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.

The cause of fatigue is not well clarified. Research suggests that immune substances such as the cytokine interleukin-1 (IL-1) and the neuro-hormone hypocretin in the cerebrospinal fluid are important, among other things, in Sjøgren's syndrome, but clinical application of this knowledge is outstanding (reference: Bårdsen K, 2019).

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 (in Danish)
• Wikipedia (English)
• Lupus and fatigue (Yuen HK, 2014)

• Bindevevssykdommer.no
• Vaskulitt.no