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Could Fibro Make Arthritis Worse?

Posted: December 31, 2009

Most people assume that as they age, the wear and tear on their joints will eventually lead to osteoarthritis (OA). Indeed, OA is the leading cause of pain and disability around the world, but have you ever considered if having fibromyalgia puts you at greater risk of developing OA? Or, could your fibro make your OA more painful and disabling? And even if the radiographic images of your painful knees or hips don't reveal the true severity of how much aggravation these joints cause, scientists believe that there is another factor that you and your doctor have overlooked.

Initially, research on OA focused solely on the joints involved. When X-rays and tests did not correlate with the patient's pain severity and disability, the focus shifted to evaluating psychological factors. Depression and anxiety do make the pain of OA worse, just as these two symptoms might cause a slight increase in the pain of fibro. However, looking at the psyche or joint does not present the full picture of what is going on in people with OA, according to a published editorial by Daniel J. Clauw, M.D., "Pain and Rheumatology: Thinking Outside the Joint."1 With close to 20 years of experience in fibromyalgia research, Clauw, of the University of Michigan, understands that issues pertaining to chronic pain involve the central nervous system and are influenced by a person's genetics.

Commenting on the radiographic evidence that joint damage in OA does not usually match the patient's report of pain, Clauw states:

"Population-based studies suggest that there is a significant disparity between the degree of peripheral damage noted on radiographs and the pain and functional limitations that patients with this condition experience. The most dramatic evidence of this is that 30-60% of individuals with moderate to severe radiographic changes of OA are completely asymptomatic, and approximately 10% of individuals with moderate to severe knee pain have normal radiographs."

Clauw points out that one regulatory system working in the spinal cord to filter out pain does not function properly in fibromyalgia and OA patients. This means that the noxious signals generated by minor joint deterioration will be perceived by the brain as painful. However, for the person with a normal functioning pain inhibitory system, these noxious signals would be filtered out and the person would not feel any discomfort in the joint. Given that this part of the pain inhibitory system isn't working in people with fibromyalgia, it would mean that even OA could produce much more pain than what the doctor might predict from your X-rays.

Problems within the pain control system may help explain why your OA is particularly painful, but what about the prevalence? Does having fibromyalgia place you at greater risk for developing OA? Perhaps. Based on a report by Michael T. Smith, Ph.D., of Johns Hopkins Medical Center, the common denominator that may contribute to OA pain and disease severity is disrupted sleep.2

In 2007, Smith showed that disruption of sleep in healthy people could cripple their pain inhibitory system and cause them to develop achy muscles.3 Smith adds: "All of the studies describing sleep disturbance in individuals with knee OA report a robust relationship between pain severity and sleep disturbance." He goes on to say that sleep studies in OA (which are very scarce) show that patients have trouble staying asleep throughout the night and that the findings are comparable to people with fibromyalgia.

So sleep impairments, or all the tossing and turning at night, interfere with your pain inhibitory system and this leads to more painful OA. The disruption of sleep has also been shown to produce and release into the bloodstream more inflammatory substances, in particular interleukin-6 (IL-6). Smith points to a recent study that followed middle-aged women for 15 years to see if any blood markers could predict the development of knee OA.4 The authors found that increasing levels of IL-6 in the blood corresponded to increasing radiographic evidence of knee OA. Unfortunately, sleep quality or pain levels were not assessed, but Smith connects the dots in his report.

When sleep disruption and chronic pain persist, they set up a vicious cycle that leads to more pain, more inflammation, and less physical activity. After all, joint pain and sleep loss will both interfere with a person's ability to function. As a result, the patient may start to gain weight. The issue is not really the weight gain, but rather, the sleep disorder that is at the root of the problem. Levels of IL-6, the inflammatory substance found to correspond with the development of OA, were also shown to be elevated in people with fibromyalgia and could place you at higher risk of developing OA.

"Aggressive management of sleep disorders should be a critical component of the comprehensive treatment of rheumatologic patients and older adults," writes Smith. If you are experiencing joint pain in addition to the muscle aches of fibromyalgia, don't just talk to your doctor about pain-relieving treatments. Make sure that everything is being done to ensure that you have the best quality sleep possible. A good night sleep seems to be key to relieving OA and fibromyalgia pain.

  1. Clauw DJ, Witter J. Arthritis Rheum 60:321-24, 2009.
  2. Smith MT, et al. Curr Pain Headache Rep 13:447-54, 2009.
  3. Smith MT, et al. SLEEP 30:494-505, 2007.
  4. Livshits G, et al. Arthritis Rheum 60:2037-45, 2009.

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