lyrica, antidepressant , amytreptiline, gabapantin, nothing works. Sleeping is very restless after 3 hrs. Lots of heat & ice to try & relieve pain. I just wish I could get some relief, my worst pain is neck, shoulders, feet, I also have psoriatic arthritis , but no psoriasis. Also osteoarthritis in my knee. Any suggestions I would appreciate. Thank you
我患有风湿性关节炎已经有12年了，7年前我被告知患有骨关节炎。我在5年前也患有纤维肌痛，所以我读了很多关于这两种病的书。我这辈子大部分时间都在执法部门工作，所以我必须在遇到医疗问题时了解它们。
I will say that this is one of the best ( if not the best ) down to earth, in plain language articles that I have come across in as many years.
Even though I have read a lot about Fibro. I still am learning more and more, and the one thing that nobody has touched on is why do men (like me) get this disease when it is supposedly a “ladies” disease.
I truly mean NO disrespect to any lady about that remark, by far!
Just the opposite, I want to know why is it that This person, over that person might get fibro.
人们没有意识到，当这种疾病降临到我身上时，我活跃的生活戛然而止。现在的我(大多数时候)一起床就给自己冲杯咖啡，找点蛋白质含量很高的东西吃(胃部手术，瘦了180磅)。然后如果我感觉还好，我可能会跑到a店骑着该死的小摩托从那里买我们需要的东西。
If I do not feel well I curl up with at least 1 – 3 heating pads, a blanket and pain meds. (BROKE THE HABIT OF THE HUGE PAIN MEDS!) I only take as needed LOL pain meds. If I go anywhere I am blessed enough to (by far paying on it) have a SUV that has heated seats, they are on almost all the time, EVEN IN THE SUMMER! ( Oh did I mention I live in Southwest Florida where it is almost always hot!)
SO sorry getting off track (normal for me now days) I do want people to realize that Men too get Fibromyalgia also, and we hurt just as much. (not more or less)
Please people when you see somebody that does not “look” handicapped—- stop and think before you mouth hurts their feelings.
(Oh don’t think for a second that I do not realize that we have people faking the system, because I know we do!!!)
God speed all with this horrid disease, and any other too!
Dan
I was diagnosed with Epstein Bar 17 years ago which causes fibromyalgia. And no matter what the new info says regarding contracting Epstein Bar from having mononucleosis, I have NEVER had mono! In the last year I have started experiencing severe joint pain and now issues with my liver because of meds, Ibuprofen and alcohol that I’ve used for years to control pain and sleep. I would love more information and help on this issue.
How can I get help with my Rheumatoid Arthritis I go from doctor to doctor and still I’m in so much pain
谢谢你！我的医生想让我开始学生物学，而我一直在拖延。我现在感受到的疼痛不是在我的手或手腕关节，而是臀部和大腿的肌肉。我正在经历不眠之夜和疲劳。下午3-4点以后我就没用了。关于纤维肌痛的信息让人大开眼界。
This helped me understand my current concurrent diagnoses.
优秀的文章!最后重点介绍纤维肌痛及其与类风湿性关节炎的关系。到现在为止，我已经被诊断患有这两种疾病6年了。我的母亲从50多岁开始就患有纤维肌痛，当时没有太多关于它的信息，当时医生告诉她，使人衰弱的疼痛和疲劳“都是她的大脑”。这让她很沮丧，看着她熬过来，在她病得很重的时候出现闪光。1981年，一位脊椎按摩师终于诊断出了她。疼痛就像收音机开到最大音量，这种比喻是完全正确的。我拿我的RA和FM的堆边。?。我正在分享这篇文章!谢谢你！
hi i have ra.and fibroyalgia and bad fatugue.my hands and feet dont sweĺ as much as they used to do.but ive noticed ive lost lots of muscle in my arms my hands have gone smaller too and my legs and ankle are lots thinner.since ive had this nee condition.is anyone feeling lime me please
Hey thanks for posting this. I really appreciate it. One thing I have found about fibromyalgia through the years (I’ve had it which is like 12 – diagnosed anyways) is about 10 years ago doctors considered it a “waste basket diagnosis” (i.e. if it’s a good doctor they will immediately throw it in the waste basket and move on. If it’s a bad doctor though they would ‘label’ you with it.
Why was the latter the bad doctor? Because the diagnosis meant nothing, solved nothing and did nothing so if you ‘label’ the patient that (I.e. fibromyalgia) then you could be missing something much more serious (I.e. RA) and end up not treating either. As a 26 year old, I have come to realize the concept of a waste basket diagnosis is pretty much the worst analogy anyone could ever conceptualize for a diagnosis (or worse, a patient).
然而，这是我在12岁时向医生询问纤维肌痛时得到的答案。对她来说不幸的是，她不知道的是，我是那种当她离开房间时就会翻她的垃圾的孩子，有时没有标签比任何标签都更糟糕(即使它写在餐巾上，被扔掉，最终某个酒吧外的顾客在垃圾桶里发现了它，并为自己和他的朋友们建立了一个支持小组来治疗他们共同的标签(如纤维肌痛)。
P.s. if they tell you about someone with MS leave the clinic and find a doctor who will take your situation more seriously.
有趣又有料的文章…我从来没有把RA和纤维联系起来(因为我一直想知道纤维是从哪里来的)。现在如果我能控制我的红斑狼疮/Descoid狼疮和骨关节炎，我会做得很好。
So what to do when l don’t have RA but osteo arthritis AND fibromyalgia.
最后，我直觉上“知道”的链接被验证了。不同的医生在不同的时间告诉我，我有或没有“炎症性疾病”，现在他们可以握手了!30年来，我咨询过的一半医生都告诉我，我“只有纤维肌痛”，原因是慢性疼痛、筋膜结、触发点等。急性加重、可见的关节肿胀、抗核抗体升高、CT扫描显示极度炎症等，都被排除在外。我第一次被诊断为炎症性疾病(在一家教学医院)是在我36岁的时候。我现在67岁了，这些年大部分时间都没有得到足够的治疗。感谢您将这一链接公之于众，并继续对这一联系进行研究。Sincerely, Barbara Harris
骨关节炎和FM呢?OA和RA有何不同?
I will share the article with my support group.
有时候我一觉醒来，坐在沙发上，我太累了，我真的在沙发上睡了一整天。当我醒来的时候，我在雾中，我所能做的就是起床，四处走动，我唯一想做的就是睡觉。有什么可以帮助你呢?不是所有的时间，但通常是一天或两个月几次。