Rheumatoid Arthritis, Lupus and Fibromyalgia
Rheumatoid arthritis, or RA, is an autoimmune disease, meaning that your body confuses healthy tissue for diseased tissue and subsequently attacks it.
As autoimmune disorders are frequently difficult for doctors to identify due to their sometimes vague symptoms and individualistic tendencies, it can be difficult for doctors to differentiate between RA and other diseases like lupus or fibromyalgia.
Some people may even have RA and lupus, fibromyalgia or other autoimmune diseases, which can make diagnosis and treatment even trickier.
In order to explore RA and its links to lupus and fibro, we need to first understand the differences.
Lupus vs RA – Differences
While both sufferers of lupus and RA experience joint pain and stiffness, pain with RA usually gets better throughout the day and with movement, while lupus pain may remain constant throughout the day.
RA can also cause joints to deform, whereas lupus usually does not. And lupus can, unfortunately, be fatal because it can attack not only the joints but also internal organs, whereas RA is typically not fatal on its own.
Patients with RA, however, may need to have joint replacements, which is rare for lupus patients unless they suffer from both illnesses.
Fibromyalgia vs RA – Differences
Like lupus and RA, fibromyalgia and RA can be confused for one another. Those with fibromyalgia, however, do not typically have inflammation factors in their blood and their joints do not swell (although they can be painful). Pain associated with fibromyalgia is typically in the muscles, though the joints may also affected.
Fibromyalgia also appears to not be degenerative, but instead appears in episodes or flares. As mentioned above, RA can cause damage to the joints and muscles and can cause the need for joint replacements or other therapies over time due to the progressive nature of the disease.
Now let’s take a look at how these conditions are similar, and why it can take so long to reach a proper diagnosis.
Lupus vs RA – Similarities
Lupus and RA are extremely similar, which can make diagnosis a struggle. In both disorders, the joints can be painful, red and hot to the touch. Both lupus and RA sufferers may develop extreme fatigue that can impact their daily lives and have fevers that seem to come on both often and randomly.
Because lupus and RA are both rheumatic diseases, rashes can develop with either disease. People with RA and lupus can also develop ulcers in their nose and mouths, which can be both annoying and painful. These ulcers and rashes are symptoms of vasculitis, or the inflammation of the blood vessels.
Additionally, people with both lupus and RA can develop secondary autoimmune disorders such as Raynaud’s phenomenon (the lack of circulation to fingers and toes) and Sjogren’s syndrome (in which the orifices of the body become uncomfortably dry). Both diseases are characterized by bursts of disease activity (known as flares) and remission.
However, RA’s flares are progressive, whereas they are not with lupus. In both diseases, patients may suffer from mood disorders such as depression and anxiety.
Fibromyalgia vs RA – Similarities
RA and fibromyalgia can be confused due to the fatigue factor present in both RA and fibromyalgia and the constant pain that sufferers of both diseases are in.
Similarly, those with fibromyalgia may have morning stiffness (which is one of the hallmark symptoms of RA), and may experience numbness and tingling in the hands and feet, another symptom of RA. The numbness and tingling is typically a sign of further inflammation of the blood vessels in RA, though not in fibromyalgia.
Additionally, in both fibro and RA, patients may suffer joint pain and severely tender points. Patients also often experience symmetrical pain (i.e. pain on both sides, such as pain in both knees).
They may also experience depression. And like with lupus, both RA and fibromyalgia are classified by periods of disease activity and inactivity known as flares.
Comorbidity of Lupus and RA
Lupus and RA are rarely seen together, although some people do suffer from both diseases.
On Lupus.org, Dr. Wael Jarjour discusses comorbidity of lupus and RA with the following statement: “Sometimes rheumatoid arthritis is also seen in patients with lupus... Some rheumatologists use the term 'rupus' to describe this presentation. The differentiation between someone who has rheumatoid-like arthritis and lupus vs. someone who has rheumatoid arthritis/SLE overlap is either an issue of severity of the findings or more likely a matter of semantics with no significant clinical difference."
If you do have lupus, make sure to check with your doctor to ensure that the disease is not eroding any bones, which would quantify it as RA. Likewise, if you have RA, keep a watch on your symptoms.
Because the diseases are so similar, it is not impossible to be misdiagnosed with one or the other for quite a long time before figuring out what your proper diagnosis is.
Comorbidity of RA and Fibromyalgia
There is not, at present, much data on the comorbidity of these diseases, but it seems that they can exist in tandem. A diagnosis and treatment of these two diseases together would need to sussed out by a rheumatologist, who is a specialist of such disorders.
Because all three of these diseases are so similar in nature, it is extremely important that your rheumatologist takes a thorough history of your health and examines you closely.
Blood tests are needed (sometimes more than once) in order to fully understand what disease (or diseases) you are suffering from. And as stated before, keep a close eye on any new symptoms developing as it is very easy to misdiagnose such disorders.
No matter what you are suffering with, it is very important to keep a clear line of communication with your doctor to ensure you are getting proper and effective treatment.