Tag: fibromyalgia

Gender differences in patients with chronic fatigue syndrome

Abstract:

OBJECTIVE: To determine whether there are differences between men and women patients who have chronic fatigue syndrome (CFS) and, if so, to ascertain whether a gender-related pattern exists.

DESIGN: A descriptive study of demographic, clinical, and psychosocial measures, the results of which were prospectively collected for patients who had CFS.

SETTING: A university-based referral clinic devoted to the evaluation and management of chronic fatigue.

PATIENTS: 348 CFS patients who had undergone complete medical evaluations.

MEASURES: Clinical variables included symptoms, physical examination findings, and laboratory results. Psychosocial assessment consisted of a structured psychiatric interview, the Medical Outcomes Study Short-form General Health Survey to assess functional status, the General Health Questionnaire to ascertain psychological distress, the Multidimensional Health Locus of Control, and measures of attribution, social support, and coping.

MAIN RESULTS: Overall, few gender-related differences were identified. Women had a higher frequency of tender or enlarged lymph nodes (60% versus 33%, p < or = 0.01) and fibromyalgia (36% versus 12%, p < or = 0.001) and lower scores on the physical functioning subscale of the Medical Outcomes Study Short-form General Health Survey (37.6 versus 52.2, p < 0.01); men more often had pharyngeal inflammation (42% versus 22%, p < or = 0.001) and reported a higher lifetime prevalence of alcoholism (20% versus 9%, p < or = 0.01).

CONCLUSIONS: In general, demographic, clinical, and psychosocial factors do not distinguish men from women CFS patients.

 

Source: Buchwald D, Pearlman T, Kith P, Schmaling K. Gender differences in patients with chronic fatigue syndrome. J Gen Intern Med. 1994 Jul;9(7):397-401. http://www.ncbi.nlm.nih.gov/pubmed/7931750

 

Pain rehabilitation. 2. Chronic pain syndrome and myofascial pain

Abstract:

This article highlights chronic pain syndrome and myofascial pain. It is part of the chapter on pain rehabilitation in the Self-Directed Medical Knowledge Program for practitioners and trainees in physical medicine and rehabilitation. This article discusses behavioral maladaptations to chronic pain which lead to global physical, psychologic, social, and vocational impairments–the chronic pain syndrome. The spectrum of myofascial pain syndromes, contributing factors, and interventions are detailed. New advances that are covered in this section include controversies in long-term use of opioids and muscle relaxants; differentiating fibromyalgia, myofascial pain syndromes, and chronic fatigue syndrome; pathophysiology of myofascial pain; and beneficial treatments.

 

Source: King JC, Goddard MJ. Pain rehabilitation. 2. Chronic pain syndrome and myofascial pain. Arch Phys Med Rehabil. 1994 May;75(5 Spec No):S9-14. http://www.ncbi.nlm.nih.gov/pubmed/7910454

 

Alpha-delta sleep in patients with a chief complaint of chronic fatigue

Abstract:

Our prospective, standardized cohort study was designed to assess the presence of alpha wave intrusions during non-rapid eye movement sleep (alpha-delta sleep) and its relationship to fibromyalgia, major depression, and chronic fatigue syndrome (CFS) in patients with a chief complaint of chronic fatigue.

The study group comprised 30 consecutive patients seen at a university hospital referral clinic for evaluation of chronic fatigue. All patients had nocturnal polysomnography, dolorimetric tender point assessment for fibromyalgia, a comprehensive history, physical, and laboratory evaluation, and a structured psychiatric interview. Alpha-delta sleep was identified in 8 of the 30 patients (26%), major depression in 20 (67%), CFS in 15 (50%), and fibromyalgia in 4 (13%). Ten of the 30 patients (33%) had a primary sleep disorder (sleep apnea, periodic limb movements, or narcolepsy).

Alpha-delta sleep was not significantly correlated with fibromyalgia, CFS, major depression, or primary sleep disorders, but was significantly more common among patients who had chronic fatigue without major depression. We conclude that primary sleep disorders are relatively common among patients with chronic fatigue and must be diligently sought and treated. Alpha-delta sleep is not a marker of fibromyalgia or CFS, but may contribute to the illness of nondepressed patients with these conditions.

Comment in: Sleep disorders and chronic fatigue. [South Med J. 1994]

 

Source: Manu P, Lane TJ, Matthews DA, Castriotta RJ, Watson RK, Abeles M. Alpha-delta sleep in patients with a chief complaint of chronic fatigue. South Med J. 1994 Apr;87(4):465-70. http://www.ncbi.nlm.nih.gov/pubmed/8153772

 

Chronic fatigue syndrome and a disorder resembling Sjögren’s syndrome: preliminary report

Abstract:

Chronic fatigue syndrome (CFS), as currently described in the working criteria proposed by the Centers for Disease Control and Prevention (Atlanta), may be associated with multiple, distinct, and possibly unique clinical and/or etiopathogenic subsets.

Sjögren’s syndrome (SS) is a disease of unknown etiology that is characterized by dryness of the mucous membranes and a variety of autoimmune phenomena and conditions. Subjective manifestations of SS such as neurocognitive dysfunction and fatigue have been stressed by some observers. We have detected a large number of patients with unrecognized SS-like illness in a clinic specializing in CFS and believe the relationship to be more than casual.

From January 1991 through April 1992, 172 patients were evaluated for CFS; the SS cohort consisted of 27 females (mean age, 41.9 years). Sixteen of these patients had previously been found to have CFS by a physician, and 11 were self-referred. All patients complained of severe, dominating, chronic fatigue. Complaints of myalgia were prominent; 20 of 27 patients met the criteria for fibromyalgia. Neurocognitive complaints and/or a history of neuropsychiatric disease was frequent.

Results of Schirmer’s test were abnormal for 16 of 27, and results of minor salivary-gland biopsy were abnormal for 20 of 25. Antibodies to nuclear antigen were present in 16 of 27, but anti-Ro was present in only 1 of 21. In the SS group, 13 of 27 patients met eight or more CDC minor criteria for CFS, and 18 of 27 met six or more of the criteria.

We believe SS may represent a common and frequently overlooked clinical subset of CFS; however, further work is needed to define the similarities and/or differences between the SS observed in association with CFS and SS in the general population as well as the prevalence of SS among patients with CFS.

 

Source: Calabrese LH, Davis ME, Wilke WS. Chronic fatigue syndrome and a disorder resembling Sjögren’s syndrome: preliminary report. Clin Infect Dis. 1994 Jan;18 Suppl 1:S28-31. http://cid.oxfordjournals.org/content/18/Supplement_1/S28.abstract

 

The “anti-Ki” syndrome: major clinical features

Abstract:

OBJECTIVE: To describe the major clinical features of patients with high titers of anti-Ki antibodies.

METHOD AND RESULTS: Four of 172 patients with connective tissue diseases showed high titers (> 1/256) of anti-Ki antibodies. In these four patients, (1) the common clinical findings were alopecia, disabling chronic fatigue, muscle weakness, tenosynovitis, dry mouth, and abnormal glucose tolerance test; (2) anti-Ki antibodies were positive not only in patients with sicca lupus, but also in those with nonsicca lupus. In this case, anti-insulin receptor antibody was positive and there was a regulatory insufficiency of the pituitary. (3) Symptoms of anti-Ki antibodies share many clinical and laboratory features of chronic fatigue syndrome and fibromyalgia, that is, they may share either a common etiologic agents or a common pathogenetic pathway or both.

CONCLUSION: “Anti-Ki antibody” syndrome may be a subset of sicca lupus.

 

Source: Matsunaga K. The “anti-Ki” syndrome: major clinical features. Rinsho Byori. 1993 Aug;41(8):882-7. [Article in Japanese] http://www.ncbi.nlm.nih.gov/pubmed/8371504

 

The chronic fatigue syndrome: what do we know?

Abnormally persistent or recurrent fatigue is a feature of many disorders. Recently, particular attention has been devoted to people whose life is dominated by protracted and disabling fatigue. Such cases are now usually categorised as the chronic fatigue syndrome, the postviral fatigue syndrome, or myalgic encephalomyelitis. Two recent publications bring together current ideas on the topic.

The historical background is important. Although the chronic fatigue syndrome has been advanced as a malaise of the latter part of this century, such cases are not a new phenomenon: they were particularly common during the latter part of the last century. The New York physician George Beard applied the label “neurasthenia” to them although the term was more widely used. After becoming an exceedingly common diagnosis it waned at the time of the first world war.

This first wave in the history of chronic fatigue was followed by a second wave, which can be dated to 1934. Nevertheless, cases of chronic fatigue did not simply disappear in the intervening period. The “effort syndrome” had a considerable vogue at that time. “Fibrositis,” a term introduced by Sir William Gowers in 1894 to designate the occurrence of diffuse muscle aching and pain without detectable explanation, evolved into “fibromyalgia.” This currently popular diagnosis has many overlapping features with the chronic fatigue syndrome, as did the effort syndrome.

You can read the rest of this article here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1677985/pdf/bmj00024-0007.pdf

 

Comment in:

Functional hypoglycaemia postulated as cause of chronic fatigue syndrome. [BMJ. 1993]

Chronic fatigue syndrome. [BMJ. 1993]

 

Source: Thomas PK. The chronic fatigue syndrome: what do we know? BMJ. 1993 Jun 12;306(6892):1557-8. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1677985/

 

ABC of sleep disorders. Sleep problems in patients with medical illness

Sleep complaints are ubiquitous in patients with medical illness. A recent survey of outpatients attending hospital clinics indicated that the vast majority of patients reported sleep disruption concomitant with their condition. The proportion with complaints (> 70%) was more than twice that among control subjects. Doctors rarely ask about sleep problems in the context of medical illness despite the fact that the patient’s first complaint disruption of sleep architecture in may be that a particular symptom caused sleep disruption.

There are specific reasons for sleep disruptions in patients with medical illness-for example, people are often deprived of sleep before an operation. Polysomnography has shown that there is a preoperative of sleep) reduction in slow wave sleep and that this is related to the anticipated importance of surgery. The increase in deep sleep that occurs after an operation is thought to facilitate the healing process.

A variety of sleep variables may be influenced by specific disorders and each of these effects is likely to differ. A decrease in deep (slow wave) sleep, for example, may lead to a sensation of having low energy, whereas repeated interruption of sleep may lead to daytime sleepiness.

Drugs may also disrupt sleep architecture by suppressing rapid eye movement (REM) sleep or by causing a withdrawal effect during the night. In both cases the drug clearly alters sleep, but the impact on health and recovery may differ.

Fatigue is common in several medical conditions. Clinicians, researchers, and patients themselves claim that the fatigue experienced in certain medical conditions differs qualitatively from the experience of tiredness or sleepiness. However, there have been few attempts to separate these states. In this article we provide an overview of the impact of medical disorders on sleep.

You can read the rest of this article here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1677972/pdf/bmj00023-0050.pdf

 

Source: Shapiro CM, Devins GM, Hussain MR. ABC of sleep disorders. Sleep problems in patients with medical illness. BMJ. 1993 Jun 5;306(6891):1532-5. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1677972/

 

Chronic fatigue syndrome–study of 51 cases treated at the Second Tokyo National Hospital

Abstract:

Fifty-one patients with chronic fatigue syndrome (CFS) were studied. Tender points, which are a characteristic clinical feature of fibromyalgia, were found in all but two of the patients at 11.4 points (mean) per patient. IgG antibody titers to EB virus viral capsid antigen were more elevated in the CFS patient group compared to that of the control (p < 0.0015). IgG antibody titers to HHV-6 were not higher in the patient group. NK cell activity was not more decreased in the patient group, whereas, the mean number of NK cells was lower (p < 0.005) in the patient group, when CD57 was used as the NK cell marker. Viral infections and/or disorders in cellular immunity may be important factors in the pathogenesis of CFS.

 

Source: Nishikai M. Chronic fatigue syndrome–study of 51 cases treated at the Second Tokyo National Hospital. Nihon Rinsho. 1992 Nov;50(11):2641-7. [Article in Japanese] http://www.ncbi.nlm.nih.gov/pubmed/1337560

 

Definition of the chronic fatigue syndrome and its issues

Abstract:

This article reviewed Definition of CFS proposed by CDC 1988. There are several issues in Definition for CFS of CDC. It is presented that other chronic clinical conditions have been satisfactorily excluded, including preexisting psychiatric diseases in (2) of major criteria.

However, fibromyalgia can not be excluded from the fifth symptom of minor criteria, myalgia, and also depression from the ninth symptom.

It is practically difficult to define impairment of average daily activity below 50% of the patient’s premorbid activity level for a period of at least 6 months, as shown in (1) of major criteria, and it is not adapted for a first visit patient.

Definition for CFS of CDC has been discussed on EBV infection, but not written on postviral fatigue syndrome and myalgic encephalomyelitis. Especially whether epidemic type of CFS is present or not was not discussed. Diagnostic criteria of CFS is necessary for clinical practice.

 

Source: Hashimoto N. Definition of the chronic fatigue syndrome and its issues. Nihon Rinsho. 1992 Nov;50(11):2591-9. [Article in Japanese] http://www.ncbi.nlm.nih.gov/pubmed/1287235

 

Pain syndromes, disability, and chronic disease in childhood

Abstract:

Childhood disability and chronic disease are common, and their prevalence is increasing as children survive with conditions that were previously fatal. It is important that physicians in training learn about disability and handicap, and the functioning of multidisciplinary teams to manage these problems. Chronic ill-health is often very expensive to manage, and some serious and creative thinking about the best way to fund such health care is urgently needed.

Pediatric rheumatologists are involved with the care of many children with chronic and recurrent musculoskeletal pain; however, they have not perhaps focused enough research effort on the investigation of pain and its management. Whether reflex neurovascular dystrophy, fibromyalgia, and chronic fatigue syndrome are part of a disease continuum is unclear, but it seems probable that psychosocial problems are often important contributing factors in all three conditions.

Immunoglobulin subclass deficiencies are being increasingly delineated, occurring in chronic fatigue syndrome as well as many other disease states. Their clinical relevance still remains, for the most part, uncertain. Short stature occurs in many chronic illnesses, and the role of growth hormone treatment in these conditions is beginning to be investigated.

 

Source: Malleson PN. Pain syndromes, disability, and chronic disease in childhood. Curr Opin Rheumatol. 1991 Oct;3(5):860-6. http://www.ncbi.nlm.nih.gov/pubmed/1836344