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Diagnosing fibromyalgia

A fibromyalgia diagnosis can be difficult to confirm. While there may be clear signs and symptoms, there isn’t one test or examination to determine whether you have fibromyalgia.

One of the best ways for a doctor to diagnose fibromyalgia is to rule out other conditions.

A doctor will also use diagnostic tools such as the widespread pain index (WPI) and the symptom severity score. According to criteria published by the American College of Rheumatology in 2010, you have fibromyalgia if you:

have a WPI score of 7 or more and a symptom severity score of 5 or more or you have a WPI score of 3 to 6 and a symptom severity score of nine or more

have had symptoms at a similar severity for at least 3 months

don’t have another health condition that can explain your symptoms

The WPI includes a list of 19 areas where individuals with fibromyalgia typically experience pain. The score is based on how many areas you’ve had pain in during the past 7 days. One point is given for each area you’ve had pain in, for a maximum of 19 points.

Your symptom severity score includes information about your symptoms and how severe they are. The maximum number of points is 12. Your symptom severity score is determined by:

the severity of each of the following symptoms over the past 7 days, scored on a scale of 0 points (no problem) to 3 points (severe):


having difficulty with thinking or remembering

waking up tired

whether or not you’ve experienced any additional symptoms over the past 6 months, such as headache, abdominal or pelvic pain, or depression

the number of additional symptoms in general, scored from 0 points (no additional symptoms) to 3 points (a great number of additional symptomatic

Treatment options for rheumatoid arthritis and fibromyalgia

Neither RA nor fibromyalgia has a cure. Overall, treatment focuses on easing symptoms and improving quality of life. In the case of RA, timely treatment can also prevent the progression of the disease and additional complications.

Treating rheumatoid arthritis

RA is primarily treated using medications. These focus on calming the inflammation associated with RA, easing symptoms, and preventing your condition from getting worse. Which medication is recommended for you will depend on the severity of your symptoms.

Typically, medications called disease-modifying antirheumatic drugs (DMARDs) are used in RA treatment. There are a few types of DMARDs:

Traditional DMARDs: These work by dampening your body’s immune response, helping to reduce inflammation. Examples of these drugs are methotrexate, hydroxychloroquine, sulfasalazine, and leflunomide.

Biologics: These target a specific part of the immune response that’s involved in RA. There are different classes of biologics that can be for RA treatment:

TNF inhibitors such as etanercept (Enbrel) and adalimumab (Humira)

IL-6 inhibitors such as tocilizumab (Actemra) and sarilumab (Kevzara)

CD80/CD86 inhibitors such as abatacept (Orencia)

CD20 inhibitors such as rituximab (Rituxan)

Janus kinase (JAK) inhibitors: These inhibitors help to reduce the activity of molecules that are important for inflammation (cytokines) and include drugs such as tofacitinib (Xeljanz) and baricitinib (Olumiant)

Other medications may also be used for RA in some cases. For example, nonsteroidal anti-inflammatory drugs (NSAIDs) may alleviate mild pain and inflammation. Additionally, corticosteroids can also be used on a short-term basis to reduce inflammation in the body. Other types of treatment that may be recommended include:

physical or occupational therapy to aid in improving flexibility, range of motion, and the ease of performing your daily activities

home remedies such as getting regular exercise, applying hot and cold to affected areas, and finding ways to reduce stress

trying out complementary therapies such as acupuncture, massage, or omega-3 fatty acid supplements

surgery to repair damaged joints

Treating fibromyalgia

The treatment of fibromyalgia includes several options that can make a big difference in your quality of life. A few different medications have been approved to treat fibromyalgia. These act on certain chemicals in your brain and help reduce the amount of pain you experience.

These medications include:

duloxetine (Cymbalta)


milnacipran (Savella)

pregabalin (Lyrica)

It’s also possible that other types of medications may be recommended for you, depending on the types of symptoms you’re experiencing. Some examples include:


medications to treat symptoms of depression or anxiety

medications to help you sleep better

Cognitive-behavioral therapy (CBT) may also be a part of your fibromyalgia treatment. CBT can help you evaluate and change negative thought patterns that may be contributing to your symptoms. It can also teach you valuable coping strategies for emotional and mental health.

Specific lifestyle changes may also be part of your fibromyalgia treatment plan. This may include:taking steps to get good sleep, such as setting regular times to go to bed and wake up, or doing a relaxing activity prior to bed

getting regular exercise to help reduce pain and promote improved sleep

trying out strategies to reduce stress in your daily life, such as yoga, breathing techniques, meditation, or focusing on a hobby that you enjoy

considering complementary therapies like massage, mindfulness meditation, or acupuncture

Can rheumatoid arthritis and fibromyalgia symptoms be a sign of another condition?

Joint pain, fatigue, and muscle pain can also be symptoms of other conditions. Some of these include:

lupus, an autoimmune disease that causes damage to any part of the body

Sjögren’s disease, an immune system disorder that also has symptoms of dry eyes and mouth

hypothyroidism, in which low levels of thyroid hormone cause fatigue and aches and pains

multiple sclerosis, an immune system disorder that attacks the central nervous system

chronic fatigue syndrome, a condition that causes extreme fatigue and may also lead to physical symptoms such as muscle and joint pain

Lyme disease, a bacterial infection that’s transmitted by ticks and can cause symptoms such as fever, fatigue, and muscle and joint pain

Talking with a doctor about all your symptoms can help them determine what’s causing your discomfort.

When to see a doctor

If you’re experiencing any of the symptoms associated with either RA or fibromyalgia, make an appointment with a doctor or other healthcare professional. Even though these conditions share similar symptoms, the treatment and outlook for people with RA differ from those for people with fibromyalgia.

A doctor can help diagnose the condition and recommend the right treatment. It’s also important to treat RA early because RA may lead to serious complications as it progresses.

The bottom line

RA and fibromyalgia share several common symptoms, such as pain, disrupted sleep, and feelings of anxiety or depression.

However, both of these conditions affect your body in different ways. They each have their own specific symptoms and are diagnosed and treated in different ways.

If you’ve developed symptoms consistent with RA or fibromyalgia, talk with a doctor about them. Be sure to give them as much detail as you can. Knowing what you’re experiencing can help the doctor make a more accurate diagnosis and begin appropriate treatment.

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