I know I haven't been active lately but I have a question. I have been experiencing one of the worst flare-ups ever! I think there are several contributors to my condition, one being the unreliable weather which out of the blue decided to go back to fall, and the other is that I'm under so much stress from several life events....
Aynway, I KNOW my sacroiliac joints are on fire because of inflammation... And I'm pretty sure my feet which make all the weird clacking noises when I walk are in pain because of inflammation too... But I also have chest/rib cage pain that comes and goes, and terrible wrist pain with NO swelling or redness or anything really... Just pain and some occasional numbness (carpal tunnel has been discussed in this forum at some point and I'll mention it to my rheumy on the 16th). And pain on my third knuckle. The knuckle pain comes and goes from time to time and since fibro is mainly described as "overall" pain, I'm wondering if these localized pains are fibro or arthritis. It feels like my ankles are wobbly and sensitive with occasional popping, and my wrist, which also makes the popping and cracking noises feels like someone is squeezing it really hard!
So I was wondering if anyone with both conditions can tell me how they differentiate between arthritis pain and fibromyalgia pain? It's driving me nuts!
Thanks Seenie, that's really nice to hear, especially when you're not feeling particularly good :)
Yes I'll be going to the rheumy on the 16th. And this time I'll be going with a check list of things to mention and ask... I always get anxious and confused when I'm there, and I have a tendency to downplay my symptoms and/or my suffering. So yep, I'll be more prepared this time! I need answers!
Sorry to hear about all the pain you are in. I am not diagnosed with Fibro, but most of my PsA pain comes without any noticeable swelling on the outside. My rheumy said the inflammation was deeper. I have had wrist and ankle pain like you describe since I was about 13 (almost 28 now) and that is from PsA…it also causes issues with my shoulder and knee on the same side.
My rheumy has discussed looking into a Fibro diagnosis since I have widespread pain throughout my back that is not specifically related to my spine or any joints…like muscle pains after exercising that don’t go away. It also gets worse if someone hugs me too hard (sensory overload I guess).
I don’t know if this helps at all, just my experience.
I was never diagnosed with fibro, just PsA, but I think a lot of the pain or soreness from the PsA is similar to fibro pain and soreness. If you don't have much psoriasis or none at all, I can see how doctors get confused about the diagnosis. My wrists, hands, shoulders, back would hurt and throb like tendonitis and the joints would lock up and be so painful to move after being still for only a short time. I had noticeable but not severe swelling in my hands and feet (and now that my shoulders look thinner I guess they were swollen too). A result of that was also
generalized weakness in my arms, back and legs. I had off and on weird stabbing pains in my hips and knees. Some doctors might have said fibro, but with my long history of moderate psoriasis I guess my rheumy made the correct diagnosis.
Please bring your list of symptoms along on the 16th, and I hope your doctor will make a correct diagnosis. You've been suffering too much without the meds that could hopefully make you feel better. Have you ever had prednisone (I should know-I think you have)! If so, did it make you feel better for awhile?
Hello LL, good to see you but sorry you're having such a bad time with your flare. All I want to add is that when I had my second opinion review/assessment with the UK's leading PsA expert and asked about all this random pain and tenderness in my back (particularly the area between spine and shoulder-blade) as well as between my fingers and toes, wrists ... etc, etc none of which appears to correspond to joint swelling her response was "yes, PsA, everywhere you've mentioned there are tendons and bursa and likely they are all involved in the PsA inflammatory process".
Hi Newbie Teach, it's good to hear (I guess!) that inflammation CAN happen without the noticeable swelling... So I should push harder for it to be looked into and not be dismissed as fibro. I don't have a problem with it being fibro, I actually prefer it since it doesn't cause the damage that arthritis causes even though it is just as unbearable, but since arthritis does cause damage, I just want to be sure that it IS fibro or know that it is arthritis. By the way, now that you mention it, I always had those "mystery" ankle sprains since forever. Some mornings I would just wake up feeling like I sprained my ankle but wouldn't be able to remember how and blame it on my absent-mindedness (which turns out to be caused by fibro so yay, I'm not stupid, just sick!!). Oh, and I also have the widespread pain, stiffness and tenderness along my spine that you mentioned. It's like the soreness you have after working out too hard but just doesn't go away! I always thought it was because of my mild scoliosis but it turns out it was because of fibro - or both of them, I don't know, maybe scoliosis just makes fibro just "more". (By the way, we are the same age, I'm 27 :).
Grandma J, no I never used prednisone. The only treatments I got was Indomethacin from my rheumy and diclofenac sodium from my ortho. Diclofenac was better for my arthritis but harder on my body. I had overall edema, my face was like a moon, I just felt so heavy and there was a breakout of acne on my back. And I lost what I thought was weight in just three-four days when I stopped taking the diclofenac so I'm guessing it was a very nasty side effect of the medicine. I can always take more Indomethacin - it is prescribed up to 8 times a day and I'm only taking one a day, two if I'm really, really bad. But I don't want to because when I take more than one then I'm no good for anything but lying around in bed and sleeping. Maybe I can shake it if I begin using it, say three times a day regularly, but I need to find a time that I don't have to do anything for a while.
Hi Jules :) There is a spot right under - no, I guess IN would be a better way to put it since it's very deep - my left shoulderblade that is sore all the time! Last summer my physical therapist worked all summer to loosen it up since the only diagnosis I had then was fibromyalgia and they thought it was a muscle knot but they just couldn't no matter how much they worked on it. And now the rib cage pain I mentioned always starts right at that point. Then spreads to my rib cage and finally arrives in the middle of my chest. It happened just two-three times but I think it too is worth mentioning to my rheumy. Like I said, I just want to know which pain is arthritis and which pain is fibromyalgia so I can decide on how much I should panic :D
Hi again, LL. I see you mentioned you have pain near your shoulder blade that radiates to your rib cage. I had pain below my clavicles in the hollows next to my shoulders. It was deep and felt really sore when I pressed there. My Rheumy said it was tendonitis and another PsA symptom. I could barely tolerate having my arms up to fix my hair, etc. Everything I did, even carrying my purse aggravated it. It wouldn't surprise me a bit if your doctor tells you your pain around that shoulder blade is a PsA symptom....especially if there's a tendon(s) involved. (IDK anything about human anatomy, so not sure there are tendons there, but I imagine there are.)
From what I understand J, there are tendons everywhere! Hell, even if they are not tendons, they are things that can potentially hurt very badly, so doesn't really matter what they are :D
I guess I'll know more on the 16th... I have so many symptoms. I need to make him understand that it's not just my SI joints, which is where he focuses every time. And he's very firm on the fibro diagnosis, which I definitely have. I just don't know "how much" :D
That's it!!!!!!!!!!!!! Mine is underneath my right shoulderblade and that is the precise spot I asked about which got me the explanation. Yay!
ladylazarus said:
Hi Jules :) There is a spot right under - no, I guess IN would be a better way to put it since it's very deep - my left shoulderblade that is sore all the time! Last summer my physical therapist worked all summer to loosen it up since the only diagnosis I had then was fibromyalgia and they thought it was a muscle knot but they just couldn't no matter how much they worked on it.
So I should definitely bring that spot up! It's funny really, after 7 years (the more I think of it the more I realize that I was 20 when I had my first flare) of thinking all those muscle cramps and chronic back pain and the fatigue was just normal and everyone was in pain, now I'm facing a new explanation everywhere I turn. And yep, I really thought everyone had back pain, don't judge me because my grandma and mom was always in pain and extremely fatigued so I thought it was how life was supposed to be :D
Jules G said:
That's it!!!!!!!!!!!!! Mine is underneath my right shoulderblade and that is the precise spot I asked about which got me the explanation. Yay!
Haha, LL, the comment about "everyone was in pain" (at 20)! Off and on everyone, or I should say a lot of people, do have some pain--headaches, cramps, whatever! But, the stuff you and the rest of us have, is more than that, and at 20, is just not right! I laughed because, and I've told this one before, when I was 40 and had plantar fasciitis I told my doctor it was probably just another symptom if old age. He laughed at me and said at 40 you shouldn't have aches and pains of old age! But I really did think I was old!!! I guess that makes me ancient now!
I thought I would give you an update... I had my appt with my rheumy on the 16th, and getting the blood test results took another day - oh, and funny thing, being the silly me, I looked at my test results online at night, saw a horribly high basophil count and thought that I had cancer for 12 hours :D Turns out there was a very simple explanation :D - Other than that, my results were pretty normal, except that even though my sed rate was still in the normal range, it was more than all my previous visits. He didn't realize it and I didn't bother him with it since, well, I'm still in the normal range and he seemed happy with my results. And I guess it's normal with all the stress that I've been under.
Anyway, he took me more seriously this time and did a very thorough examination (though still no imaging), and once again concluded that all my discomfort, except for my SI joints and my back were fibromyalgia. He said my fibro was causing me more trouble than the actual inflammation. Which is both good and bad news I guess. Good news, because it's not eroding my joints and bad, because even though there still isn't a cure, the medication for arthritis is much more effective I guess, with the biologics and stuff. With fibro, it's all shots in the dark. So now we are embracing a more aggressive treatment for it. And I'll be moving back to my hometown at the end of this month, and my mother says she'll take me to a pretty famous doctor, who actually happened to make my back pain go away for a little while a long time ago - so I'll have the opportunity for a second opinion there. And I'll go back to physical therapy again.
So there it is :) I hope everyone is OK, and once again thank you for your replies!
(Grandma J, I so understand you :D I feel 80 sometimes, though sometimes, on the better days, I vaguely remember that I'm not even thirty yet!...)
There is some over lap but the shoulder is the kicker These are the two charts The first one is the PsA enthesitis and the second FMS tender points. Keep in mind though we are highly susceptible to secondary damage. because of compensating in other areas
It looks like my shoulderblade pain might be fibro, and I have pain in almost all the tender points except for the elbows. But I'm still not sure about the foot pain... It's OK though, I'll be moving back to my hometown in a week and I'll see both my p.t. and another doctor. And I see what you mean about compensating. Whenever I have back pain or foot pain for more than a few days in a row, my knee begins to hurt too!
That’s very interesting tntlamb. So how does the toe and finger swelling fit in? I do not have fibro but just curious? I have allot of swelling where my toes connect to the foot.
Bizarre. My rheumy never told me I have fibro, but one of my common complaints was the tendons just below my clavicles. He said that was a symptom of my PsA. Also, I don't see pain points on the skeleton hands, but wouldn't the hands be a common PsA symptom? Maybe the chart just shows the most common complaints, but it seems to me PsA pain can be almost anywhere. I should mention, too, that nearly all my pain is gone or lessened significantly since I've been on Enbrel.
Ok, I could be worried about the shoulder points (as I am tender over both based on this diagram) but I think I'm going to stick with the tendon explanation. I'm sure the PsA expert would have said if she thought anything she found might indicate concurrent fibro :)
So long as I'm on the most effective, damage minimising treatment for PsA, I'm trying not to sweat the small stuff ..... although when it hurts it doesn't feel like small stuff!!!!
LL, I hope things move along treatment wise for you. Jules
I think for fibro you have to have pain in the 11 tender points or something when pressed. And I cry every time the rheumy does the examination so my fibro diagnosis was a very easy one. As for my feet, it looks like it could be enthesitis but my rheumy says fibro can and does cause hand and feet pain too. I don't know. Oh, and I have pain in both enthesitis and fibro tender points in the bottock/lower back area so yay me :)
