Fibromyalgia & Chronic Fatigue Syndrome

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Autoimmune diseases are on the rise. Both Fibromyalgia and Chronic Fatigue have been considered to be autoimmune diseases. The fact is based upon new studies which show that immune tests are abnormal in both these conditions. Both of these diseases tend to occur in people who have other autoimmune diseases.

There are many ways to treat Fibromyalgia and Chronic Fatigue Syndrome here we are presenting the immunological features of these conditions. Where you can diagnose them by a blood tests  and treat them by IVIg .

A person is supposed to have Fibromyalgia if they have body pain in all or one half or all of the body for at least six months. They have tender areas in the neck, back, hips, shoulders, elbows and knees.. The pain usually gets worse when a storm front is approaching and the barometer falls. This is associated with body stiffness.  Will usually tend to start on the left side of the body with complaints of vague numbness. These spells of numbness then spread to the other side of the body.

A person with Chronic Fatigue usually feel excessively tired. The fatigue is so severe that they have difficulty doing things at home. Both Chronic Fatigue and Fibromyalgia can occur in the same patient at the same time. With chronic fatigue patients tend to have excessive infections like sinusitis, flu, bronchitis or runny nose. 

Fibromyalgia and Chronic Fatigue Syndrome are extremely common chronic condition .  The  current etiologyis considered to be immune deficiency, characteristic alterations in the pattern of sleep and changes. The diagnosis is clinical and is characterized by widespread pain, tender points and, commonly, comorbid conditions such as chronic fatigue, insomnia and depression. The diagnosis can be confirmed by doing a IgG and IgG sublass screen. Treatment is is by using IVIg, although experience and small clinical studies have proved the efficacy IVIg. Other less well-studied measures, such as trigger point treatment, also appear to be helpful. Management relies heavily on the physician's supportive counseling skills and willingness to try novel strategies in refractory cases

Fibromyalgia is a rheumatologic condition characterized by spontaneous, widespread soft tissue pain, sleep disturbance, fatigue and extensively distributed areas of tenderness known as tender points. Estimates of prevalence are 3.4 percent for women and 0.5 percent for men.¹

Fibromyalgia can be perplexing to patients and physicians because of the lack of associated abnormalities on readily available diagnostic tests. Despite this, recent findings about the pathogenesis and pathophysiology of fibromyalgia have dispelled the belief that the disorder is psychosomatic. While no laboratory test can confirm fibromyalgia, most patients present with a history of widespread pain, physical findings and comorbid conditions. With experience, the disorder may be diagnosed with confidence on initial presentation or after a period of observation and minimal diagnostic testing. The family physician is ideally suited to treat fibromyalgia because its management calls for a longitudinal relationship, a willingness to try different therapeutic modalities and an understanding of the interrelationship of the biopsychosocial aspects of health.

Pathophysiology

While the cause of fibromyalgia  is currently considered by some  to be a  a immune mediated disease in some cases assossiated with a  IgG subclass deficiency.

Diagnosis

Fibromyalgia should be considered in any patient with musculoskeletal pain that is unrelated to a clearly defined anatomic lesion. Making the diagnosis of fibromyalgia depends on findings from the history and physical examination rather than on diagnostic testing.

In 1990, the American College of Rheumatology (ACR) established criteria for classifying patients with fibromyalgia.⁹ However, failure to meet these criteria does not absolutely exclude the possibility of fibromyalgia.

As with other rheumatologic disorders, fibromyalgia:

• Is established on the basis of clinical observations.
• Is a condition with signs and symptoms that exist on a continuum.
• Often requires observation over time to firmly establish the diagnosis.
• Some patients will have low IgG levels or low IgG subclass levels,

History

Widespread pain is characteristic of fibromyalgia. Although not all areas may be involved simultaneously, pain may occur in the occiput, neck, shoulders, thoracic and lumbar spine, paraspinous regions, buttocks, hips, elbows and knees. People complain of pain, knots and hearing noises when they move the neck or other joints. The complaints of numbness are vague and usually cross anatomic boundaries.

Physical Examination

Examination will reveal areas of pain on palpation but without the classic inflammatory signs of redness, swelling and heat in the joints and soft tissue. Although tender points are found in many different locations, the ACR has selected 18 sites that are more characteristic for fibromyalgia (Figure 1). To be classified with a definitive diagnosis of fibromyalgia, the patient must have tenderness on palpation at 11 of the 18 sites and a history as defined in Table 1, although patients with fewer than 11 sites still may have fibromyalgia. The number of tender points may change over time.

Skill in palpation of tender points is critical to establishing a diagnosis of fibromyalgia. Physical findings encountered during palpation of the soft tissues include tender points, changes in skin texture, increased resting muscle tension and changes in the texture of the subcutaneous tissue. The muscles are at times felt to be stiff and hard. There may be reduced range of motion in the joints.

TABLE 1 American College of Rheumatology Criteria for Classification of Fibromyalgia Widespread pain for at least three months, defined as the presence of all of the following: Pain on the right and left sides of the body Pain above and below the waist (including shoulder and buttock pain) Pain in the axial skeleton (cervical, thoracic or lumbar spine, or anterior chest) Pain on palpation with a 4-kg force in 11 of the following 18 sites (nine bilateral sites, for a total of 18 sites): Occiput: at the insertions of one or more of the following muscles: trapezius, sternocleidomastoid, splenius capitus, semispinalis capitus Low cervical: at the anterior aspect of the interspaces between the transverse processes of C5-C7 Trapezius: at the midpoint of the upper border Supraspinatus: above the scapular spine near the medial border Second rib: just lateral to the second costochondral junctions Lateral epicondyle: 2 cm distal to the lateral epicondyle Gluteal: at the upper outer quadrant of the buttocks at the anterior edge of the gluteus maximus muscle Greater trochanter: posterior to the greater trochanteric prominence Knee: at the medial fat pad proximal to the joint line Adapted with permission from Wolfe F, Smythe HA, Yunas MB, Bennett RM, Bombardier C, Goldenberg DL, et al. The American College of Rheumatology 1990 criteria for the classification of fibromyalgia. Report of the Multicenter Criteria Committee. Arthritis Rheum 1990;33:160-72.

Associated Conditions

Patients with fibromyalgia often have one or more comorbid conditions (Table 2¹¹). Along with myofascial pain syndrome, the most common of these are migraine headache, irritable bowel syndrome and a history of depression and chronic fatigue.¹¹ Although treatment for fibromyalgia may help to alleviate the symptoms of comorbid conditions, specific treatment for these comorbidities may be indicated.

Treatment

Because the symptoms of fibromyalgia wax and wane, treatment (as with that of other chronic autoimmune diseases) is an ongoing process rather than management of a single episode. Flare-ups often exacerbate the patient's underlying stress. Furthermore, stress can also precipitate flare-ups of fibromyalgia. Physicians should spend some time eliciting and hearing the ongoing narrative of the struggle of living with a chronic disease and attempt to ameliorate the effects of the symptoms on the patient's quality of life.

For the treatment of irritable bowel syndrome just ask the person to eat small portions of diet 6-7 times a day. Thus they cannot have meals but only snacks.

People with Chronic Fatigue cannot do over activity. If they do they will have to pay for it by fatigue. Then they will have increased fatigue on the next few days. Due to immune dysfunction they cannot metabolize in the muscles.  .

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