Fibromyalgia is a disorder associated with chronic widespread pain and poor quality sleep (not necessarily the quantity of sleep). Individuals experience very tender points on their body, in an around the joints and muscles – referred to as trigger points. The condition is frustrating and at times maybe difficult to manage for the patient and their family. Frustration and low mood are common. Aerobic fitness is poor and coping strategies are compromised. The presence of fibromyalgia in patients with pre-existing rheumatoid arthritis or other inflammatory rheumatic disease such as ankylosing spondylitis is well recognized. The fibromyalgia can make the disease activity assessment difficult. Owing to the presence of pain, the disease activity scores may be high – the pain escalates the score and this might result in an unnecessary increase in immune suppressant medication. It is therefore important to recognize and appropriately manage fibromyalgia in this context.

This situation has been seen reported in one U.S. centre where of 62 patients with confirmed ankylosing spondylitis (AS), 27 (44%) also met the 2010 American College of Rheumatology diagnostic criteria for fibromyalgia syndrome.

Apart from the pain which occurs with fibromyalgia , the fatigue and general hyperarousal (hypersentivity to light, sound and touch) make this condition a complex. Recognition and acknowledgment of its presence are the first steps. Enlisting the help of a psychotherapist is important in facilitating the patient becoming in touch with the ‘unhealthy strategies’ that they use to manage their stress.

A structured, paced and focused exercise programme is immensely helpful in improving the muscle fatigue, sleep and well-being.