Arch Dermatol -- Page Not Found 1992;12549551. MEDLINE 2. Mana J, Marcoval J, Graells J, Salazar A. Cutaneousinvolvement in sarcoidoisis relationship to systemic disease. Arch Dermatol. http://archderm.ama-assn.org/issues/v137n4/ffull/dlt0401-6.html
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Family Connection Question - Www.ezboard.com Like MS, JRA, Rheumatoid arthritis, Lupus, sarcoidoisis, Sjogrens syndrome,ankylosing spondylitis and others. I hope this helps, Mike B. http://pub5.ezboard.com/firitisiritisfaqforum.showMessage?topicID=700.topic
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SIMeR - Gruppi Di Studio - Fisiopatologia Respiratoria Translate this page in inducing an increase of the oxidative burst of both circulating monocytes andalveolar macrophages in patients with active pulmonary sarcoidoisis as well as http://www.pneumonet.it/simer/gr_stud/gr4/documenti.html
DJO - Knowledge Review Chest XRay would be useful to rule out sarcoidoisis and rarely tuberculosisas a possible cause of lacrimal gland enlargement. http://www.djo.harvard.edu/KR/Shiuey012398/Shiuey012398A.html
Extractions: Answer: There are many entities in the differential diagnosis of a lacrimal gland mass including: sarcoidosis, orbital inflammatory pseudotumor, pleomorphic adenoma (benign mixed tumor), dermoid, lymphoid tumor, adenoid cystic carcinoma, pleomorphic adenocarcinoma (malignant mixed tumor), lacrimal gland cyst (dacryops), dacryoadenitis. Other entities are also possible. Answer: CT scan of the orbits with axial and coronal cuts will help define the nature of the lesion. Chest X-Ray would be useful to rule out sarcoidoisis and rarely tuberculosis as a possible cause of lacrimal gland enlargement. If there is suspicion of lymphoma abdominal and head CT imaging may be indicated after consultation with an internist.
Extractions: Pneumococcal disease accounts for 80,000 cases of pneumonia, 4,000 cases of bacteremia, and 500 cases of meningitis in Canada each year. Based on data collected by sentinel health units across Canada in 1996, the annual incidence rate for invasive pneumococcal disease (based on invasive isolates of Streptococcus pneumoniae) is estimated to be 15.1/100,000 population. Table 1:
Sjogren's Syndrome Iatrogenic xerostomia due to drugs; irradiation; graftversus-host disease. Non-iatrogenicxerostomia due to sarcoidoisis; HIV Disease. Special Investigations. http://www.eastman.ucl.ac.uk/cal/oralmed/97_98/salivary/sjogrens.htm
CHEST Prednisone Improves Symptoms But Not Lung Function In Prednisone should still be prescribed in symptomatic patients with sarcoidoisisbecause, there are no other drugs in the pipeline for this disease. , http://www.pslgroup.com/dg/20d4ca.htm
December 2002 many people who will understand. I was diagnosed with sarcoidoisisjust after Thanksgiving this year (2002). I have been going to http://www.sarcoidosisonlinesites.com/msgforum/archive/122002.htm
Extractions: At the time I first had a bad chest xray 1/99....my eyes would burn daily. I thought it was just allergies. When I found out by biopsy 8/99 that I had sarc I had the answer to my lung problems. Never went on meds and my symptoms went away in 2000. My chest xray shows improvement each time I have one but I was told by Dr. Sharma that they may never be totally clear again. Now to my eyes. I found out last year I had dry eyes and that is why they were burning. I know sarcoidosis can be cause of dry eye and I see my eye doctor every 6 months. Last week it was very windy and I started to have some pains in my eye. Saw the eye doctor who said that it was the dry eye and he put plugs in.
Extractions: Too much medical research is based on what is called "epidemiological" studies. Instead of trying to get an understanding of what endocrinological factors are behind a disease, the epidemiologist gathers together a lot of statistical data from a census, or from a hospital's records, and tries to make inferences based (usually) purely on the statistical (epidemiological) data. I, too, was trained in statistics. But my professor introduced the course with a book called "How to Lie with Statistics". Effectively it showed the many ways in which statistics can be misused in order to prove one's own point. We were taught to make sure that we understood the problem before beginning to draw inferences from the data.
Answers To Syllabus Questions- Cumulative Both caseating (eg typical of mycobacterial infections) and noncaseating granulomas(eg sarcoidoisis) are forms of immune granulomas (see text). http://141.214.6.12/cyberscope631/answers.htm
Extractions: TISSUE INJURY LAB These vacuoles consist of triglyceride predominantly and reflect either increased fatty acid synthesis (protein malnutrition), increased delivery (obesity, peripheral lipolysis) or decreased processing due to cell injury (alcohol [most common cause in industrialized societies], other toxins). Alcohol used to dehydrate sections (so that paraffin can be infused) extracts lipids. Also fat does not stain with the hematoxylin (nucleic acids) or eosin (protein) dyes used to make cells visible. Other lipids (cholesterol and cholesterol esters in atherosclerotic plaques [see slide 12], lipids ingested by phagocytic cells); glycogen (accumulates in many cells when glucose or glycogen metabolism is defective, e.g. Diabetes mellitus); some "mucins". Sometimes the appearance of deposit provides clue to contents- triglycerides accumulate in round vacuoles, cholesterol and its esters form crystals which appear as "clefts" in routine sections, glycogen deposits have less defined "vacuoles" than lipids. Tissues can also be stained with dyes that react with specific substances such as Oil red-O or Sudan black for lipids and the periodic acid Schiff (PAS) reaction for polysaccharides such as glycogen. The appearance in routine tissue sections and the reactivity with selective dyes are useful for the general categorization of deposits.
HDC - Health And Disability Commissioner It is possible that Ms A's worsening health and associated anxiety about the haematuriaand possible sarcoidoisis, and possible other factors, resulted in a http://www.hdc.org.nz/opinions/opin_2000/00HDC06335.html
Extractions: Ms A Consumer Dr B Provider/General Practitioner, a Medical Centre Dr C A second General Practitioner consulted by Ms A Dr D A General Practitioner in the same practice as Dr B. Ms A's medical records from two medical centres and a private hospital were obtained and reviewed. The Commissioner also sought expert medical advice from two independent general practitioners, Dr Chris Kalderimis, and Dr Keith Carey-Smith. Complaint The Commissioner received a complaint from Ms A on 20 June 2000 regarding the services she received between October 1999 and February 2000 from Dr B, general practitioner at a medical centre. The complaint is as follows: When Ms A consulted Dr B between 4 October 1999 and 14 February 2000, Dr B: did not listen or act upon Ms A' description of her symptoms or her concerns failed to diagnose that Ms A had an atrial myxoma. An investigation was commenced on 4 October 2000. On 21 March 2001 a provisional no breach opinion was sent to Ms A. Ms A provided an extensive response to the Commissioner's provisional opinion. The matter was then referred to the Commissioner's expert advisor for further comment. Additional expert advice was also received from a further independent general practitioner. Information gathered during investigation Ms A, aged 42 at the time of the complaint, stated that she consulted the medical centre on 18 August 1999, as she required a medical report for insurance purposes. The completed report was lost, so Ms A made an appointment for 4 October 1999 at the medical centre to obtain another medical report.
Extractions: Chronic Fatigue Syndrome (CFS), also known as Chronic Fatigue and Immune Dysfunction Syndrome (CFIDS), Fibromyalgia Syndrome (FMS), Multiple Chemical Sensitivity (MCS), and Gulf War Syndrome (GWS) share many of the same symptoms, and often occur together, but they differ greatly in the methods used for their diagnosis and treatment. Which of these diagnoses a person receives usually depends on the type of specialist he or she sees. CFS is most likely to be diagnosed by internists or infectious disease specialists, FMS by rheumatologists, and MCS by occupational and environmental medicine physicians. Gulf War Syndrome is seen mostly by military and VA physicians buteven though the top 10 symptoms they report are all common to CFS, FMS and MCSthey call them "unexplained" and refuse to even screen for any of these disorders. DISEASES WHICH CAUSE FEVER WITH JOINT AND MUSCLE PAIN Infectious Arthritis. Lyme disease, septic arthritis, bacterial endocarditis, mycobacterial and fungal arthritis, viral arthritis. Postinfectious or Reactive Arthritis. Enteric infection, Reiter's syndrome, rheumatic fever, inflammatory bowel disease.
SARCOID (London) I was first diagnosed in having sarcoidoisis at age 27, which was very hard for meto deal with, as most doctors couldnt even tell me what I was suffering from http://www.cheshire-med.com/programs/pulrehab/forum/messages/27578.html
Extractions: Follow Ups Post Followup TCMC Chronic Lung Disease Forum FAQ Posted by Marcus Suitor on June 12, 2000 at 06:04:12: My name is Marcus, I am 30 years old and live in London (England). I was first diagnosed in having Sarcoidoisis at age 27, which was very hard for me to deal with, as most doctors couldnt even tell me what I was suffering from. To date I am constantly in and out of hospital, constant testing here and there and it is very frustrating and de-moralising. Over the last three years I have learned to deal with it, but am still finding it very difficult in getting straight answers from the doctors. I would like to know if there are any support groups near by, where I could maybe attend to learn more about my illness. As for others who may be suffering from this mystery illness,.. dont let it get to you, I know its had at times, but dont give up faith.
Extractions: Ask NOAH About: Chronic Fatigue Syndrome Bron: http://noah.cuny.edu/wellkon/chonicftge.html Datum: 10-10-1996 Chronic Fatigue Syndrome - What Is Chronic Fatigue Syndrome? - What Are the Symptoms of Chronic Fatigue Syndrome? - What Other Conditions Show the Same Symptoms as Chronic Fatigue Syndrome? - Who Gets Chronic Fatigue Syndrome? - What Causes Chronic Fatigue Syndrome? - What Tests May Be Required to Diagnose Chronic Fatigue Syndrome? - How Serious Is Chronic Fatigue Syndrome? - How Is Chronic Fatigue Syndrome Treated? - How Can Chronic Fatigue Syndrome Be Prevented? - Where Else Can Help Be Found for Chronic Fatigue Syndrome? - Diseases Which Cause Fever With Joint and Muscle Pain - What Is Chronic Fatigue Syndrome? Over 6 million patient visits are made each year because of fatigue, although a very small percentage of these can be attributed to chronic fatigue syndrome. Depression, infections, pregnancy, extreme exercise, and excessive stressthese and many other factors can lead to feelings of exhaustion. In many instances, fatigue can be relieved with adequate rest. It is important to note that because fatigue can be the harbinger of a serious medical or psychologic problem, anyone who experiences unexplained fatigue longer than one month should see a physician. If no medical or psychological problems account for the fatigue, and if it has lasted for more than six months and impairs normal activities, experts define the condition as unexplained chronic fatigue. The Centers for Disease Control have now developed criteria for further differentiating this unexplained fatigue as either chronic fatigue syndrome (CFS) or idiopathic chronic fatigue. (Idiopathic simply means that the cause is not known.) A number of physicians still believe that CFS is not an actual disease but a col- lection of symptoms that may be attributable to different causes, inclu- ding viruses, medical conditions, or responses to psychologic conditions or stresses. - What Are the Symptoms of Chronic Fatigue Syndrome? Fatigue that persists or occurs regularly for longer than six months is considered to be chronic fatigue. When other medical or psychological conditions have been ruled out, chronic fatigue syndrome, is diagnosed if other criteria are met. If the following criteria are not met, then the condition is considered to be idiopathic chronic fatigue. First, the fatigue must be severethat is, it is not relieved by sleep or rest, it is not the result of excessive work or exercise, and the fatigue substantially impairs a person's ability to function normally at home, at work, and in social occasions. The fatigue must be a newnot life-long condition with a definite time of onset. For instance, many patients with chronic fatigue report having had a flu-like illness that triggered it. (In one study 20% reported chronic fatigue following a flu.) Often, the condition first appears as a viral upper respiratory tract infection marked by some combination of fever, headache, muscle aches, sore throat, earache, congestion, runny nose, cough, diarrhea, and fatigue. Typically, the initial illness is no more severe than any cold or flu. Second, for a condition to be diagnosed as chronic fatigue syndrome, four or more of the following symptoms must have been present for longer than six months: 1.short-term memory loss or a severe inability to concentrate that affects work, school, or other normal activities; 2.sore throat; 3.swollen lymph nodes in the neck or armpits; 4.muscle or pain in a number of joints without redness or swelling; 5.headaches that do not resemble previous types; 6.unrefreshing sleep; 7.after any exertion, weariness that lasts for more than a day. Some experts also add to this criteria nausea, and, possibly, intolerance to alcohol, and dry mouth. In ordinary infections, symptoms go away after a few days, but in CFS, fatigue and other symptoms recur or persist for months to years. Many patients experience symptoms as recurring bouts of flu-like illness, with each attack lasting from hours to weeks. Even mild exercise often makes the symptoms, especially fatigue, much worse. - What Other Conditions Show the Same Symptoms as Chronic Fatigue Syndrome? In one study, 27% of people experienced fatigue for over six months, but most of these cases were explained by other medical or psychologic pro- blems; only 8.5% of these patients had fatigue that could be diagnosed as CFS according to various definitions, and only 2% continued to seek medi- cal help for the problem. Many factors must be considered as possible other causes of chronic fatigue, including various physical diseases, sleep disturbances, medications, and toxins. Psychologic causes of fatigue, including depression and anxiety, must also be considered. Because no laboratory test can confirm a diagnosis of chronic fatigue syndrome, physicians must first rule out other conditions. The problem becomes increasingly confused because fatigue, muscle and joint aches, and flu-like symptoms comprise many disorders that also do not lend themselves easily to a definite diagnosis. Experts have recently defined conditions that would rule out unexplained chronic fatiguethat is, either CFS or idiopathic chronic fatigue. - Conditions That Rule Out CFS. - Medical Conditions. Many diseases, both benign and serious, can fully explain prolonged or chronic fatigue, including hepatitis, anemia, infec- tions, various forms of cancer, neuromuscular diseases (such as multiple sclerosis or myasthenia gravis), hypothyroidism, and diabetes. In additi- on, a number of illnesses also cause arthritic symptoms and fever [see Table, below]. Physicians can usually distinguish these diseases from CFS after a clinical evaluation and laboratory testing. Patients and physici- ans should also not overlook diseases that have been previously treated, but which may not have completely resolved or may cause residual fatigue, including Lyme disease, cancer, or hepatitis. - Depression and Psychosis. The Centers for Disease Control, which set up the definitions for research in chronic fatigue syndrome, recognize depression as one of the symptoms of CFS, but rule out chronic fatigue syndrome as a diagnosis for anyone with a history of major depression or other psychiatric disorder. British and Australian researchers do not make such an exclusion, since depression and chronic fatigue syndrome can and often do coexist. The link between psychologic disorders and chronic fatigue syndrome is problematic, because so many of the symptoms overlap with each other and also can occur as symptoms in other disorders. Fatigu- e, listlessness, poor concentration, memory deficits, agitation, and sleep disorders can all be manifestations of depression and anxiety. Stressful eventssuch as surgery, a significant illness or injury, the birth of a child, divorce, the death of a loved one, or other serious emotional traumafurther complicate the picture, because even everyday stress can contribute to fatigue and may play a role in lowering the body's resistan- ce to infection. Depression is very common, affecting up to a fifth of all Americans at some point in their lives, and most depressed people feel fatigued. Unlike ordinary periods of sadness, an episode of depression can last many months. Symptoms of depression include : 1.a depressed mood daily, 2.significant weight gain or loss (more than 10% of an individual's normal body weight), 3.insomnia or excessive sleeping, 4.restlessness or a sense of being slowed down, 5.low energy daily, 6.worthless or inappropriately guilty feelings, 7.an inability to concentrate or to make decisions, and 8.suicidal thoughts. The presence of several of these symptoms suggests depression, particular- ly if physical symptoms, such as sore throat, aches and pains, or fever, are not also present. The longer fatigue continues without the presentati- on of other symptoms, the more likely the diagnosis is depression. Although many patients who are diagnosed with CFS report feeling depressed before the onset of chronic fatigue, many feel alert and well before experiencing chronic fatigue. Depression in people with CFS is usually a reaction to the disease. They are discouraged, but not hopeless and wish to enjoy life, not avoid it. Many of these previously healthy patients get depressed and anxious because they feel so exhausted all the time after coming down with the syndrome. - Sleep Disturbances.Another cause of long-term fatigue is chronic sleep deprivation. In one small study of people who had been diagnosed with chronic fatigue syndrome, it turned out that over half were suffering from sleep disorders, including insomnia, which caused the daytime fatigue. Chronic sleep deprivation can occur during sleep itself because of the sleep apnea syndrome, a breathing disorder often marked by loud snoring and thrashing in bed. A person may have this condition and not realize it unless it is brought to his or her attention by a sleeping partner or observer. At particular risk for sleep apnea are people who are obese. Severe obesity itself can cause sleeping problems and chronic fatigue. - Drugs and Alcohol. Fatigue is a side effect of many prescription and over-the-counter medications, such as antihistamines. In addition, depen- dency on or abuse of alcohol or illicit drugs may manifest as chronic fatigue. Medications should be considered as a possible cause of fatigue if an individual has recently started, stopped, or changed medications. Withdrawal from caffeine can produce depression, fatigue, and headache. - Conditions That May Not Rule Out CFS. Many conditions can be identified or diagnosed that can account for extreme fatigue, but may not necessarily rule out chronic fatigue syndrome. - Other Conditions Diagnosed Only by Symptoms. A number of conditions can be diagnosed by a physician only on the basis of symptoms and cannot be confirmed by laboratory tests. A diagnosis in such cases should not rule out the possibility that CFS or idiopathic chronic fatigue may still be the primary cause of the symptoms. Of particular note is the disease known as fibromyalgia (sometimes referred to as fibrositis), which affects three to six million Americans and which some experts believe is simply another variant of chronic fatigue syndrome. It commonly causes prolonged fatigue and muscle aches and pains. Recurrent sore throat, headache, low fever, and depression are also common features. A characteristic feature of fibromyalgia is the existence of distinct sites of deep muscle tenderness that hurt when touched firmly, including the side of the neck and breast- bone, the top of the shoulder blade, the outside of the upper buttock and hip joint, and the inside of the knee. Some patients with CFS exhibit similar tender pressure points. As with CFS, the cause of fibromyalgia is unknown, and its course is chronic. physicians define fibromyalgia as an extreme variant of chronic fatigue, with more pronounced mental disturban- ces and more evidence of immune system abnormalities. One physician compa- red fibromyalgia to chronic fatigue as the same relationship as a migraine to a headache. Other conditions that cause fatigue and can only be diagnosed using repor- ted symptoms are anxiety and depressed and nervous conditions that are not psychiatric disorders. Exposure to various chemicals and environmental toxinssuch as solvents, pesticides, or heavy metals (cadmium, mercury, or lead, for example) can cause fatigue and other symptoms of CFS, inclu- ding psychologic changes. Identifying such exposure, however, does not rule out the possibility of chronic fatigue syndrome. - Fatigue Following Adequately Treated Disorders. If a physician can verify that a disease has been treated adequately and yet symptoms of chronic fatigue persist, then CFS or idiopathic chronic fatigue cannot be ruled out. If hypothyroidism, for example, is treated by replacement thyroid hormone, and if fatigue and other relevant symptoms continue after normal levels of thyroid have been reached and appraised, then a diagnosis of CFS cannot be eliminated as a suspect. - Weak Results from Laboratory Tests. Some tests for diseases that cause the same symptoms as CFS or idiopathic chronic fatigue may be ambiguous or weak. In such cases, unexplained chronic fatigue should not be ruled out. - Who Gets Chronic Fatigue Syndrome? Chronic fatigue syndrome does not appear to be new. In the 19th century, there were various reports of neurasthenia, or nervous exhaustion; in the 1930s through the 1950s, outbreaks of disease marked by prolonged fatigue were reported in the United States and many other countries. Beginning in the early to mid-1980s, interest in chronic fatigue syndrome was revived by reports in the United States and other countries of various outbreaks. Chronic fatigue occurs throughout the world, but it is not known how many people actually have chronic fatigue syndrome, because the disorder is still not well understood or defined and often goes unrecognized. Based on the results of a study of members of a health maintenance organization, between 2% and 6% of the population experience chronic fatigue, and be- tween 0.1% and 0.27% of Americans meet the criteria for chronic fatigue syndrome. Chronic fatigue is most often experienced by patients 20 to 50 years old with a peak incidence between 49 and 50, although adolescents and those in late middle age also experience this problem. Chronic fatigue syndrome is more often reported in women, Caucasians, and people who are well-educated, but many physicians believe that such people are more likely to seek medical help, be aware of chronic fatigue syndrome as a specific disorder, and have health insurance. An analysis of a recent study has indicated that the problem is more widespread and that the disease is under-diagnosed in lower-income and some ethnic groups. One study found that symptoms consistent with chronic fatigue syndrome have been found in women who have had silicon breast implants. - What Causes Chronic Fatigue Syndrome? The cause of chronic fatigue syndrome remains unknown. Some physicians and researchers believe it is caused by an infectious agent, such as a virus. Others doubt that the syndrome exists at all and believe that it is "all in the patient's head." It is possible that there is no single cause for CFS and that it results from a combination of factors, both physical and psychologic. - Viruses. Because many of the features of CFS resemble those of a linge- ring viral illness, many researchers have focused on the possibility that a virus causes the syndrome. Most cases of CFS occur sporadically, crop- ping up individually without appearing to be contagious. There is no consistent evidence that CFS is spread through casual contact, such as shaking hands or coughing, or by intimate sexual contact. However, out- breaks of CFS have occurred in which members of the same household, work- place, or community have contracted chronic fatigue syndrome. One theory referred to as "hit and run" suggests that chronic fatigue syndrome might be the result of a virus that infects the body, causes immune abnormalities, and is then eliminated, leaving behind a damaged immune system that continues to cause flu-like symptoms even in the absen- ce of the virus. Three candidate viruses have received considerable atten- tion: Epstein-Barr virus (EBV), human herpesvirus type 6 (HHV-6), and a family of viruses known as retroviruses. A recent study of people who experienced chronic fatigue after a viral infection found that the presen- ce of the fatigue did not relate to severity of flu symptoms but rather to the behavior of the physician and the attitude of the patients. - Epstein-Barr Virus. Epstein-Barr Virus (EBV) is the virus that causes infectious mononucleosis ("mono"), which is marked by fatigue and swollen glands and which primarily affects adolescents and young adults. In the early to mid-1980s, what is now called chronic fatigue syndrome was often known as chronic Epstein-Barr virus infection, because some patients who suffered from a bout of apparent mononucleosis never fully recovered, had lingering fatigue that persisted for many months, and appeared to have an active and persistent low-level EBV infection, indicated by virus parti- cles circulating in the blood. However, researchers subsequently noted that many healthy persons without CFS had the same signs of low-level EBV infection and that other individuals with CFS showed no signs of EBV infection. Because of these and other findings, many researchers do not believe there is any direct link between Epstein-Barr virus infection and CFS, although research in this area continues. - Human Herpesvirus Type 6. Some researchers believe that human herpesvi- rus type 6 (HHV-6), which was discovered in 1986, may play a role in the development of chronic fatigue syndrome. HHV-6 has been implicated in cases of roseola infantum, a common illness in infants characterized by fever followed by rash. HHV-6 has also been linked to a mild illness in young adults that is marked by enlarged and tender lymph nodes in the neck. Evidence of active HHV-6 infection has been found in most patients with CFS, but some healthy persons also show signs of active infection with this virus. Indeed, almost everyone carries an inactive form of the virus because of exposure to the virus as children. The connection between HHV-6 and CFS remains uncertain. - Retroviruses. In the past 10 to 15 years, the scientific community has learned much about retroviruses. Specific retroviruses known as human T cell lymphotropic viruses (HTLVs) show up in about 2.5% of the general population and have been linked, in rare cases, to a certain form of leukemia and to a progressive neuromuscular disorder. One study found that markers of active HTLV infection were most common among patients with CFS, moderately common among acquaintances of CFS patients, and nonexistent among persons with no exposure to those with CFS. This suggests that HTLV could be an infectious cause of CFS, but further research is needed. Research is also under way on the so-called human foamy viruses, known as spumaviruses, which induce persistent infections but produce no known symptoms. - Miscellaneous Viruses. Other viruses that have been studied as possible causes of CFS are measles virus, coxsackie B virus (related to the polio virus and a cause of meningitis and respiratory tract and GI infections), and cytomegalovirus (which causes a disease resembling mononucleosis). However, no convincing evidence currently exists for a direct cause-and-effect relationship for these (or any other) infectious agents. - Fungal Infections. Candida, the yeast-like fungus that causes vaginal yeast infections and thrush (white fungal growth in the mouth), has been postulated as a possible cause of CFS. This supposed association has been termed the yeast connection, or candidiasis hypersensitivity. According to most research, however, candida does not cause CFS. - Allergies. More than 65% of all CFS patients report experiencing food or other types of allergies prior to contracting chronic fatigue syndrome. Studies are now going on to find out if CFS patients have more dramatic allergic reactions than others. - Immune System Abnormalities. CFS has been referred to as the "chronic fatigue immune dysfunction syndrome", because patients with the syndrome have so many irregularities of the immune system. Some components of the immune system appear to be overreactive, whereas others appear to be underreactive. However, there appears to be no consistent pattern, and the abnormalities can vary widely from patient to patient. One theory holds that CFS is caused by a hyperactive immune system. It has been reported that some patients with CFS, particularly those with severe symptoms, have increased numbers of infection-fighting white blood cells known as CD8 killer T cells, which launch attacks on invading viruses and other disease-causing microorganisms. However, these same individuals have lower-than-normal numbers of another type of white blood cell, known as the suppressor T cell, which helps to shut down the immune response once the invading organisms have been killed. The result, according to this theory, is an overactive immune system that pours uncontrolled amounts of chemicals called lymphokines into the body, apparently provoking fatigue, muscle aches, and other symptoms. Cancer patients who are given experimen- tal treatments with a cancer-fighting lymphokine known as interleukin-2 experience symptoms similar to those of CFS, including memory deficits, muscle aches, and lethargy. When the treatments stop, the symptoms disap- pear. Further study of the role of the immune system in patients with CFS is under way. - Muscle Defects. Patients with CFS sometimes complain that they feel so weak that it seems as if their muscles are no longer working properly. It has been proposed that a defect in skeletal muscle could be the cause of the fatigue. However, physical, chemical, and metabolic studies have not found any consistent pattern of abnormalities in the muscles of these patients. Because many patients report having a flu-like illness prior to coming down with CFS, scientists have also proposed that physical inacti- vity during the initial illness could lead to physical deconditioning and a subsequent loss of strength and stamina. Experiments in which patients with CFS were closely monitored during exercise, however, have shown that a loss of physical conditioning is not a major factor in the development of CFS, although moderate exercise is recommended for any patient with the syndrome [see How is Chronic Fatigue Syndrome Treated?, below]. - Brain Abnormalities. Brain abnormalities, including pinpoint spots of brain inflammation, abnormal levels of certain hormones, and irregulari- ties in brain wave patterns during sleep, have been reported in patients with CFS, but similar findings have also been found in those without the illness. More research is therefore needed. - Low Blood Pressure. One recent study found that some people with chro- nic fatigue syndrome experience a dramatic drop in blood pressure when standing up, even for as short a time as ten minutes. This defect may be caused by infection or injury. Some people have improved by increasing salt in their diets or taking drugs to increase blood pressure. No one should take such measures without a physician's approval. - What Tests May Be Required to Diagnose Chronic Fatigue Syndrome? A physician should first take a careful personal and family medical histo- ry, which may include a psychologic profile, as well as perform a thorough physical examination. Patients should be prepared to answer such questions as: When did the fatigue first begin? Does anything make it worse or better? Is it better at certain times of the day? Does physical activity make it worse? Are there any other symptoms? Has anyone else in the family ever complained of fatigue? Is your personal and professional life stres- sful? The physician may also ask about any changes in weight or request a patient to monitor morning and afternoon body temperatures. The patient should report any drugs being taken, including vitamins and over-the-coun- ter or herbal medications. In most cases of chronic fatigue syndrome, all laboratory tests are nor- mal; inexpensive tests are given to rule out other conditions, which would include thyroid and liver function tests, blood count, and sedimentation rate. If any of the results from these laboratory tests are abnormal, additional tests will be needed. In addition, follow-up psychologic profi- le testing may be suggested. Since many insurance policies do not cover this testing, the patient may want to determine the cost beforehand (usu- ally less than $200). In academic centers where CFS is studied, a series of tests may be perfor- med to measure immune function. Such testing is controversial, because it is expensive ($200 to $800) and difficult to interpret. However, these studies may be helpful, because they may be able to detect defects in certain immune system components (such as gamma globulins) that could benefit from replacement therapy [see How Is Chronic Fatigue Syndrome Treated?, below]. - How Serious Is Chronic Fatigue Syndrome? Treatments for CFS are limited, and many people have disabling symptoms for years. The severity of chronic fatigue syndrome varies. In extreme cases, patients are bedridden and can do virtually nothing, including even light housework. More often, CFS sufferers can work at least part-time. Most commonly, patients with CFS report that they can fulfill their home and work responsibilities but are much more easily fatigued from these activities and have no energy left for anything else. Most patients say that fatigue is the most incapacitating symptom, whereas cognitive symp- toms, such as an inability to concentrate, are the most distressing. The long-term course of CFS has not been well studied. Some physicians have observed that patients whose symptoms began abruptly following a severe viral illness recovered completely after six months to a year, whereas patients whose problems developed slowly and insidiously experien- ced symptoms for a longer period of time. The mean duration of the illness in one major study was 37 months. In one study, only about one quarter of patients showed improvement after a year, and some patients say they felt fatigued for several years before even seeing a physician. On the other hand, many patients have reported turning a corner after a year or two and slowly regaining energy despite some setbacks along the way. Most patients eventually report improvement, and some experience complete recovery. Although some patients get progressively worse and never recover fully, the disorder is not fatal. - How Is Chronic Fatigue Syndrome Treated? Patients who suffer from chronic fatigue syndrome must acknowledge the condition without feeling guilty about it. Those with CFS should take naps when needed and adjust their schedules to fit their energy levels. There is no proven or reliable cure for CFS. The goal should be to control symptoms rather than to find a quick and easy answer. The use of various medications, life-style changes, and support from medical professionals, family, and friends can all help a patient manage CFS. - Support. First, chronic fatigue syndrome sufferers should find a good and reliable physician and schedule regular follow- up visits, as physici- ans can help them get through this syndrome. It is also important to garner support from family and friends. Groups composed of others who suffer from CFS can help to provide support and insight. Contact a local mental health agency for a referral or contact one of the national agencies [see Where Else Can Help Be Found for Chronic Fatigue Syndrome?, below]. However, beware of those who promise a cure or urge the purchase of expen- sive but useless and potentially dangerous treatments, such as hydrogen peroxide injections (which can cause blood clots or strokes), megadoses of vitamins (which can be toxic), high colonic enemas, bee pollen, and aloe vera juice. - Medications. Certain medications may help relieve some of the symptoms of chronic fatigue syndrome. - Antidepressant and Antianxiety Drugs. The antidepressant amitriptyline (Elavil) is known to relieve many of the symptoms of CFS and is the first choice for many physicians. It is commonly used to treat the symptoms of fibromyalgia, migraine headaches, and depression. It also sometimes alle- viates certain types of pain in diabetics. Patients with CFS normally respond to much lower doses than those used to treat people with other disorders. Elavil has side effects common to other antidepressant drugs. Many researchers report that other antidepressant medications have also helped their patients with CFS. Antidepressants have a proven track record for the treatment of depression, although this form of therapy is still regarded as experimental for treating CFS. Antidepressants that have been found to be useful for CFS include fluoxetine (Prozac), doxepin (Sine- quan), desipramine (Norpramin), nortriptyline (Pamelor), clomipramine (Anafranil), and imipramine (Tofranil, Janimine). It often takes several weeks for these drugs to produce benefits. Common side effects include dry mouth, restlessness, a slightly increased heart rate, and constipation. If anxiety is also a problem, an anxiety-relieving drug, such as alprazolam (Xanax), may be prescribed. In addition to recommending medications, a physician may suggest counseling or stress-reduction classes. - Pain and Inflammation Relievers. If muscle aches or pains persist, nonprescription pain-relievers, such as aspirin, acetaminophen (Tylenol), or ibuprofen (Advil, Motrin), may help. (Pregnant women or those with ulcers should not take aspirin or ibuprofen unless a physician recommends it.) Because chronic fatigue syndrome can cause on-going joint pain, some patients may abuse over the counter medications. It is important to note that even these medications are not without risk. Aspirin and other simi- lar pain killers known as nonsteroidal anti-inflammatory drugs can cause bleeding and excessive use of acetaminophen has been associated with liver or kidney damage and even death. If joint pain cannot be relieved with nonprescription pain-killers, local injections of lidocaine (an anesthetic to relieve pain) or steroids (to reduce inflammation) may be administered. Deep massage, hot and cold applications, topical anesthetics, stretching, acupuncture, and chiroprac- tic treatment may also help minimize symptoms. - Experimental Treatments. Many drugs are under investigation. Some of these programs are testing very potent drugs normally used for severe diseases such as epilepsy, schizophrenia, and Alzheimer's disease. Because chronic fatigue syndrome still has not been clearly defined as a specific disorder, patients should approach any experimental treatment cautiously and seek more than one opinion before embarking on such programs. Various experimental therapies aimed at boosting the immune response are under investigation. One approach has been to administer gamma globulins, compo- nents of the immune system that help protect against a broad range of microorganisms; results with this method have been mixed. Another study reported that an experimental antiviral drug called Ampligen provided some relief of symptoms in patients with CFS. Further study of both approaches is needed before they can be recommended.Acyclovir (Zovirax), an antiviral drug that is used to treat herpes infections, has been studied extensively for the treatment of CFS, but it is not effective. There has been no proven benefit for magnesium sulfate, which appeared to have some promise in previous studies. Antifungal treatments directed against Candida ("ye- ast infections") are not useful in the treatment of CFS. In some studies the levels of the steroid hormone cortisol, or hydrocortisone, were sligh- tly lower than those in healthy individuals. Cortisol is responsible for some of the mechanisms involved in responses to acute stress. A trial is underway testing whether low doses of the hormone might be beneficial for CFS patients. - Life-style Changes. Certain life-style modifications may help make the symptoms of chronic fatigue syndrome more manageable. While they won't cure it, they can make life easier for a person with CFS. - Energy Diary. Keeping a diary for a week or two can help a person with CFS determine when during the day he or she has the most energy. The individual can then plan to do the most important activities during those times. In addition, the patient should note any factors that may be con- tributing to fatigue: Does anything make the fatigue worse, or better? Does the fatigue seem to be related to a job, a relationship, other perso- nal problems? The diary can serve as a general guide for setting limits and planning activities, although energy levels will most likely be very unpredictable, and a reliable pattern that can be strictly followed will probably not emerge. Developing fairly rigid daily routines around proba- ble energy spurts or drops, such as getting up in the morning, eating, and going to bed at fixed times, may help establish a more predictable pat- tern. - Limit Setting. Defining and setting limits are extremely important for CFS patients. These limits should be designed to keep both mental and physical stress within a manageable framework, so that patients do not get discouraged by forcing themselves into situations in which they are likely to fail because of the constraints of the syndrome. Flexibility is impor- tant, however, since as conditions change so will the limits. Patients may need between 5 to 10 minutes rest period every hour or more, during which time relaxation or meditation methods are useful. DD> - Increasing Attention Capacity. Because impaired concentration is a common problem, it is important that the patient engage in activities that are appealing and which will focus attention and help increase alertness. When being given instructions, the CFS patient should request that they be given as concise simple statements. External distractions, such as music or talking, should be kept to a minimum and ideally eliminated when the patient engages in activities needing concentration. - Exercise. Some patient experience profound fatigue following even modest exercise. Weight lifting for short 20- to 30- second intervals seems to be especially beneficial. In general, activity is still an impor- tant aspect for recovery in order to prevent muscle atrophy and increased fatigue. It is necessary to go slowly, however, to prevent relapse. An incremental program of activity, beginning with as little as three to five minutes of moderate exercise a day, is suggested, although capacity varies greatly among CFS sufferers. The goal is to increase activity by about 20% every two to three weeks. Setbacks will occur, so patients must persevere. - Diet. Chronic fatigue syndrome patients should maintain a healthy diet low in animal fat and high in fiber, with plenty of fresh fruits and vegetables. There is no scientific evidence that vitamin and mineral supplements will relieve CFS, but taken in moderation, they are not harm- ful. Megadoses of vitamins, however, can be toxic and should not be taken. A number of herbal medicines have been used for chronic fatigue syndrome; none have been proven to have any benefit, and some can be harmful. It is extremely important for patients to realize that herbal medicine has as many potential side effects and toxic reactions as standard drug therapy, and the dangers increase because no standards exist for safe or effective dosages. - How Can Chronic Fatigue Syndrome Be Prevented? There are no specific guidelines for the prevention of CFS. The causes of the syndrome are not well understood, and little is known about what makes certain people susceptible to it. An individual's best bet against coming down with CFSor any serious illness for that matteris to maintain a healthy life-style, including adequate sleep, a healthy diet, and regular exercise. In addition, people should avoid smoking, minimize stress, and maintain strong social ties. A physician should be consulted if CFS or any serious illness is suspected. - Where Else Can Help Be Found for Chronic Fatigue Syndrome? National Chronic Fatigue Syndrome and Fibromyalgia Association 3521 Broadway Suite 222 Kansas City, MO 64111 (call 816-931-4777) Offers a 24-hour information line, a quarterly newsletter Heart of America, and educational materials. This organization is a good source of accurate information on CFS. National Institute of Allergy and Infectious Diseases (NIAID) Office of Communications Building 31, Rm. 7A50 31 Center Dr., MSC 2520 Bethesda, MD 20892-2520 American Association for Chronic Fatigue Syndrome 8317 Woodhaven Blvd. Bethesda, MD 20817 Formed by health professionals to promote dissemination of information on CFS. - Diseases Which Cause Fever With Joint and Muscle Pain Infectious Arthritis. Lyme disease, septic arthritis, bacterial endocarditis, mycobacterial and fungal arthritis, viral arthritis. Postinfectious or Reactive Arthritis. Enteric infection, Reiter's syndrome, rheumatic fever, inflammatory bowel disease. Rheumatoid Arthritis and Still's Disease (Juvenile Rheumatoid Arthritis) Systemic Rheumatic Illness. Systemic vasculitis, systemic lupus erythmatosis Crystal Induced Arthritis. Gout and pseudogout Other Diseases. Familial Mediterranean fever, cancers, sarcoidoisis, AIDs, leukemia, Whipple's disease, dermatomyositis, Behcet's disease, Henoch- Schonlein pupura, Kawasaki's disease, erythema nodosum, erythema multiforme, pyoderma gangrenosum, pustular psoriasis. Data from New England Journal of Medicine, March 17, 1994. Polyarthritis and fever, Robert S. Pinals, M.D. Nidus Information Services Well Connected 175 Fifth Avenue, Suite 2338 New York, New York 10010 1-800-334-WELL (9355) 212-260-4268 Fax 212-529-2349 Email Nidus@panix.com This page has been published by the NOAH team. For questions or comments on this page please send e-mail to webmaster@noah.cuny.edu, or visit our feedback page. ÄÄ[ EOF ]ÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄ[ NOAH.TXT ]ÄÄÄÄÄÄÄÄÄÄÄÄ
Extractions: Solutions for........ Airborne Allergies Arthritis Asthma Candida (Yeast Infection) CFS (Chronic Fatigue Syndrome) High Cholesterol Flus and Colds Cancer Depression Diabetes (High Blood Sugar) Diverticulosis Food Allergies Fibroids and Cysts Fibromyalgia Hay Fever (Airborne Allergies) HBP (High Blood Pressure) Hepatitis A and B Hepatitis C, D, and E Hepatitis C HIV AIDs Holiday Health Prevention HypoThyroid Hypo/Hyper Thyroid IBS (Irritable Bowel Syndrome) Liver Help Menopause MS (Multiple Sclerosis) Prostate function Osteoarthritis Osteoporosis PMS (Pre Menstrual Syndrome) BPH (Benign Prostatic Hypertrophy) Rheumatoid Arthritis Sarcoidoisis Sinusitis
