Definition

Controversial clinical entity: disease involving several symptoms not recognized by some medical teams. It is characterized by prolonged, for more than six months, fatigue occurs without reason and that is not improved by the rest.

Causes

It is undetermined by definition. Many diseases result in chronic fatigue, most often associated with a more or less intense depression.The difficulty, in this syndrome, lies in the decision-making of a number of complementary examinations. Indeed, outside the economic context, the abuse of prescription of blood, of x-rays, scan, etc… may unnecessarily inconvenience the patient. By contrast, insufficient prescription of complementary examinations can miss the diagnosis. Hence the interest of questioning and a very extensive review. Keep in mind that the halves of the asthénies are often linked to depression and psychological in origin.Currently the most often chosen cause of chronic fatigue syndrome is infection associated with various immunological disorders with neuropsychological complaints see depression.Compared to what happens in Fibromyalgia, biological analyses show quite frequently high levels of antibodies are directed against several viruses. Were found in the blood of some patients, antigens and specific nucleic acid of a given viral agent but without confirmation.On the other hand some components of the immune process changes have been highlighted in chronic fatigue syndrome. It is as it describes an increase in levels of antinuclear antibodies and a decrease in the amount of certain immunoglobulins and a decrease of the proliferation of lymphocytes with a decrease in activity of NK (natural killer) cells. Abnormalities in the production of cytokines have also been highlighted. Recent studies seem to show that there is a too much production of cytokines and especially Interleukin 1, resulting in the onset of fatigue and other close symptoms of flu.Finally there could be, in the course of the syndrome of chronic fatigue, a dysfunction of the autonomic nervous system (sympathetic and parasympathetic) characterized by the occurrence of orthostatic hypotension patients (when the patient lie in the standing position, there was a decrease in blood pressure), the appearance of syncope and printing unusual dizziness when the patient is standing. This would return in the Dysautonomia.

Symptoms

The consultation of syndrome of chronic asthenia, and asthénies in General, comes from different medical specialties: General Medicine, internal medicine, rheumatology, cardiology, psychology, psychiatry, Endocrinology (for major).Examination is evidence of more or less net psychic disorders, essentially difficulties concentrating, a certain irritability and sometimes visual disorders.Physical signs:

• Presence of chronic fatigue (which lasts relatively long)
• Whether or not weakness accompanied by muscle aches (myalgia)
• Small rise in the temperature (low-grade fever) or sometimes high fever
• Various pain (chest, throat, upper limbs, lower limbs, abdomen, etc.)
• Respiratory difficulty.

Consultation doctor

It must be complete: it will search the lower index likely to guide a diagnosis for an organic disease (a “true” disease).It is or not revealed the presence of Lymphadenopathy (more or less large ganglia) more or less painful and the presence of arthralgia (joint pain).This review is before any neurological (reflex, muscle strength, etc…), oral (mouth, teeth), dermatological (skin review), rheumatologic (research areas and painful joints), gynecological (palpation of the breast, vaginal), endocrine (thyroid palpation). It aims not only to ease the patient but especially to discover organ damage that may explain asthenia. This is the case for example in Addison’s disease: in this condition, it is necessary to find a discoloration of the skin and the presence inside the mouth of colored spots.

Medical analysis

A minimum of analysis must be applied. This is:

• The formula blood count (number of blood cells red, white blood cells and platelets)
• The sedimentation speed
• Of the blood electrolyte (sodium, potassium, magnesium, calcium)
• Of the (determination of creatinine in the blood) creatinine
• Liver enzymes
• Of the determination of cortisol and ACTH (suspected of adrenal insufficiency) and thyroid hormones (T3, T4, TSH).

Additional analyses are sometimes necessary in the presence of an asthenia moved beyond several months (three to six months), when is suspected for example a metal (mercury among others) poisoning.

Evolution of the disease

Chronic fatigue syndrome sometimes sounds on professional activity and in General on family and social relations.Monitoring of the patient is important. Do not miss serious organ damage. May eventually result in a significant loss of weight, loss of appetite, fatigue that is going to grow. In this case, additional analyses are required.In a few weeks, the monitoring of the patient allows whether rest is RESTful or not, if asthenia disappears or if other symptoms appear, which can redirect the diagnosis.

Differential diagnosis

• Determination of adrenal hormones to eliminate adrenal insufficiency which is often the cause of the most frequently isolated major asthenia.
• Fibromyalgia is a condition primarily women (about 90% of cases) of late onset (after 50 years) but that there are cases before 35 years. It occurs more frequently in certain medical specialties (osteopathy, rheumatology, General Medicine). Individuals with Fibromyalgia are fewer from 70 years. This condition consists of muscle aches associated with sleep disorders, fatigue and a slowdown in the daily professional or other activities.

Treatment

Treatment includes support long-term patients who legitimately ask for information and explanations on their disease and the impact of the disease is likely to have both in the physical domain that psychological and social. Physicians need to know this affection, do not be confused with fibromyalgia. They must also explain it also and take seriously complaints of patients. This generally allows to play down this pathology that sometimes responds to anti-inflammatories and painkillers especially when patients have headaches of diffuse pain and a low-grade fever (unlike Fibromyalgia in which no anti-inflammatory or analgesic or almost, and especially not those derivatives of morphine are effective against pain).Patients, which is not usual in the course of the Fibromyalgia symptoms of rhinitis and bronchitis, can be treated by Nasal Decongestants and eventually the anti-infective respiratory.Anticonvulsants (pregabalin, clonazepam) medication are not particularly effective, while they are generally in Fibromyalgia.However, antidepressants and anxiolytics sometimes give good results, instead of fibromyalgia.The stimulants (coffee, alcohol, “soft” drugs) are of course contraindicated because aggravating fatigue of the patient.The exercise, without excess, is likely to bring a significant improvement. This is the reason for which it is recommended within acceptable limits (without excess).The use of certain drugs based on corticoids (cortisone), intravenous immunoglobulins (antibodies), the aciclovir is the evidence of their effectiveness.However behavioural therapy, based on some controlled studies in England in Australia and the Netherlands seems to have a certain interest.