Fibromyalgia and Ankylosing Spondylitis

David G. Borenstein, MD MACP MACR

Having one illness is more than any patient wants to bear, but, often, patients may have more than one medical problem affecting their musculoskeletal system. In those circumstances, treating only one of those problems may explain why patients are not improving as much as they desire. This situation may occur in individuals who, for example, have both fibromyalgia and ankylosing spondylitis.

Fibromyalgia is a condition characterized by chronic widespread pain in the upper and lower parts of the body and frequently is associated with symptoms including fatigue, restless sleep, mental fogginess, irritable bowel syndrome, interstitial cystitis, and unstable blood pressure. Optimal treatment for fibromyalgia includes a multidisciplinary approach including non-pharmacologic interventions such as patient education, aerobic exercise, and cognitive behavioral therapy. Also used is pharmacologic therapy such as nonnarcotic analgesics that increase neurochemicals like serotonin and norepinephrine, which increase the tone in each individual’s [**is it individual’s or individual??**] pain inhibitory pathway that travels from the brain to structures throughout the body. Up to about 8% of people in the United States have fibromyalgia

Ankylosing spondylitis is an autoimmune-related chronic inflammation of the structures of the spine that can destroy tissues and, in the setting of spondyloarthritis, ultimately results in the calcification of spinal structures and spinal fusion. Ankylosing spondylitis is associated with prolonged morning stiffness that is exacerbated by sitting for variable lengths of time and is improved by exercising. The goals of therapy for ankylosing spondylitis are to control inflammation, decrease pain, maintain function, and prevent deformity with non-pharmacologic (exercise and physical therapy) and pharmacologic (nonsteroidal anti-inflammatory drugs, disease-modifying anti-rheumatic drugs, and biologics) interventions. The estimate for ankylosing spondylitis and other inflammatory spinal disorders in the United States is about 4% of the population.

The question arises as to how many individuals have both fibromyalgia and ankylosing spondylitis. A recent survey reviewed medical literature to determine the frequency of individuals with both conditions. The prevalence of fibromyalgia in ankylosing spondylitis patients is reported to be 4-25%, more women than men. These individuals tend to have more subjective complaints of pain in the spine and other areas than those ankylosing spondylitis patients without fibromyalgia. The clinical importance of this fact is that the usual therapies effective for ankylosing spondylitis may not be adequate to control pain in these individuals. The addition of effective therapy for fibromyalgia will be required to fully treat these individuals.

For more information about these conditions, please go to where ARA partner David Borenstein, MD, MACP, MACR, is executive editor.

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