Rheumatology diseases that may not be real

Question 1

What is Chronic Fatigue syndrome? AKA? S/S?

Answer 1

presenting with acute onset of severe fatigue after what appears to be a viral infection (possibly EBV). His symptoms have been persistent and disabling and the fatigue is his major complaint, though he has some associated mild musculoskeletal and joint pain without objective findings on either examination or laboratory examination. He additionally complains of worsening fatigue which is severe after exercise, unrefreshing sleep, as well as progressive cognitive impairment. This is consistent with chronic fatigue syndrome (CFS) or myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), an unexplained disease that is usually considered after six months of fatigue that lasts at least half of the time and is moderate or severe in intensity. Other symptoms of the disease include post-exertional fatigue, poor sleep, cognitive impairment, and orthostatic-related symptoms. Symptom onset is usually acute and often felt to be temporally related to an infection, though no specific infectious agent has been determined.

The examination in patients with chronic fatigue syndrome is usually normal. There may be some joint pain, but no synovitis, erythema, or effusion. While muscle fatigue is a common complaint, strength is normal and biopsy or electromyogram will be normal. Some lymphadenitis may be reported, but true lymphadenopathy is absent and lymph node biopsy will show only reactive hyperplasia. Any abnormal physical examination findings should raise concern for an alternative diagnosis. Some patients may have significant overlap with fibromyalgia and meet the criteria for both. Unfortunately, there is no treatment for chronic fatigue syndrome. Sometimes the symptoms improve over time or they may have a relapsing/remitting pattern.

Question 2

What are the 2015 institute of Medicine Diagnostic criteria for Chronic fatigue syndrome?

Answer 2

The following symptoms MUST be present:
Substantial reduction in pre-illness functioning of at least six months, accompanied by profound fatigue which is new in onset (not lifelong), and is not due to ongoing excessive exertion or relieved by rest
Post-exertional malaise
Unrefreshing sleep

At least one of the two following symptoms MUST be present:
Cognitive impairment
Orthostatic intolerance