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Arthritis and Rheumatism

Fibromyalgia

06/23/2009

Question:

I have had RA for 5 years and the medications have not worked or worked less time then they normaly would. I always have pain. My doctor is trying to see if I also havefibromyalgia. He tried me on Lyrica and I took three pills and had major side effect so stoped taking them. I think if they had to help with the pain he would have said that I had fibromyalgia. The problem is I have some of the signs but not enough to meet the critia. I do have the being tired all the time but no problems sleeping. That could be from my ra. I do have the widespread pain. I only have 3 tender points. My doctor is not sure if I have it or not. Can you still have fibromyalgia without the tender points?

Answer:

Yes. It is possible to have Fibromyalgia Syndrome without meeting the classification criteria that relies on tender points. The classification criteria is useful particularly for the purposes of clinical trials as it allows the evaluation of individuals with a similar set of syndrome characteristics. However, it is possible that one may have the altered central processing of pain due to Fibromyalgia without meeting all of the tender point criteria. Typically the pain is chronic and located both above and below the diaphragm.

A caveat in diagnosing Fibromyalgia is that one must rule out other causes of the pain. Given the fact that you have Rheumatoid Arthritis (RA), your physician would need to be certain that the RA is not the source of your pain.

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Response by:

Raymond  Hong, MD, MBA, FACR Raymond Hong, MD, MBA, FACR
Formerly, Assistant Professor of Medicine
School of Medicine
Case Western Reserve University