Osteoarthritis & Fibromyalgia: What Should I Do?
Osteoarthritis & Fibromyalgia: What Should I Do?
If you have osteoarthritis and fibromyalgia you might find yourself grimacing when you put weight on your knee, or move your shoulder, or your elbow, or maybe even when you're at rest.
These chronic pain conditions are widespread, with fibromyalgia (FM) affecting approximately 2% of people, and osteoarthritis (OA) impacting around 7–9% of the total population1. Older people and women are more likely to be affected by both disorders. In fact, prevalence of OA in Australia increases to 36% for people aged 75 and older, according to the Australian National Health Survey2, and globally, women make up about 60% of people with OA1.
Chronic pain isn’t fun, but we're going to unpack these two disorders and help you figure out what to do.
Osteoarthritis is a degenerative joint disease, which means that the joint(s) affected progressively gets worse.
OA predominantly causes pain, swelling and stiffness in joints, and the knee is most likely to be affected. Around 70% of cases affect the knee, with the hips and hands the next most likely sites for symptoms3.
Fibromyalgia also causes pain and stiffness, but the pain can be felt in any place around the body and often moves around, rather than staying localized in one place. FM also usually presents with fatigue, brain fog, sleep disturbances and mood challenges such as depression and anxiety – symptoms that are not as common in OA.
So, what actually causes these symptoms?
The pain associated with OA is caused by a breakdown of the cartilage – a strong and flexible connective tissue that protects your joints and bones – in the joints. Cartilage exists to protect our joints by absorbing the shock of impacts (such as the impact of running or another high-impact sport) and reduce internal friction4.
When the cartilage starts to deteriorate, the joints are less protected which leads to pain, swelling, and stiffness.
The pain of fibromyalgia does not come from joint damage, but is most likely caused by central sensitization, when the central nervous system generates pain even if there is no physical damage.
Despite the difference in structural damage, the symptoms of both FM and OA can make it harder to remain as physically active as before. Unfortunately, this reduction in movement means that the surrounding muscles lose strength and the person becomes weaker and less mobile. This in turn can impact their quality of life, make the person more susceptible to falling, and reduce their cardiovascular fitness which can lead to other health concerns, such as cardiovascular diseases and diabetes5.
Knowledge is power
We’ve already mentioned that older women are more at risk of both fibromyalgia and osteoarthritis than other parts of the population. But anyone can develop either disorder.
Fibro can have a genetic link, but is often caused by a difficult physical or emotional experience, such as an accident, surgery, or a challenging emotional experience.
Other risk factors of OA include:
- having had a joint injury, such as a broken bone or repeated stresses and strains (such as repeated high-impact stress or repetitive strain injury)
- other joint diseases such as rheumatoid arthritis
- obesity and a sedentary lifestyle.
There is a strong link between diabetes and OA – around 50% of people with diabetes also have some sort of arthritis and 60% of people with arthritis develop diabetes6. So what’s going on, and what can you do about it?
One reason for the link is that having ongoing high levels of glucose in the bloodstream (a problem with diabetes) can cause inflammation in the body, which can lead to joint pain and stiffness, and diabetes can make cartilage stiffer5.
A second reason is that obesity and sedentary behavior is a risk factor for both OA and diabetes. Carrying extra weight contributes to insulin resistance4 and means that the body needs to move and support more weight, which puts additional strain on the joints – especially the knees and hips that are integral to walking.
An osteoarthritis diagnosis depends on the person reporting their symptoms, eliminating other possible causes, and can include scans of the affected joints to look for damaged cartilage and thickened bones. However, as with FM, what shows – or doesn’t show – on scans doesn’t always relate to the pain that a person feels7. In these cases, holistic treatments, such as psychology and movement are particularly beneficial.
Fibromyalgia can be difficult to diagnose, because no simple test exists. To diagnose the condition, the healthcare practitioner needs to eliminated all other possible causes of a person symptoms, and confirm that they have had ongoing and widespread pain for at least three months, along with some other symptoms, such as fatigue or brain fog.
Although, OA is not that hard to diagnose, if you have both arthritis and fibromyalgia, it can be difficult to determine how much each condition is contributing to your pain.
In both cases, tracking your symptoms can be very helpful. You’ll likely also have some physical examinations to check for pain and tenderness and to rule out other conditions.
Despite the differences, many treatments can help to ease the symptoms of both osteoarthritis and fibromyalgia. These include:
- making movement part of your daily life – this doesn’t have to be formal exercise, but anything that gets you moving
- physical therapy and massage
- hot or cold packs to ease pain and stiffness
- pain medication8,9.
Pain medications can offer short-term relief in FM, whilst non-steroidal anti-inflammatory drugs (NSAIDs) can be helpful to reduce OA pain. If the osteoarthritis in a joint is particularly severe, joint-replacement surgery can be helpful, although all surgeries come with risks and can’t offer any guarantees1.
For OA, weight management is particularly helpful, and eating a nutritious and balanced diet that supports healthy gut bacteria can be beneficial for people with fibromyalgia (and all of us!).
For people with fibromyalgia, psychological approaches can also be extremely valuable, particularly to provide support with stress management (stress is the number one factor that causes people’s pain to flare up), mood stability, addressing adverse life events and difficulties with sleep. This whole-of-person approach has been shown to give the greatest results.