I’m asked very often, ‘how do you know if I have Lyme Disease, Chronic Fatigue, or Fibromyalgia?’
As we move into our new space, I sat down to document my thought process from the beginning to end. Hope you enjoy
Comprehensive Evaluation for Chronic Pain, Fatigue, and Cognitive Symptoms
**Patient’s Concern:**
“Doc, my muscles are sore and achy; it feels like I have arthritis. I can’t focus, I’m forgetting things, and I have this rash! Did I mention how weak I am? I can barely get out of bed in the morning. My sister thinks I have fibromyalgia. Can you help me? What do you think?”
**Doctor’s Response: I understand that you have muscle pain, fatigue, brain fog, and a skin rash. Yet, you don’t have Fibromyalgia until you DON’T have the following:”**
1 **Chronic Fatigue Syndrome (Myalgic Encephalomyelitis):** This condition is often associated with viral triggers like Epstein-Barr Virus (EBV), Human Herpesvirus, Enterovirus, Human Parvovirus, Retrovirus, or Ross River Virus.
2. **Lyme Disease:** Characterized by erythema migrans rash, fever, chills, and malaise following a tick bite. Diagnosis involves testing for Borrelia bacteria.
3. **Ankylosing Spondylitis:** Affects men aged 13-35. Symptoms include chronic back pain, morning stiffness, and eye inflammation. Diagnosis is clinical and may involve imaging.
4. **Lupus (Systemic Lupus Erythematosus or SLE):** More common in younger women but can affect men. Symptoms include headaches, fever, light sensitivity, and a characteristic facial rash. Diagnosis involves a positive ANA test.
5. **Multiple Sclerosis:** Typically affects individuals aged 20-50. Symptoms include sensory loss, vision changes, and muscle weakness. Diagnosed through MRI imaging of the brain and spine for plaques.
6. **Rheumatoid Arthritis:** Primarily affects women over 50. Symptoms include swollen, stiff, and warm joints. Diagnostic tests include rheumatoid factor (RF), anti-cyclic citrullinated peptide (anti-CCP), CRP, and ESR.
7. **Polymyalgia Rheumatica:** Common in individuals over 55. Symptoms include weight loss, fever, and morning stiffness. Elevated ESR and CRP levels are diagnostic, and treatment usually involves corticosteroids.
8. **Myofascial Pain Syndrome:** Causes pain in the head, neck, and jaw areas, often involving the temporomandibular joint.
### Recommended Workup:
1. **History & Physical Examination:**
– Onset of symptoms, especially after an insect bite?
– Presence of rashes or specific patterns like a facial rash or erythema migrans?
– Consideration of age, gender, and reproductive history.
2. **Laboratory Tests:**
– **Complete Blood Count (CBC):** Checks for infection or inflammation.
– **Erythrocyte Sedimentation Rate (ESR) & C-Reactive Protein (CRP):** Indicates chronic inflammation, useful in diagnosing polymyalgia rheumatica and rheumatoid arthritis.
– **Cyclic Citrullinated Peptide (anti-CCP):** Specific marker for rheumatoid arthritis.
– **Coeliac Serology/Antibodies:** Rules out celiac disease, which can cause systemic symptoms.
– **Thyroid Panel:** Assesses for thyroid dysfunction, which can contribute to fatigue and weakness.
– **Vitamin Levels:**
– **Vitamin D & Vitamin A:** Deficiencies can cause fatigue and muscle pain.
– **Vitamin B12 and Folate:** Deficiencies can cause fatigue, cognitive impairment, and neuropathy.
– **Mineral Levels:**
– **Zinc, Magnesium, Boron:** Deficiencies in these cofactors can contribute to muscle pain and weakness.
– **Autoimmune Markers:**
– **Rheumatoid Factor (RF), ANA Panel, Anti-Phospholipid Antibodies:** Help diagnose autoimmune diseases like lupus and rheumatoid arthritis.
– **Viral Serologies:**
– **EBV, HPV, HBV, Enterovirus, Parvovirus, Retrovirus, Ross River Virus:** Rule out viral causes of chronic fatigue and muscle pain.
– **Other Specific Tests:**
– **Creatine Kinase (CK):** Indicates muscle damage or inflammation.
– **Anti-Neutrophil Cytoplasmic Antibodies (ANCA):** Evaluates for vasculitis.
– **HLA-B27:** Associated with ankylosing spondylitis.
– **Comprehensive Metabolic Panel (CMP):** Assesses liver and kidney function, electrolytes, and glucose.
– **Ferritin/Iron Studies:** Evaluate for iron deficiency or overload.
– **Anti-MuSK and Anti-AChR Antibodies:** Rule out myasthenia gravis.
– **Cortisol Levels:** Check for adrenal insufficiency.
– **Lactate Dehydrogenase (LDH):** Indicates tissue damage.
This comprehensive evaluation will help determine whether your symptoms are due to fibromyalgia or another underlying condition. We will proceed with these tests and a detailed physical exam to pinpoint the cause of your symptoms.