Joint Pain: Insights on Arthritis and Fibromyalgia Management

Q: Joint Pain: Insights on Arthritis and Fibromyalgia Management

Hello, internet user： Joint pain can be caused not only by arthritis but also by surrounding structures such as cartilage, ligaments, and muscles. <br>Therefore, it is possible to experience joint pain even if blood test results are normal. <br>Medications for fibromyalgia and ar

Joint pain

I have juvenile arthritis and fibromyalgia.
I have been managing my condition with medication for about a year, and it has improved significantly.
However, after an accidental ankle sprain and fracture, my joints suddenly started to hurt again.
Strangely, my blood tests came back normal, and while there is some improvement with joint pain medication, I still feel discomfort.
I am currently trying medication for fibromyalgia.
Doctor, I have a few questions:
1.
If my blood test results are normal, why am I still experiencing significant joint pain?
2.
Both the fibromyalgia medication and the arthritis medication provide only partial relief; should I take them together?
3.
The pain in my shoulder is the most pronounced.
Is it related to a previous injury? It hurts a lot when I push against something after the pain starts.
How can I improve this?

Shuofang, 10~19 year old female. Ask Date: 2015/10/31

Dr. Zeng Guosen reply Internal Medicine

Hello, internet user: Joint pain can be caused not only by arthritis but also by surrounding structures such as cartilage, ligaments, and muscles.
Therefore, it is possible to experience joint pain even if blood test results are normal.
Medications for fibromyalgia and arthritis can be taken together.
If you have a history of injury, the cause of shoulder pain can be more complex.
It is recommended to use soft tissue ultrasound or magnetic resonance imaging (MRI) for further differential diagnosis.
Thank you for your question.

Reply Date: 2015/10/31

More Info

Understanding joint pain, particularly in the context of conditions like juvenile arthritis and fibromyalgia, can be complex. Your experience of joint pain following an ankle sprain, despite normal blood test results, is not uncommon. Let's address your questions one by one.

1. Why is there significant joint pain despite normal blood test results?
Normal blood tests can be misleading when it comes to joint pain. Many forms of arthritis, including juvenile idiopathic arthritis, may not show up in standard blood tests. Inflammatory markers like ESR (Erythrocyte Sedimentation Rate) or CRP (C-Reactive Protein) may be normal even when there is significant pain. Additionally, pain can arise from mechanical issues, such as joint instability or damage to soft tissues (ligaments, tendons, or cartilage) that may not be detected through blood tests. The pain you are experiencing could also be due to the body's response to injury, which can lead to inflammation and pain even in the absence of detectable systemic inflammation.

2. Should you take medications for both fibromyalgia and arthritis together?
The management of fibromyalgia and arthritis often requires a multifaceted approach. While both conditions can cause pain, they may respond differently to various treatments. Medications for fibromyalgia, such as pregabalin (Lyrica) or duloxetine (Cymbalta), target nerve pain and may help alleviate some of the discomfort associated with fibromyalgia. On the other hand, medications for arthritis, such as NSAIDs (non-steroidal anti-inflammatory drugs) or DMARDs (disease-modifying antirheumatic drugs), focus on reducing inflammation in the joints. It is not uncommon for patients to require a combination of therapies to manage their symptoms effectively. However, it is crucial to consult with your healthcare provider to tailor a treatment plan that considers potential interactions and side effects.

3. Is the shoulder pain related to previous injuries, and how can it be improved?
Shoulder pain, especially if it is exacerbated by certain movements, can indeed be related to previous injuries. Injuries can lead to changes in the mechanics of the shoulder joint, resulting in pain during specific activities. Conditions such as rotator cuff injuries, bursitis, or tendinitis can develop as a result of prior trauma. To improve shoulder pain, a combination of physical therapy, targeted exercises, and possibly corticosteroid injections may be beneficial. Physical therapy can help strengthen the muscles around the shoulder, improve range of motion, and reduce pain. Additionally, practicing good posture and avoiding activities that exacerbate the pain can also be helpful.

In summary, managing joint pain from conditions like juvenile arthritis and fibromyalgia requires a comprehensive approach. It is essential to work closely with your healthcare team to monitor your symptoms, adjust medications as necessary, and explore physical therapy options. Understanding the underlying causes of your pain, even when blood tests are normal, is crucial for effective management. If you continue to experience significant pain, consider seeking a referral to a rheumatologist or pain specialist who can provide further insights and treatment options tailored to your needs.

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