I should tell you about myself first I guess :) The story is quite long but to cut it short, what sent me to a rheumy's office was horrible SI joint pain on May last year. Before the MRI results, the rheumy diagnosed me with fibromyalgia (when I cried during the trigger points test), and he was a little upset when the MRI showed inflammation in my left SI and some erosion. Then he told me to come back if it happened again, so when I went in for a second time in November, I was diagnosed with PsA, although despite my lifelong skin problems, I was never diagnosed with psoriasis, only eczema. He told me to let my skin get worse if I get patches and go to a dermatologist asking if it was psoriasis, but as can be predicted, my skin decided to give me a break last year!!! So I was never diagnosed with psoriasis (but in the meantime my mom was!), and when I went in again he changed my diagnosis to Ankylosing Spondylitis, without crossing out PsA entirely. The people in the PsA forum were kind enough to let me stay in the forum since there is no Ben's Friends group for AS and even if there were I had gotten very used to the lovely people in the PsA group as my friends anyway. So they once again supported me through my new diagnosis. And the only big difference between AS and PsA is the skin manifestations I guess, so I'm still in the same page with people with PsA...
Anyway, since I still have my fibromyalgia diagnosis too (and have all the symptoms, brain fog being the worst), I'm having a really hard time differentiating between arthritis pain and fibro pain! What I really know for sure is that I DEFINITELY have inflammation in my sacroiliac joints. There's no doubt about that. But I also have a feet problem, which sometimes gets so bad I can't walk more than 15 minutes and it's the most debiliating symptom I have by far! My rheumy said it was because of fibro, but he didn't do any imaging or anything to determine if there was in fact inflammation there. He just looked at my bloodwork, which didn't show anything when I was there for the first time about my SI pain either! And it doesn't really make a difference for me if it is fibro or arthritis other than arthritis causing damage in the long run, I just want to know what it is so I can get the proper treatment for it or I don't know, accept the fact that my feet just might erode away! At one point, after the fibro treatment (Trazodone to give me quality sleep) didn't fix my feet problem while it took away a great deal of other pain and discomfort I was having, I went to an ortho and he diagnosed me with metatarsalgia. My main problem then was as you can guess my metatarsal area, and my ankles which felt like I sprained them but couldn't remember how! Then as months passed the pain slowly moved to my heels and now I feel like there's no buffer between my heels and the floor! And my ankles feel wobbly and I somehow don't feel "safe" while walking! Another thing is chest/rib cage pain, which is an overlapping symptom with AS and fibro I guess. It happened a few times, but it was scary as hell! And the bone in the middle of my chest (I really don't know the name of it) is always tender. My latest problem is with my wrists. They both hurt lately, like someone is squeezing my wrists really, really hard and sometimes I feel like I can't grab things properly - which is also a problem even when I don't have wrist pain. But there's no swelling or redness in my wrists. They are just painful and they make those clacking and popping sounds (my feet and ankles have the clacking and popping too - sometimes the popping gives me relief, sometimes it hurts like hell when it happens).
Oh my, look at how much I wrote, I'm so sorry if I'm boring you guys! My question is, since fibro is generally described as "overall" pain (which I also have, so fun!), could those localized pains be fibro as my rheumy suggests? Or should I demand harder that he investigates more to completely rule out inflammation? How do you guys differentiate between arthritis pain and fibro pain? It's driving me crazy not knowing which is what and what I should expect...
I can differentiate the two, usually, by location and type of pain. My PsA shows up mostly in my joints in my hands, my shoulders, hips, and lumbar spine. When it is the arthritis, it is a sharp, almost grinding pain that gets worse with movement. For instance, in my hands, it feels as if I have punched a hard object and moving hurts. The pain is not as bad if I can stabilize the joint or affected area (good luck stabilizing your hips!) Whereas with my fibro pain, it is the tissue. So the underside of my forearm will start having an achy "throb" that is annoying and insatiable, and compares easily with my migraine pain. No amount of stabilization helps or eases the pain (I can be completely still and STILL hurt.) However, with my fibro pain, I have discovered that some therapeutic movement can ease it - best example, being in warm (not HOT!) water. The PsA affects tissue as well, but the pain is sharper and I can tell it is the tissue around the bone whereas the fibro, it is any and all tissue that is affected - pain with it can show up literally anywhere on my body. :)
Thank you for this. I am trying to understand if I am dual-diagnosis or not. I have often suspected my earlier diagnosis of Fibro was simply a MIS-diagnosis of PsA which had not yet become severe enough to identify. My pain is mostly all in my joints and even the soft-tissue pain is NEAR the joints. This tells me that PsA is the main player in my case. You offer a much clearer explanation than any doctor has so far!
Suzanne said:
I can differentiate the two, usually, by location and type of pain. My PsA shows up mostly in my joints in my hands, my shoulders, hips, and lumbar spine. When it is the arthritis, it is a sharp, almost grinding pain that gets worse with movement. For instance, in my hands, it feels as if I have punched a hard object and moving hurts. The pain is not as bad if I can stabilize the joint or affected area (good luck stabilizing your hips!) Whereas with my fibro pain, it is the tissue. So the underside of my forearm will start having an achy "throb" that is annoying and insatiable, and compares easily with my migraine pain. No amount of stabilization helps or eases the pain (I can be completely still and STILL hurt.) However, with my fibro pain, I have discovered that some therapeutic movement can ease it - best example, being in warm (not HOT!) water. The PsA affects tissue as well, but the pain is sharper and I can tell it is the tissue around the bone whereas the fibro, it is any and all tissue that is affected - pain with it can show up literally anywhere on my body. :)
I also have a hard time telling the difference but I know there IS a difference if that makes sense. MY PsA is in all my joints and below some as in my shoulder. The fibro is am all over pain kind of like my whole body is slightly on fire and it hurts when people touch me. Hope this helps.
Yes, also that helps me (i'm not the OP). When I worked as a massage therapist, I had a pt with Fibro. I could only do the very lightest massage on her. NO deep work at all. My pain and trigger points are localized to my joints or specific areas and I can tolerate deep touch. I hope I can explain all this to my doctor who is waffling on dx and doesn't seem to listen very well!
Melinda said:
I also have a hard time telling the difference but I know there IS a difference if that makes sense. MY PsA is in all my joints and below some as in my shoulder. The fibro is am all over pain kind of like my whole body is slightly on fire and it hurts when people touch me. Hope this helps.
I learned to differentiate between the two (mostly) by really sufferring for a while. My Rheumatologist thinks like a scientist. I agree with him. Instead of treating both things at once, right off the bat, he explained that he wanted to get the more dangerous PSA with it’s uber elevated CRP under control and then treat the fibro. WOW what a relief once we started the med for the fibro. But I can tell joint from muscle and nerve pain now. The fibro is the burning, don’t touch me or even come near touching me kind of nerve pain Melinda described. I can’t tell which the fatigue is from and I don’t tend to have brain fog unless I have a chemical exposure. I guard against those carefully though. I can really tell that yes, I do need the meds when I goof and forget one.
PS Treating the fibro even helped with the Humira shot pain most of the time. I’ve learned to time the Gralise/gabapentin and Humira so the gaba is in full swing when I take the shot. (I still hate them!) Yes, bwahck bwahck bwahck!
Well he didn’t get there right away, believe me. Failed to communicate with me WHY he was allowing me to suffer until I had a meltdown in his office. He’d always known me as brave. That day he learned that he needs to TELL patients what he’s doing and why. He also told me once I was getting older. Oh boy. That wasn’t so good. He’s pretty good about communicating now.
Good for you, communicating your feelings to him. I think one of the most important things a doctor can do is outline the plan, or at least the next steps, to the patient.
Ya, we’re all getting older. It’s so easy to blow symptoms off with that excuse!