Fibromyalgia, Arthritis & Gout Facebook Chat

Transcript Highlights

Dennis Ang, MD, MS
May 23, 2017

Welcome! Thank you for joining us today for a discussion on “Fibromyalgia, Arthritis and Gout pain”. This Facebook chat will be hosted by Dr. Dennis C. Ang and will cover topics such as:

– Common causes of arthritis and gout pain
– Identifying symptom of fibromyalgia
– Non-surgical therapies that are available
– Other treatment options
– Advise for talking more effectively with your physician
– How to get on a path to wellness

PainPathways Magazine: As a rheumatologist, Dr. Ang, a physician at Wake Forest Baptist Medical Center provides support in managing various rheumatologic disorders from arthritis (e.g., rheumatoid, gout, psoriatic arthritis) to inflammatory conditions such as lupus, connective tissue disease, and vasculitis. Dr. Ang completed his residency in Internal Medicine at the Cleveland Clinic Foundation in 1995, and his fellowship in 1999.

As an offshoot of his clinical duties, his research interests include: fibromyalgia, exercise, pain, osteoarthritis and much more

Lynn Julian: I’ve been diagnosed with Fibromyalgia since 1998…but found out I have chronic Lyme disease in 2015. How do I know if Lyme is causing my Fibro symptoms? Is there any way to tell if I really DO have fibromyalgia?

Dr. Ang: Hello Lynn Julian. There is a test to check for active Lyme infection. Your doctor just has to know how to interpret the test result. It is possible that you had Lyme in the past, but not currently active.

If active Lyme infection (through blood test) is ruled out, then if you have the constellation of symptoms including fatigue, body pain, sleep disturbance and memory issues, then a physician could make a diagnosis of fibromyalgia.

If you do have active Lyme infection, then you should receive the right course of antibiotic. After completing the antibiotic, if you still have lingering symptoms such as pain and fatigue, then those remaining symptoms can be attributed to fibromyalgia.

Gary Larson wrote: My wife has been seeing a pain doctor for her fibromyalgia, should she see a rhematologist instead? 

Dr. Ang: A pain specialist in a multidisciplinary clinic should adequately manage or treat fibromyalgia.

A multidisciplinary clinic should include physical therapists, occupational therapist, psychologist, and occasionally, vocational rehabilitation specialist.

Unfortunately, a few of the pain specialist just offers injection and prescription medications. Managing fibromyalgia really requires the help of different health professionals.

Your wife can see a rheumatologist if there is any lingering concern for possible lupus or connective tissue disease. If lupus or other connective tissue disease has been ruled out, then a pain specialist or a good primary care provider should be able to manage fibromyalgia.

Tamika Barnes: My father has been diagnosed with gout. Are there therapies that do not include meds that we should consider? Will his diet affect this diagnosis?

Dr. Ang: Diet definitely plays a role in the management of gout. Diet definitely plays a role in the management of gout. I would suggest that your father’s primary care provider reviews his medication list.

I would suggest that your father’s primary care provider reviews his medication list. Another important trigger of gout flare is furosemide (Lasix) – a diuretic f possible, avoid medications (such as diuretics) that can cause gout flares.

It is also important to avoid alcoholic beverages. Manage ‪ alcohol can trigger gout flares.

Low purine diet (search the web for examples of low purine diet) should help. However, in the majority of the time (assuming that gout diagnosis is well established), medication would be needed.

PainPathways Magazine: Here is a great article about managing gout.

Terri Matthews: What is the difference between chronic fatigue and fibromyalgia?

Dr. Ang: when we see patients with chronic fatigue (or fibromyalgia), it is important for us to rule out other conditions that may mask as chronic fatigue or fibromyalgia.

Michele Rice: What would those conditions be?

Dr. Ang: Once the other conditions are ruled out (such as lupus or rheumatoid), then we suggest a low intensity low impact aerobic exercise. The benefits from a consistent low impact/low intensity exercise is substantial. It will not cure chronic fatigue or fibromyalgia, but it will substantially improve the quality of one’s life.

PainPathways Magazine: Here is a great article on chronic fatigue syndrome.

Donna Greyerbiehl: Is there a direct correlation between RA & CVID?

Dr. Ang: There are several large epidemiological studies that demonstrates the associated between rheumatoid arthritis and cardiovascular diseases.

The rheumatological community now considers rheumatoid arthritis as one risk factor for developing heart condition in the future.

As such, we recommend that RA patients strictly follow the healthy heart recommendations such as low cholesterol diet, smoking cessation, consistent aerobic exercise, and monitoring of blood pressure.

If blood pressure is elevated on multiple occasions despite a low sodium diet, then a blood pressure medication may be indicated.

A physician has to be careful in determining the cause of the immune deficiency. Is it a primary immune deficiency? or is it a secondary immune deficiency because of medications.

If it is a primary immune deficiency, then yes, monthly immunoglobulins may be needed.

PainPathways Magazine: Here is a great article on Matt Iseman and arthritis.

Bob Williams: Is there a medical test available to confirm arthritis? I’ve had pain most of my adult life and with age it has worsened.

Dr. Ang: Good question. There is no single medical test to confirm arthritis. It really depends on a good history and physical exam by a competent physician. Blood tests (example, rheumatoid factor) is only helpful if the doctor sees multiple joints that are swollen, warm and tender.

They also use X-rays to confirm arthritis.

Adrianna Rodriguez Shannon: I have been diagnosed with Fibromyalgia. Drs are trying to treat with pharmaceuticals. Nothing is helping with the fatigue. No matter how much I sleep or can’t I am tired and wake with terrible soreness and stiffness. What treatments have you found effective for chronic fatigue?

Dr. Ang: First, if you snores heavily at night, or if someone has mentioned that you stop breathing at night, then a formal sleep study may be needed.

You also want to make sure that your medications are not aggravating your chronic fatigue.

In the absence of heavy snoring, chronic fatigue tends to improve with a consistent low impact/low intensity aerobic exercise. Examples include, brisk walking 5 minutes per day, 3-4 x per week.

If you are taking multiple medications that can cause drowsiness or lightheadedness, then those medications may worsen your chronic fatigue. Ask your doctor to carefully review your medication list.

Twenty percent of patients with fibromyalgia or chronic fatigue have depression. If so, depression needs to be treated as well in order to reduce the severity of fatigue.

PainPathways Magazine: Everyone, our time is unfortunately up. We appreciate all of your thoughtful questions and our experts’ informative responses. Check back with us for our next Facebook chat!

To order a subscription to PainPathways, visit us online at https://www.painpathways.org/…/1-year-subscription-4-issues/.

PainPathways Magazine: Hi everyone! This is Amy North, editor of PainPathways Magazine. On behalf of the magazine, we’d like to thank our expert and all those who participated in tonight’s chat! We are excited to be offering this great forum for information and inspiration. We’ll post transcripts of the chat to our website soon. Have a good night everyone!

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All information provided is for educational purposes only. Neither PainPathways Magazine nor their Facebook Chat hosts are responsible for a medical diagnosis. Individuals should seek a physician for evaluation and personalized treatment plan.