Chronic fatigue syndrome differential diagnosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

## Overview[edit | edit source]

## Disease associations[edit | edit source]

Some diseases show a considerable overlap with CFS. According to an article in American Family Physician in 2002, Multiple Sclerosis, Thyroid disorders, anemia, and diabetes are but a few of the diseases that must be ruled out if the patient presents with appropriate symptoms.[1]

People with fibromyalgia (FM, or Fibromyalgia Syndrome, FMS) have muscle pain and sleep disturbances. Fatigue and muscle pain occurs frequently in the initial phase of various hereditary muscle disorders and in several autoimmune, endocrine and metabolic syndromes; and are frequently labelled as CFS or fibromyalgia in the absence of obvious biochemical/metabolic abnormalities and neurological symptoms.[2] Those with multiple chemical sensitivity (MCS) are sensitive to chemicals and have sleep disturbances. Many veterans with Gulf War syndrome (GWS) have symptoms almost identical to CFS.[3] One study found several parallels when relating the symptoms of Post-polio syndrome with CFS, and postulates a possible common pathophysiology for the illnesses.[4]

Although post-Lyme syndrome and CFS share many features/symptoms, a study found that patients of the former experience more cognitive impairment and the patients of the latter experience more flu-like symptoms.[5]

One review (2006) found that there was a lack of literature to establish the discriminant validity of undifferentiated somatoform disorder from CFS. The author stated that there is a need for proponents of chronic fatigue syndrome to distinguish it from undifferentiated somatoform disorder. The author also mentioned that the experience of fatigue as exclusively physical and not mental is captured by the definition of somatoform disorder but not CFS.[6] Hysterical diagnoses are not merely diagnoses of exclusion but require criteria to be met on the positive grounds of both primary and secondary gain.[7] Primary Depression can be excluded in the differential diagnosis due to the absence of anhedonia and la belle indifference, the variability (lability) of mood, and the presence of sensory phenomena and somatic signs such as ataxia, myclonus and most importantly, exercise intolerance with paresis, malaise and general deterioration, which can in some cases become a comorbid situational depression.

Disease  | Differentiating signs and symptoms  | Diagnostic findings

|
|

Fibromyalgia |

* Symptoms have been present at a similar level for at least 3 months.
* Chronic musculoskeletal pain with multiple tender points
* Stiffness, numbness, and fatigue
* Headaches
* Sleep disorder

* All lab tests are normal

Rheumatoid arthritis |

* Multiple joint swelling
* Morning stiffness
* Rheumatoid nodules

* RF or anti-cyclic citrullinated protein (CCP) antibody is positive.

* Markers of systemic inflammation (ESR, CRP) are typically elevated.

SLE |

* Maculopapular rash
* Multi-system involvement

* Positive anti-Smith antibodies

Chronic fatigue syndrome | Fatigue plus 4 of the following symptoms:

* Short-term memory loss
* Sore throat
* Tender lymph nodes in the neck or armpit
* Muscle pain
* Joint pain without swelling or redness
* Headaches
* Insomnia
* Malaise

* Diagnosis of exclusions
* Symptoms must present for more than 6 months

Spondyloarthritis |

* Axial skeletal pain and stiffness
* Restricted spinal motion

* Elevated ESR or CRP
* Negative RF

* Bamboo spine on x-ray

Polymyalgia rheumatica |

* Older at onset
* Generalized stiffness

* An elevated erythrocyte sedimentation rate (ESR) OR C-reactive protein (CRP)
* Response to corticosteroids

Osteoarthritis |

* Localized joint pain
* Restricted to affect joints
* Older at onset

* X-ray of the involved joints demonstrate degenerative changes

Hypothyroidism |

* Systemic symptoms such as weight gain, constipation, dry skin
* Muscular aching and prominent fatigue that improves on replacement of thyroid hormone.

* TSH is elevated and free T4 is low.

Myopathaies (polymyositis and dermatomyositis)  |

* Pelvic and shoulder girdle muscle weakness
* Rash

* Muscle biopsy confirms the diagnosis
* Elevated CPK enzyme

Neuropathy |

* Numbness and tingling
* Paresthesia

* Abnormal EMG

## References[edit | edit source]

1. ↑ Craig, T and Kakumanu S (Mar 2002). "Chronic fatigue syndrome: evaluation and treatment". Am Fam Physician. 65 (6): 1083–90. PMID 11925084.
2. ↑ van de Glind G, de Vries M, Rodenburg R, Hol F, Smeitink J, Morava E (2007). "Resting muscle pain as the first clinical symptom in children carrying the MTTK A8344G mutation". Eur J Paediatr Neurol. PMID 17293137.CS1 maint: Multiple names: authors list (link)
3. ↑ Vojdani A, Thrasher J (2004). "Cellular and humoral immune abnormalities in Gulf War veterans". Environ Health Perspect. 112 (8): 840–6. doi:10.1289/ehp.6881. PMID 15175170.
4. ↑ Bruno RL, Creange SJ, Frick NM (1998). "Parallels between post-polio fatigue and chronic fatigue syndrome: a common pathophysiology?". Am J Med. 105 (3A): 66S–73S. doi:10.1016/S0002-9343(98)00161-2. PMID 9790485.CS1 maint: Multiple names: authors list (link)
5. ↑ Gaudino EA, Coyle PK, Krupp LB (1997). "Post-Lyme syndrome and chronic fatigue syndrome. Neuropsychiatric similarities and differences". Arch Neurol. 54 (11): 1372–6. PMID 9362985.CS1 maint: Multiple names: authors list (link)
6. ↑ van Staden WC (2006). "Conceptual issues in undifferentiated somatoform disorder and chronic fatigue syndrome". Curr Opin Psychiatry. 19 (6): 613–8. PMID 17012941.
7. ↑ Jenkins R, Mowbray J, ed. Post-viral Fatigue Syndrome. 1991 John Wiley & Sons Ltd

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