The differences between fibromyalgia and rheumatic polymyalgia

Although they are 2 diseases that can generate painful symptomatology at the level of the muscles, rheumatic polymyalgia and fibromyalgia differ fundamentally in some characteristics, including age, sex, inflammatory status, and location of pain. Let's look at them specifically.

Age

Rheumatic polymyalgia generally affects individuals over the age of 50, with the majority over 65 years old.
Fibromyalgia predominantly affects younger people of childbearing age.            

Sex

Rheumatic polymyalgia generally affects both sexes with a slight prevalence for the female gender.
Fibromyalgia affects young women with clear predilection and much more rarely men.

Inflammatory status

Rheumatic polymyalgia presents with intense painful symptoms in the shoulders and hips (scapular girdle and pelvic girdle) of an inflammatory nature, occurring at night and especially upon waking in the morning.
Fibromyalgia, which is related to a pain perception disorder on a probably neuropathic basis, is not an inflammatory disease. It is not associated with alterations in laboratory tests and results in continuous pain, without nocturnal and morning focality.

Location of pain 

Rheumatic polymyalgia manifests with bilateral pain and functional limitation typically in the shoulders and hips (outer region of hips and buttocks) or both.
Fibromyalgia is a chronic widespread pain syndrome that can affect all somatic regions. 

Rheumatic polymyalgia is an inflammatory process that occurs without any specific predisposition and due to yet unknown causes. Although fibromyalgia also develops from causes yet unknown, according to some theories, it could be determined by an alteration in the processing of the pain stimulus (nociceptive) at the level of certain neurological circuits.

Are polymyalgia rheumatica and fibromyalgia hereditary?

Rheumatic polymyalgia and fibromyalgia are not hereditary diseases. For fibromyalgia, at any rate, some recent studies highlight how familial cases and genetic factors, combined with environmental factors, could play a key role in the onset of the condition. 

Rheumatic polymyalgia and fibromyalgia can generally be differentiated by a blood draw that goes to assess inflammatory indices (ESR and PCR):

• elevated ESR and CRP values: this is indicative of the inflammatory process related to rheumatic polymyalgia;
• ESR and CRP values in the normal range: suggest fibromyalgia.

It should be pointed out that the diagnosis of fibromyalgia is provided by the rheumatologist following the exclusion of other conditions. In any case, even the presence of elevated inflammatory indices is not in itself indicative of rheumatic polymyalgia, but must be carefully evaluated by the specialist in the overall clinical picture of the person.

Even in treatment, the 2 diseases require a different approach.

The therapy of choice for rheumatic polymyalgia is the administration of corticosteroids, which play a curative role and not just control symptoms. Just a few milligrams induce almost complete regression of symptoms within hours of administration. As inflammatory indices reduce, the physician goes on to gradually reduce consumption, assessing the patient's overall health status, the presence or absence of other comorbidities, and the possibility of any recurrence.

Fibromyalgia, on the other hand, does not respond to cortisone therapy. To date, there is still no cure to this disease, but a number of approaches are being followed, often in combination with each other, aimed at learning to live with the same. Prescribed drugs go to act on other elements, such as the central nervous system, and adjuvant therapies, such as ozone therapy, acupuncture, relaxing sports (yoga, pilates, etc.), may be added to these. Physiotherapy and muscle relaxant techniques play a major role in these cases.

Rheumatic polymyalgia is one of the few rheumatologic diseases that, if corticosteroid therapy is scrupulously followed, heals permanently in at least 60 percent of cases, allowing the patient to resume his normal life within a few days. 

"Rheumatic polymyalgia generally leaves no functional outcomes and does not threaten the integrity of the affected joints even during its acute phase in which, in any case, rest would be indicated," explains Dr. Sinigaglia.

Fibromyalgia, despite its associated painful symptoms, does not damage muscles and organs or have degenerative character.

"The important difficulty in this case," the doctor concludes, "is precisely finding an effective therapy against pain, which, if not properly addressed, drastically impairs the patient's quality of life, being very disabling.”