Fibromyalgia & Myalgic Encephalomyelitis Flashcards
Abnormalities present in ME?
- neurological abnormalities (brain imaging shows abnormalities in grey and white matter)
- energy metabolism - impaired mitochondrial function (chronic viral & immune activation can cause this)
- infectious triggers - often follows infection
- immune activation - evidence of chronic T cell activation
- genetic component - twin studies, studies of HLA antigens, gene sequencing studies
Prevalence of fibromyalgia in Canada?
6%
Prevalence of CFS/ME in Canada?
3%
immune system findings in ME?
- shift toward Th2 dominant (humeral over cell-mediated immunity)
- immune activation w/increased T cells
- poor cellular function with low NK cell cytotoxicity
- dysregulation of antiviral defence pathway (2-5a synthetase/Rnase L)
What are the neuroendocrine dysregulation findings in ME?
- mild hypocortisolism & weakened diurnal cortisol curve (note effects on sleep: if bedtime cortisol is too low - insufficient REM sleep (poor sleep quality & architecture); if bedtime cortisol too high - suppresses melatonin [trouble initiating and sustaining sleep])
- reduced function of HPA axis
- blunted DHEA response to ACTH injection (despite normal base levels)
- relatively reduced levels of aldosterone (vs healthy controls)
describe cognitive impairment in ME?
- impaired working memory
- inability to synthesize new information
- decrease in ability to concentrate and multitask
- difficulty with word retrieval
- slowed processing speed
describe autonomic/CV disturbances in ME?
- orthostatic intolerance (development of symptoms when standing upright which are relieved when reclining)
- heart palpitations
- low blood volume
describe mitochondrial abnormalities in ME?
impaired aerobic metabolism:
impaired oxygen consumption during exercise
activation of anaerobic pathways in early stages of exercise
raised brain ventricular lactate levels
abnormal recovery after exercise
What do we know about the telomeres of CFS patients?
Telemores (ends of chromosomes) are shorter in patients with CFS than in matched healthy control subjects
Telomere length is a marker of cell aging; shorter telomeres indicate cells aging more rapidly
What are the common symptoms of CFS/ME, FM?
- Fatigue - profound, pathological
- Sleep - interrupted, non-restorative
- Pain - arthralgia, and/or myalgia
- CNS - decreased concentration and short term memory/ slowed processing / overload phenomenon [inability to multitask]
- autonomic nervous system - postural hypotension, vertigo, intestinal or bladder disturbances, cardiac arrhythmia, respiratory irregularities
- neuroendocrine: thermostatic instability, heat and cold intolerance, abnormal appetite, stress intolerance
- immune: sore throat, flu-like symptoms, general malaise, exacerbation of allergies, development of new allergies
- Neuroimmune: hypersensitivity to alcoholic beverages , medications and/or synthetic chemicals
unique PE findings
- red crescents on soft palate; coated tongue; cervical lymphadenopathy
- CNS: spacey, difficulty staying focused and retrieving words; poor balance; hyper- or hyporeflexia
- tender points
What does the Acronym CHHOPDD for taking environmental exposure history stand for?
Community Home Hobby Occupation Personal Diet Drugs
what labs should be done for this?
CBC + differential ESR ALT total protein, albumin, globulin alkaline phosphatase calcium, phosphorus glucose electrolytes creatinine TSH urinalysis
viral screen celiac profile vit D B12, ferritin, RBC magnesium and folate immunoelectrophoresis, C3, C4 urine/blood for mycoplasma/ureaplasma ANA, RF, anti-ds-DNA, anti-thyroid Ab Free T3, free T4, am/pm cortisol, ACTH
what other testing can we do aside from PE and labs?
- Beck depression inventory
- allergy testing
- RAND 36 questionnaire (The SF-36 taps eight health concepts: physical functioning, bodily pain, role limitations due to physical health problems, role limitations due to personal or emotional problems, general mental health, social functioning, energy/fatigue, and general health perceptions.)
- MRI (r/o MS)
- sleep study
- sinus X-rays and CT scan
- functional testing
Clinical criteria for CFS/ME dx?
- fatigue - severe, physical & mental; post-exertional
- sleep dysfunction
- pain
- neurological symptoms (2 neurocognitive sxs present)
- autonomic, neuroendocrine & immune symptoms (at least 2 of these 3 categories)
- chronic (adults >6mos, kids > 3mos)
