MUPS (Medical Unexplained Physical (Physical) Symptoms)
MUPS (medically unexplained physical symptoms) is a large group of conditions with subjective complaints without objective findings during examinations. A thorough medical examination reveals no signs of disease in the blood, organs, nervous system or otherwise. MUPS has no clear, international definition. Thus, various diseases and symptoms are covered by the term MUPS. Often mentioned Fibromyalgia, Irritable Bowel Syndrome (IBS), Chronic Fatigue Syndrome (CFS/ME), Gulf War diseaseInexplained headache, unexplained back pain and unexplained chest pain. Whiplash injury, pelvic dislocation, candida syndrome, amalgam injury, electrical allergy and multiple chemical intolerance can also be included (Malterud K, 2010). MUPS overlaps with "somatoform autonomic dysfunction" characterized by symptoms from at least three organ systems such as the heart and blood circulation (cardiovascular), mage-tam (gastrointestinal) or airways (respiratory) or urinary tract (reference: Hartman TC, 2017). Some distinguish MUPS from a "somatic syndrome" condition that is manifested by one or more physical symptoms combined with excessive thought activity, depression, emotions with agitation or other behavior that causes significant suffering and/or dysfunction (D'Souza RS, 2021). The rheumatologist's task with symptoms of MUPS is to exclude an underlying rheumatic disease or manage the condition if there is also a current rheumatic disease. The GP (general practitioner) plays the main role in the investigation and is coordinating if special examinations are requested.
By definition, no medical cause has been detected. However, surveys have shown that many with MUPS also have depression and / or anxiety (reference: Li CT, Chu YH, 2009), but it is unclear whether these are contributing causes or consequences of the symptoms. The thinking about symptom development can, through sensitization, lead to persistent activation or maintenance of the symptoms. Thus, the interaction between bodily and mental processes and life conditions can be explanatory reasons for MUPS (Malterud K, 2010).
It is estimated that 3% of all consultations with general practitioners are due to MUPS. About three out of four who contact a doctor for the condition are women (reference: Aamland A, 2014).
Before concluding the diagnosis of MUPS, symptoms must be investigated and evaluated to exclude organ disease. The medical examinations may extend over several years, although special disease findings are not made. The general doctor (general practitioner) plays the lead role in the investigation and is coordinating if special investigations are requested. Among diseases that should be ruled out are Systemic connective tissue diseases: and other Autoimmune diseases, including metabolic diseases og chronic bowel inflammation. It is well known that handling MUPS is a challenge (reference: Hartman TC, 2017).
Treatment measures are aimed at the symptoms. At the sign of depression and/or anxiety, it is important to take measures to overcome these. In case of rheumatic pain and/or exhaustion have custum physical activity and careful training proven to help a part in the long term.