dan062
Senior Member
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- 120
I've been wondering this for a while so thought I'd put it out for consideration to the group. I'd be particularly interested to hear from @Jonathan Edwards and any other residents doctors / retired doctors we have in our midst.
I spent a lot of (pointless) time the past year looking for a diagnosis that fit my symptoms - I'm sure a lot of us have. One I kept coming back to was the various vasculidities but I ultimately concluded that given their rarity and a with (in my case) a normal ESR, CRP, WCC and no hematuria that it was highly improbable.
Nevertheless, of all the strange diseases I've been looking at, vasculitis seemed (to my un-medical brain) to fit the CFS/ME bill the best. (There's one other blog post on the net that wonders this also).
This does nothing, of course, for treatment (unless we can managed to get diagnosed) but I wanted to see if anyone else thought the hypothesis was credible.
Reasoning for:
Maybe this might only apply to a subset of patients, but perhaps CFS/ME being a subclinical (or undiagnosed) systemic vasculitis could be an explanation for some.
I spent a lot of (pointless) time the past year looking for a diagnosis that fit my symptoms - I'm sure a lot of us have. One I kept coming back to was the various vasculidities but I ultimately concluded that given their rarity and a with (in my case) a normal ESR, CRP, WCC and no hematuria that it was highly improbable.
Nevertheless, of all the strange diseases I've been looking at, vasculitis seemed (to my un-medical brain) to fit the CFS/ME bill the best. (There's one other blog post on the net that wonders this also).
This does nothing, of course, for treatment (unless we can managed to get diagnosed) but I wanted to see if anyone else thought the hypothesis was credible.
Reasoning for:
- CFS/ME is characterized by three key dysfunctions: neurological, circulatory/cardiovascular and immunological. Vasculitis can easily explain the first two through recurrent ischemic damage to the brain stem (or other parts of the brain) and the heart; as an autoimmune disease, I presume that dysfunctional immunity would be expected.
- The pathogenesis of the vasculidities seems something of a mystery, but viral infections seem to be implicated in the majority of cases (this is true, of course, of many other autoimmune diseases).
- Although unlikely, vasculitis occasionally can have normal inflammatory markers (example case report), but most doctors will follow the rule that 99% of the time a normal ESR strongly argues against the diagnosis and mark it off the differential. In such a situation, it would seem highly unlikely that any doctor would risk performing a blood vessel biopsy.
- The success of the rituximab trials would be consistent with CFS/ME being a vasculitis.
- Many of us report symptoms such as chronic sinusitis, prostatitis, etc, which would be consistent with vasculitis.
- Our generally normal inflammatory markers.
- Generally, we lack major renal or liver disease (however not all vasculidities attack these organs) and chest x-rays are also normal.
- Supposed rarity of vasculidities (although perhaps, given the 'protean nature' of their presentations, perhaps they are underdiagnosed?).
- We also lack major vasculitic skin findings. Although some of the things many of us report (such as bier spots) could seem consistent with a vasculitic process.
Maybe this might only apply to a subset of patients, but perhaps CFS/ME being a subclinical (or undiagnosed) systemic vasculitis could be an explanation for some.
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