Posted by TENA/ DIAMOND on 1/2/2009, 3:34 pm
Chronic fatigue syndrome fibromyalgia chronic lyme
by Nathan Wei, MD, FACP, FACR
Nathan Wei is a board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.
Click here: Second Opinion Arthritis Treatment Kit
Chronic fatigue syndrome (CFS)must be differentiated from other disorders that have fatigue as a prominent component. CFS usually is sometimes differentiated from other causes of CFS by the presence of cognitive dysfunction, which is less common in almost all other fatigue-producing disorders. Possible differentials include the following:
Adrenal insufficiency
Malignancy
AIDS
Liver disease
Renal disease
Psychosomatic illness: Patients with psychosomatic disorders may have elevated IgG VCA EBV titers, which may mislead them and their physicians to believe they have CFS. As mentioned, EBV may precede CFS, but it does not cause CFS. Such patients do not have the physical findings or abnormal laboratory tests that are part of the diagnosis of CFS. Such patients also do not have the cognitive dysfunction that is typical for a patient with CFS.
Lyme disease: CFS may be readily differentiated from Lyme disease in various ways. Patients from endemic areas may have elevated IgG Lyme titers. Few of these patients have neuroborreliosis, which must be diagnosed by doing simultaneous cerebrospinal fluid (CSF) and serum IgM and IgG Lyme titers. If the CSF titers are higher than those simultaneously obtained from the serum, then the patient has neuroborreliosis. Most patients with acute Lyme disease have a neurologic component, but chronic neuroborreliosis is distinctly uncommon. Patients with chronic neuroborreliosis do not have the same cognitive defects as patients with CFS, and fatigue usually is not present.
Fibromyalgia: Fibromyalgia may be differentiated from CFS but not always easily. Cognitive defects mimic those of CFS. Patients with CFS do not usually have trigger points, which are characteristic of patients with fibromyalgia.
Other diseases may be ruled out by history, physical, or laboratory tests.
An interesting and intriguing variation on this theme was reported by Bonnie Gorman RN. In an article entitled, “Fibromyalgia, Chronic Fatigue Syndrome and Lyme Disease , “ she reports the following…
Dr Sam Donta presented a comprehensive, compassionate, cutting-edge lecture to Mass. CFIDS/FM Association members on November 3rd, 2002. His topic was "The Interface of Lyme Disease with CFS and FM: Diagnostic and Treatment Issues." Dr. Donta is a nationally recognized expert on Lyme disease. He is the Director of the Lyme Disease Unit at Boston Medical Center and a Professor of Medicine at BU Medical School. He is a bacteriologist and an infectious disease specialist, who views CFS and FM from that vantage point. He is also a consultant to the National Institutes of Health (NIH), and presented at NIH's scientific meetings on CFS research.
What does Lyme disease have to do with CFS and FM you might be asking? Some people believe that Lyme disease may be one of the causative factors in both CFS and FM. Others believe that some CFS and FM patients are really misdiagnosed chronic Lyme disease patients and vice versa. Some believe that there is no such thing as chronic Lyme disease, instead these patients actually have CFS or FM. We asked Dr. Donta to help sort all this out.
Dr. Donta presented the symptom lists for chronic Lyme disease, chronic fatigue syndrome (CFS), fibromyalgia (FM), and Gulf War Illness (GWI). He pointed out the similarities between them, and found there were few differences. He has treated hundreds of patients with these illnesses. He found that CFS and GWI have identical symptoms, and FM is only distinguished by a positive tender point exam, that is often positive in CFS and GWI as well. Clinically it is almost impossible to distinguish or differentiate these illnesses.
He has concluded that chronic Lyme disease is remarkably similar to CFS, FM, and GWI. These multi-symptom disorders have similar symptom patterns consisting of fatigue and neurocognitive dysfunction, along with numerous other symptoms that probably relate to altered neurological function. Musculoskeletal symptoms may be more frequent in FM and in some patients with chronic Lyme than in CFS, but the definition of CFS and GWI also includes muscle aches (myalgias) and joint aches (arthralgias) .
Lyme Disease Symptoms
Flu-like illness, fever, malaise, fatigue, headache, muscle aches (myalgia), and joint aches (arthralgia) , intermittent swelling and pain of one or a few joints, "bull's-eye" rash, early neurologic manifestations include cognitive disorders, sleep disturbance, pain, paresthesias (including numbness, tingling, crawling and itching sensations), as well as cognitive difficulties and mood changes.
The only symptom difference in Lyme disease is the expanding circular rash with a clearing area and center resembling a "bull's eye." He pointed out that Lyme has multiple types of rashes and half of the rashes are not typical, they may not even include the "bull's eye" rash. They can appear from two day after the bite, then go on for a week or so. Patients who are infected may not develop or see the rash, and may not develop any future symptoms. In studies, only one third of the patients were actually aware of their tick bites.
30-50% of acute Lyme disease patients went on to develop chronic Lyme disease. Additionally, some previously asymptomatic patients may reactivate their infection following various stressors such as trauma, surgery, pregnancy, coexisting illness, antibiotics treatment, or severe psychological stress. The Lyme vaccine can also reactivate their infection. Similar triggers such as trauma, surgery etc. are known to precipitate CFS, FM and GWI as well. This is not a new phenomenon with infectious diseases. We know infectious diseases (i.e. TB) will reactivate after illnesses or surgery-- any stressor.
Dr. Donta reported on the effects of gender on host susceptibility in Lyme disease, CFS, FM and other multi-symptom diseases. In all these disorders, women appear to be more affected than men, usually at about 2:1 ratios. He noted that neural cells contain estrogen and progesterone receptors, and that herpes viruses can utilize estrogen receptors to gain access to the reservoir in the cell nucleus. Treatment of chronic Lyme disease also seems to be gender-dependent to some degree, with men generally having more speedy and complete recoveries compared to women. He concluded that gender relationships are known for a number of infectious diseases, so it would not be surprising that such a relationship exists for chronic Lyme disease, CFS, FM and other multi-symptom disorders.
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