Chronic fatigue syndrome differential diagnosis: Difference between revisions
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One review (2006) found that there was a lack of literature to establish the [[discriminant validity]] of undifferentiated [[somatoform disorder]] from CFS. The author stated that there is a need for proponents of chronic fatigue syndrome to distinguish it from undifferentiated somatoform disorder. The author also mentioned that the experience of fatigue as exclusively physical and not mental is captured by the definition of somatoform disorder but not CFS.<ref>{{cite journal | author = van Staden WC | title = Conceptual issues in undifferentiated somatoform disorder and chronic fatigue syndrome. | journal = Curr Opin Psychiatry | volume = 19 | issue = 6 | pages = 613–8 | year = 2006 | pmid = 17012941}}</ref> Hysterical diagnoses are not merely diagnoses of exclusion but require criteria to be met on the positive grounds of both primary and secondary gain.<ref>Jenkins R, Mowbray J, ed. Post-viral Fatigue Syndrome. 1991 John Wiley & Sons Ltd</ref> Primary Depression can be excluded in the [[differential diagnosis]] due to the absence of [[anhedonia]] and [[la belle indifference]], the variability (lability) of mood, and the presence of sensory phenomena and somatic signs such as ataxia, myclonus and most importantly, exercise intolerance with paresis, malaise and general deterioration, which can in some cases become a comorbid situational depression. | One review (2006) found that there was a lack of literature to establish the [[discriminant validity]] of undifferentiated [[somatoform disorder]] from CFS. The author stated that there is a need for proponents of chronic fatigue syndrome to distinguish it from undifferentiated somatoform disorder. The author also mentioned that the experience of fatigue as exclusively physical and not mental is captured by the definition of somatoform disorder but not CFS.<ref>{{cite journal | author = van Staden WC | title = Conceptual issues in undifferentiated somatoform disorder and chronic fatigue syndrome. | journal = Curr Opin Psychiatry | volume = 19 | issue = 6 | pages = 613–8 | year = 2006 | pmid = 17012941}}</ref> Hysterical diagnoses are not merely diagnoses of exclusion but require criteria to be met on the positive grounds of both primary and secondary gain.<ref>Jenkins R, Mowbray J, ed. Post-viral Fatigue Syndrome. 1991 John Wiley & Sons Ltd</ref> Primary Depression can be excluded in the [[differential diagnosis]] due to the absence of [[anhedonia]] and [[la belle indifference]], the variability (lability) of mood, and the presence of sensory phenomena and somatic signs such as ataxia, myclonus and most importantly, exercise intolerance with paresis, malaise and general deterioration, which can in some cases become a comorbid situational depression. | ||
{| class="wikitable" | |||
!Disease | |||
!Differentiating signs and symptoms | |||
!Diagnostic findings | |||
|- | |||
|[[Fibromyalgia]] | |||
| | |||
* Symptoms have been present at a similar level for at least 3 months. | |||
* Chronic [[musculoskeletal pain]] with multiple tender points | |||
* [[Stiffness]], [[numbness]], and [[fatigue]] | |||
* [[Headaches]] | |||
* [[Sleep disorder]] | |||
| | |||
*All lab tests are normal | |||
|- | |||
|[[Rheumatoid arthritis]] | |||
| | |||
* Multiple [[joint swelling]] | |||
* Morning [[stiffness]] | |||
* [[Rheumatoid nodules]] | |||
| | |||
* [[Rheumatoid factor|RF]] or [[Anti-citrullinated protein antibody|anti-cyclic citrullinated protein (CCP) antibody]] is positive. | |||
* Markers of systemic inflammation ([[ESR]], [[CRP]]) are typically elevated. | |||
|- | |||
|[[SLE]] | |||
| | |||
* [[Maculopapular rash]] | |||
* Multi-system involvement | |||
| | |||
*Positive anti-Smith [[antibodies]] | |||
|- | |||
|[[Chronic fatigue syndrome]] | |||
|Fatigue plus 4 of the following symptoms: | |||
*Short-term [[memory loss]] | |||
*[[Sore throat]] | |||
*Tender [[lymph nodes]] in the neck or armpit | |||
*[[Muscle pain]] | |||
*[[Joint pain]] without [[swelling]] or [[Redness of the skin|redness]] | |||
*[[Headaches]] | |||
*[[Insomnia]] | |||
*[[Malaise]] | |||
| | |||
*Diagnosis of exclusions | |||
*Symptoms must present for more than 6 months | |||
|- | |||
|[[Spondyloarthritis]] | |||
| | |||
* [[Axial skeleton|Axial skeletal]] pain and [[stiffness]] | |||
* Restricted spinal motion | |||
| | |||
* Elevated [[ESR]] or [[CRP]] | |||
* Negative [[RF]] | |||
* [[Bamboo spine]] on [[x-ray]] | |||
|- | |||
|[[Polymyalgia rheumatica]] | |||
| | |||
* Older at onset | |||
* Generalized [[stiffness]] | |||
| | |||
* An elevated [[erythrocyte sedimentation rate]] ([[ESR]]) OR [[C-reactive protein]] (CRP) | |||
* Response to [[corticosteroids]] | |||
|- | |||
|[[Osteoarthritis]] | |||
| | |||
* Localized [[joint pain]] | |||
* Restricted to affect joints | |||
* Older at onset | |||
| | |||
* [[X-ray]] of the involved joints demonstrate degenerative changes | |||
|- | |||
|[[Hypothyroidism]] | |||
| | |||
*Systemic symptoms such as [[weight gain]], [[constipation]], [[dry skin]] | |||
*[[Myalgia|Muscular aching]] and prominent [[fatigue]] that improves on replacement of [[thyroid hormone]]. | |||
| | |||
*[[TSH]] is elevated and free [[T4]] is low. | |||
|- | |||
|Myopathaies ([[polymyositis]] and [[dermatomyositis]]) | |||
| | |||
*Pelvic and shoulder girdle [[muscle weakness]] | |||
*[[Rash]] | |||
| | |||
*[[Muscle biopsy]] confirms the diagnosis | |||
*Elevated [[CPK|CPK enzyme]] | |||
|- | |||
|[[Neuropathy]] | |||
| | |||
*[[Numbness]] and [[tingling]] | |||
*[[Paresthesia]] | |||
| | |||
*Abnormal [[EMG]] | |||
|} | |||
==References== | ==References== | ||
Revision as of 18:41, 14 August 2017
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Chronic fatigue syndrome Microchapters |
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Differentiating Chronic fatigue syndrome from other Diseases |
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Diagnosis |
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Treatment |
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Chronic fatigue syndrome differential diagnosis On the Web |
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American Roentgen Ray Society Images of Chronic fatigue syndrome differential diagnosis |
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Risk calculators and risk factors for Chronic fatigue syndrome differential diagnosis |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Disease associations
Some diseases show a considerable overlap with CFS. According to an article in American Family Physician in 2002, Multiple Sclerosis, Thyroid disorders, anemia, and diabetes are but a few of the diseases that must be ruled out if the patient presents with appropriate symptoms.[1]
People with fibromyalgia (FM, or Fibromyalgia Syndrome, FMS) have muscle pain and sleep disturbances. Fatigue and muscle pain occurs frequently in the initial phase of various hereditary muscle disorders and in several autoimmune, endocrine and metabolic syndromes; and are frequently labelled as CFS or fibromyalgia in the absence of obvious biochemical/metabolic abnormalities and neurological symptoms.[2] Those with multiple chemical sensitivity (MCS) are sensitive to chemicals and have sleep disturbances. Many veterans with Gulf War syndrome (GWS) have symptoms almost identical to CFS.[3] One study found several parallels when relating the symptoms of Post-polio syndrome with CFS, and postulates a possible common pathophysiology for the illnesses.[4]
Although post-Lyme syndrome and CFS share many features/symptoms, a study found that patients of the former experience more cognitive impairment and the patients of the latter experience more flu-like symptoms.[5]
One review (2006) found that there was a lack of literature to establish the discriminant validity of undifferentiated somatoform disorder from CFS. The author stated that there is a need for proponents of chronic fatigue syndrome to distinguish it from undifferentiated somatoform disorder. The author also mentioned that the experience of fatigue as exclusively physical and not mental is captured by the definition of somatoform disorder but not CFS.[6] Hysterical diagnoses are not merely diagnoses of exclusion but require criteria to be met on the positive grounds of both primary and secondary gain.[7] Primary Depression can be excluded in the differential diagnosis due to the absence of anhedonia and la belle indifference, the variability (lability) of mood, and the presence of sensory phenomena and somatic signs such as ataxia, myclonus and most importantly, exercise intolerance with paresis, malaise and general deterioration, which can in some cases become a comorbid situational depression.
| Disease | Differentiating signs and symptoms | Diagnostic findings |
|---|---|---|
| Fibromyalgia |
|
|
| Rheumatoid arthritis |
|
|
| SLE |
|
|
| Chronic fatigue syndrome | Fatigue plus 4 of the following symptoms:
|
|
| Spondyloarthritis |
|
|
| Polymyalgia rheumatica |
|
|
| Osteoarthritis |
|
|
| Hypothyroidism |
|
|
| Myopathaies (polymyositis and dermatomyositis) |
|
|
| Neuropathy |
|
References
- ↑ Craig, T and Kakumanu S (Mar 2002). "Chronic fatigue syndrome: evaluation and treatment". Am Fam Physician. 65 (6): 1083–90. PMID 11925084.
- ↑ van de Glind G, de Vries M, Rodenburg R, Hol F, Smeitink J, Morava E (2007). "Resting muscle pain as the first clinical symptom in children carrying the MTTK A8344G mutation". Eur J Paediatr Neurol. PMID 17293137.
- ↑ Vojdani A, Thrasher J (2004). "Cellular and humoral immune abnormalities in Gulf War veterans". Environ Health Perspect. 112 (8): 840–6. doi:10.1289/ehp.6881. PMID 15175170.
- ↑ Bruno RL, Creange SJ, Frick NM (1998). "Parallels between post-polio fatigue and chronic fatigue syndrome: a common pathophysiology?". Am J Med. 105 (3A): 66S–73S. doi:10.1016/S0002-9343(98)00161-2. PMID 9790485.
- ↑ Gaudino EA, Coyle PK, Krupp LB (1997). "Post-Lyme syndrome and chronic fatigue syndrome. Neuropsychiatric similarities and differences". Arch Neurol. 54 (11): 1372–6. PMID 9362985.
- ↑ van Staden WC (2006). "Conceptual issues in undifferentiated somatoform disorder and chronic fatigue syndrome". Curr Opin Psychiatry. 19 (6): 613–8. PMID 17012941.
- ↑ Jenkins R, Mowbray J, ed. Post-viral Fatigue Syndrome. 1991 John Wiley & Sons Ltd