By Dr. Javier Rivera | Mar. 15, 2019 | Posts in English

What happens when there is another main disease and the patient also has an associated fibromyalgia? In this second article I will tell you how fibromyalgia can influence other diseases (I recommend reading the previous article).

When fibromyalgia accompanies other diseases, it adds more symptoms to the patient’s clinical picture, but it can also modify some symptoms of the main disease. Let’s see how this works:

Cancer, inflammatory diseases such as rheumatoid arthritis, ankylosing spondylitis, lupus erythematosus, psoriasis or inflammatory bowel disease are always the main diseases due to the serious repercussions they have. However, in a high percentage of patients there is also fibromyalgia as an associated comorbidity that, moreover, is usually undiagnosed.

We have known for several years that the presence of fibromyalgia in a patient with rheumatoid arthritis modifies its severity indexes. Due to the fact that the sum of joints that hurt or how the patient is globally are used to calculate the severity of arthritis, those who present associated fibromyalgia always have greater severity and, therefore, receive more drugs and at higher doses. Obviously, this is accompanied by a higher risk of complications and side effects for the patient that could have been avoided simply by taking into account the diagnosis of associated fibromyalgia and better assessing their situation.

There are multiple studies that show the same problem in patients with ankylosing spondylitis, lupus erythematosus, Sjögren’s syndrome, psoriasis or inflammatory bowel disease, since it is estimated that between 15% and 20% of these patients also have fibromyalgia. This high figure gives an idea of the importance of correctly establishing the diagnosis of associated fibromyalgia.

In some cancer patients, after cancer treatment is finished, they continue to have many symptoms and a poor quality of life, when this should not be the case. This forces the medical oncologist to continue looking for possible dissemination of cancer in other organs that satisfactorily explain the poor situation of the patient. But, on the other hand, the new explorations and analyzes to which he is subjected prolong his suffering due to the uncertainty of his situation. Again, if the possibility of associated fibromyalgia had been taken into account and that the symptoms could be in this context and not as another manifestation of cancer, these doubts would have been avoided.

But, it is that in other less dramatic diseases something similar happens. For example, some patients with disc protrusions or even disc herniations with severe low back pain undergo surgery to resolve pain that is not satisfactorily explained by lesions found on MRI. If an associated fibromyalgia existed in this patient, the ability of this disease to amplify pain would explain the poor situation of the patient, instead of attributing it to the severity of the hernia, and surgery would probably have been avoided.

In summary, when fibromyalgia is the comorbidity associated with another main disease, the risk that exists is the overtreatment of the main disease. Establishing the diagnosis of fibromyalgia as an associated comorbidity is important because it offers us a new vision of what happens to the patient and, furthermore, because treating it avoids other unnecessary and potentially harmful treatments.