Severe fatigue and exhaustion are common also in rheumatic diseases

Definition

Fatigue is morbid fatigue and prolonged or recurrent fatigue with reduced capacity for mental and / or physical activity (reference: Krupp LB, 1996). Fatigue can be divided into subgroups such as: "general fatigue", "physical fatigue", "mental fatigue" and "mental fatigue".

Chronic fatigue is observed in a variety of diseases and conditions, including Systemic connective tissue diseases: and other rheumatic diseases.

From the animal kingdom, we recognize symptoms of fatigue in infectious diseases. Animals hide to rest until their physical condition improves ("sickness behavior", reference: Heart BL, 1988). That way, they protect themselves from attack by predators in an exposed phase.

Conditions with fatigue

• Connective Tissue Diseases
  • Sjögren's syndrome
  • Systemic lupus erythematosus (SLE)
• Mentally
  • Depression
  • Anxiety
  • Somatization

• Nutritional Deficiency
• Drug Addiction
• Medication
  • Sleep medicine and sedative medication
  • Blood pressure medication (beta blocker)
  • Antidepressants
• Fabry's disease (hereditary enzyme deficiency)

• Hormonally
  • hypothyroidism (TSH, F-T4)
  • hyperthyroidism (TSH, F-T4)
  • Diabetes mellitus (Blood sugar, HbA1c)
  • Pituitary failure (ACTH, FSH, LH, TSH, growth hormone, prolactin)
  • Hyperparathyroidism (calcium, PTH)
  • Adrenal crisis (Addison's disease; low cortisol level, high ACTH, non-measurable aldosterone level and elevated plasma renin concentration or renin activity (PRA))
• Hypercalcemia (Ca, ionized Ca, PTH, 25OH-White D)
• Chronic renal failure (Creatinine, GFR, urine)
• Liver failure (Liver enzymes, albumin)

• Cancer
• After a stroke or brain damage
• Low hemoglobin (serious anemia: Hgb, haptoglobin, MCV, transferrin receptor, vitamin B12, folic acid)

• Infections
  • Endocarditis (Blood cultures)
  • Tbc (IGRA tests)
  • Mononucleosis (EBV) (Blood test)
  • Hepatitis (Hepatitis B og C tests)
  • Parasitic disease (eosinophilic leukocytes, various)
  • HIV Infection (HIV test, CD4 T cells)
  • Cytomegalovirus virus (CMV-PCR from blood, urine and other)

• Chronic heart failure (Pro-BNP)
• COPD (C examination of lungs)
• Sleep apnea (ENT, Sleep Laboratory)
• Oesophageal reflux (gastroscopy, x-ray of the esophagus)
• Allergic rhinitis (Allergy study)

• Unknown cause (exclusion diagnoses)
  • Idiopathic Chronic Fatigue (unknown cause)
  • Chronic fatigue syndrome, ME, CFS
  • Fibromyalgia

Incorrect diagnosis (Similar conditions / Differential diagnoses)

• Narcolepsy

  • Nerve system disorders with sudden short sleep disorders during the day
  • Some genetic disposition (HLA-DQB1). Some also triggered by the vaccine (Pandemrix ) against swine flu

• Sleep apnea

  • Night sleep with abnormal breathing breaks causes a pronounced fatigue a day. Children can develop hyperactivity

Measurement / registration of fatigue

• “Fatigue Severity Score” (FSS) I, Norwegian version)

Literature

• More about fatigue / fatigue (after brain injury and brain stroke) (Norwegian doctor's association)
• Chronic fatigue syndrome, ME, CFS: (Bindevevssykdommer.no) here
• Wikipedia (English)
• Lupus and fatigue (Yuen HK, 2014)

• Bindevevssykdommer.no
• Vaskulitt.no