Osteoarthritis vs Fibromyalgia

Why Many “Fibromyalgia” Patients Actually Have Missed Osteoarthritis

Chronic, widespread pain is often difficult to diagnose, and many patients spend years — sometimes decades — feeling misunderstood or dismissed. Two conditions are especially prone to diagnostic confusion: osteoarthritis (OA) and fibromyalgia.

While both disorders involve persistent pain, stiffness, and fatigue, an important truth is often overlooked:

A significant number of people diagnosed with fibromyalgia actually have undiagnosed osteoarthritis — or a combination of both.

This happens because OA can be surprisingly difficult to detect, even with modern tests. And when OA is missed, patients are often told their pain is “central”, “unexplained”, or “just fibromyalgia”, leading to years of untreated structural pain.

This article explains why OA is so frequently overlooked, how it differs from fibromyalgia, and how proper diagnosis leads to effective treatment — especially with movement, diet, supplementation, and pulsed radiofrequency neuromodulation (PRF/RFR).

 

Understanding Osteoarthritis: A Silent, Often-Missed Joint Disease

Osteoarthritis is not simply “wear and tear”. It is a chronic inflammatory condition affecting cartilage, bone, joint lining, and surrounding tissues.

The problem?
OA does not always show up clearly on tests, especially in its early or moderate stages.

Why OA Is So Hard to Diagnose

1. Blood tests cannot diagnose OA
OA does not produce inflammatory markers like ESR or CRP. Normal blood tests falsely reassure clinicians that “nothing is wrong.”

2. X-rays often miss early or moderate OA
X-rays only show bone, not cartilage, tendons, ligaments, or inflammation. Many patients with normal X-rays have significant OA pain.

3. MRI scans can also be misleading
MRI may show mild age-related changes and fail to identify the true pain source, because OA pain often arises from:

• synovial inflammation
• small nerve irritation in the joint capsule
• bone marrow lesions
• fat pad impingement
• micro-instability
  These aren’t always obvious — or even routinely reported.

4. OA pain is not always located where the damage is
Referred pain patterns confuse diagnosis.
For example:

• Hip OA → groin, thigh, knee pain
• Knee OA → calf or shin pain
• Cervical OA → headaches, shoulder pain
• Lumbar facet OA → gluteal or thigh pain

5. Many OA patients have central sensitisation
After years of unmanaged joint pain, the nervous system becomes hypersensitive. The result looks similar to fibromyalgia — widespread pain, fatigue, poor sleep — even though the primary generator is mechanical OA.

 

Understanding Fibromyalgia: A Nervous System Disorder

Fibromyalgia is a central nervous system hypersensitivity condition, not a structural joint disease.

Key features include:

• widespread muscle pain
• fatigue
• sleep disturbance
• “fibro fog”
• sensitivity to touch, noise, temperature
• symptoms lasting > 3 months
• normal imaging and blood tests

Fibromyalgia patients do not have localised joint damage. Their pain is global, fluctuating, and often unrelated to physical load.

 

OA vs Fibromyalgia: Key Differences

Feature	Osteoarthritis	Fibromyalgia
Pain Location	Localised to specific joints (hips, knees, spine, hands) but can refer	Widespread, affects both sides of the body
Cause	Structural joint degeneration + inflammation	Central sensitisation (brain and spinal cord)
Tests	Often normal in early stages	Always normal
Morning stiffness	Usually < 30 mins	Often > 45 mins
Activity effect	Worsens with load, improves with rest	Improves with aerobic exercise
Tender points	Joint-line tenderness	Widespread soft-tissue tenderness
Progression	Gradual, structural	Functional, not structural

 

Many patients have both, which makes diagnosis even more challenging.

 

Why Many “Fibromyalgia” Patients Actually Have OA

At The Pain Collective, we see this pattern daily:

• Patients with chronic pain were told, incorrectly, “Your X-rays are normal — you must have fibromyalgia.”
• Patients with clear symptoms of OA (hip, knee, spinal facet degeneration) never had the right diagnostic blocks done.
• Their “fibromyalgia symptoms” resolved once their underlying OA was treated.

Because OA hides on imaging and blood tests, the only reliable diagnostic method is:

Targeted diagnostic nerve blocks

Injecting local anaesthetic around the suspected joint (e.g., facet joint, hip capsule, genicular nerves) and assessing pain reduction.

If the pain improves dramatically, OA is the culprit — even when imaging says otherwise.

 

Treating Osteoarthritis Properly: What Works

OA does not have a cure, but early and appropriate management prevents disability, reduces flare-ups, and restores mobility.

1. Movement: The Foundation of OA Treatment

OA improves with:

• walking
• water-based exercise
• cycling
• Pilates
• strength training

Movement reduces joint inflammation, nourishes cartilage, and rewires pain pathways.

The old advice — “stop moving and rest” — is now considered harmful.

2. Diet: Joints Thrive on Anti-Inflammatory Nutrition

The best evidence supports:

• Mediterranean-style diet
• high omega-3 intake
• reduced processed carbohydrates
• weight optimisation (every 1kg lost = 4kg less force on knees)

Many patients with “flare-ups” are actually experiencing inflammatory responses to food or excess visceral fat.

3. Targeted Supplementation

Evidence-based supplements for OA include:

• Omega-3 fatty acids
• Turmeric/curcumin
• Vitamin D (if deficient)
• Collagen peptides
• Boswellia serrata
• Magnesium
• Glucosamine/chondroitin in selected patients

Supplements work best when combined with diet and movement — not as standalone treatments.

4. Pulsed Radiofrequency Neuromodulation (PRF/RFR): A Major Breakthrough

PRF is one of the most effective modern treatments for OA pain — especially when:

• X-rays and MRIs are “normal”
• Pain is severe but not surgical
• Patients want to avoid opioids or joint replacement

How PRF works:

• No heat and no nerve destruction
• Uses electromagnetic fields to calm overactive joint nerves
• Reduces inflammation
• Improves nerve signalling
• Has systemic anti-inflammatory gene-expression effects
• Provides 18–24 months of relief on average

PRF can be used for:

• knee OA (genicular nerves)
• hip OA
• cervical and lumbar facet OA
• sacroiliac joint OA
• shoulder OA

It is safe, repeatable, and ideal for patients misdiagnosed with fibromyalgia but who actually have OA-driven pain.

 

Final Thoughts: Not All Widespread Pain Is Fibromyalgia

The biggest takeaway:

Fibromyalgia is often over-diagnosed because osteoarthritis is under-diagnosed.

When OA is properly identified — using clinical skill, diagnostic blocks, and pain-pattern recognition — most patients improve dramatically.

If you or your patient has been labelled with fibromyalgia but the pain is:

• worse with movement
• focused around joints
• causing stiffness
• disrupting sleep
• progressing over time

…it is essential to rule out occult osteoarthritis.

Modern treatments like movement therapy, anti-inflammatory diets, targeted supplementation, and PRF/RFR can restore mobility and quality of life.