Summarized content of Chronic Fatigue Syndrome and Fibromyalgia

1. Chronic Fatigue syndrome
and Fibromyelgia

2. Approach to the adult patient with
fatigue
• Acute fatigue is defined as lasting one month or less, subacute
fatigue as lasting between one and six months, and chronic
fatigue as lasting over six months.
• Patients can have a state of chronic fatigue without meeting
criteria for chronic fatigue syndrome (CFS).

3. Chronic fatigue syndrome
• Persistent fatigue accompanied by other specific symptoms
• symptoms should be present for at least six months and have
moderate, substantial, or severe intensity at least one-half of the
time.
• (eg, DaCosta's syndrome, effort syndrome, soldier's heart,
neurasthenia, myalgic encephalitis/encephalomyelitis, Iceland
disease, Akureyri disease, Royal Free disease, and chronic fatigue and
immune dysfunction syndrome

4. • In addition to fatigue, other criteria include: post-exertional
malaise, unrefreshing sleep, cognitive impairment, and
orthostatic-related symptoms.

5. • Chronic fatigue syndrome is disorder without a known cause.
• May be related to a previous infection.
• CFS for six months .
• Accompanied by cognitive difficulties :problems with short-term memory and
Concentration.

6. Why its important
• Prevalence of CFS : 0.2–0.4%
• Age: Occur at any age, but it most
• commonly affects people in their 40s and
• 50s.
• - sex: Women more than men
• - Live style : overweight and inactive .
• - Stress appears to be a factor.

8. What else to look for ?

11. PATHOPHYSIOLOGY
1.Unknown including oxidative stress,
2. Genetic predisposition,
3. Infection by viruses as Epstein-Barr, human herpesvirus 6 and leukemia viruses.
4. Hypothalamic-pituitary-adrenal axis
5. Immune dysfunction as well as
psychological and psychosocial factors.

15. Management
• Manage symptoms early – do not wait for diagnosis
• Advise about:
-Fitness for work and education
- Adjustments or adaptations
-Liaise with:
- employers
-education providers
- support services

16. When to refer ?
• Refer to specialist CFS care depend on:
- Person’s needs
- Symptoms (type, duration, complexity, severity)
- Comorbidities
- Referral within 6 months if CFS is mild, 3-4 months if moderate and immediately if severe

18. • Combination of psychological counseling with a gentle exercise
program.
• Graded exercise : Inactive people often begin with range-of-motion and stretching exercises
for just a few minutes a day.
• Psychological counseling: To figure out options to work around some
of the limitations ,Feeling more in control of life can improve CFS
dramatically.

19. • In general, treatment must be individualized, addressing the most
disruptive symptoms first
so its good to establish a good rapport with the patient
Sleep disorders: frequent awakenings during the night (difficulty
staying asleep) and awakening unrested nearly every morning.
Sleep hygiene measures should be discussed with patients with
insomnia.
Amitriptyline 10 mg one hour before bedtime is a good starting dose.

20. Dizziness and lightheadedness
• There may be a role for fludrocortisone or atenolol in patients
with CFS who have persistent dizziness and lightheadedness
• We begin with fludrocortisone at a dose of 0.1 mg daily. If there
is no benefit in two weeks, we increase the dose to 0.2 mg daily.
If this is not effective, we switch to atenolol at an initial dose of
25 mg daily, and increase the dose every two weeks up to a
maximum of 100 mg daily

21. Fibromyelgia
• Fibromyalgia is an idiopathic, chronic, nonarticular pain syndrome with generalized tender points.
• It is a multisystem disease characterized by sleep disturbance, fatigue, headache, morning
stiffness, paresthesias, and anxiety
• Initially called fibrositis, the name was changed to fibromyalgia when it became evident that
inflammation was not a part of this condition

22. Epidemiology
• Fibromyalgia is a common rheumatologic disorder that is underdiagnosed. Using the 1990 ACR
classification criteria, the prevalence of fibromyalgia in the general population of the United States is
reported to be 3.4 percent in women and 0.5 percent in men.3 Prevalence increases steadily
through 80 years of age, and then declines. This condition affects women 10 times more often than
men.
• Fibromyalgia is usually considered a disorder of women 20 to 50 years of age; however, it also has
been observed in males, children, adolescents, and older persons. Fibromyalgia is more common in
relatives of patients with fibromyalgia suggesting the contribution of both genetic and environmental
factors

23. Pathophysiology
• The pathophysiology of fibromyalgia is unclear. Fibromyalgia clusters in families, suggesting a
genetic predisposition. Environmental and psychological factors which could impact various
members of the same
• family, may contribute to the symptomatology of the disease.
• Current theories of pathogenesis include central sensitization and hypothalamic-pituitary-
adrenal axis dysregulation; however, more research is needed to determine a definite
pathophysiology.

25. Diagnosis
• Fibromyalgia is not a diagnosis of exclusion and should be identified by its own characteristics
• The ACR criteria have two components: (1) widespread pain involving both sides of the body, above
and below the waist as well as the axial skeletal system, for at least three months; and (2) presence
of 11 tenderpoints among the nine pairs of specified sites (18 points) as shown in Figure 1.2

27. Differential Diagnosis
• myofascial pain syndrome, chronic fatigue syndrome, and hypothyroidism.
• These conditions also can affect patients with fibromyalgia, thereby making the diagnosis more
difficult.