I fully agree with you,
@Vasha ,
I really don't think there's a right or wrong answer to whether one should use only one or both of these diagnosis.
I'm really trying to gain more insight into what other people believe, think, and/or feel more comfortable with in order to feed my own reflection on the subject. But I assure you, I do so absolutely without judging or thinking that the conclusions others have personally reached are faulty.
I have met, in the past, a patient suffering from SLE who was actually diagnosed by her doctor as having both lupus and ME/CFS (as opposed to lupus with "lupus fatigue"). That was done before PEM became a widely recognized criteria for ME/CFS, mind you, but I'd still be intrigued by the fact that her doctor had recognized both disorders in that patient, rather than assuming that her profound exhaustion following minimal exertion was simply caused by the lupus.
In a way, this was encouraging for me to hear, because this truly showed that ME/CFS was starting to be recognized as a full entity rather than a diagnosis that would be offered to the patient only if the fatigue had "no other cause or explanation than ME/CFS".
And I remember that one of the things I personally shared with SLE patients was elevated anticardiolipin antibodies (ACA), which are a form of anti-mitochondrial antibodies... So, at some, point I was wondering if the kind of fatigue experienced by lupus patients and ME/CFS patients couldn't have to do with the ACA attacking the mitochondria and therefore impairing cellular energy production.
(Finding this particular
article had gotten me pretty excited back then.)
However, I feel like the differences between SLE and ME/CFS are a little bit clearer and better defined to me than between MCAS and ME/CFS (a little, because the lines between both are still heavily blurred in many areas)...
The patient with both diagnosis of lupus and ME/CFS had a pretty solid personal concept of which symptoms belonged to her lupus, and which symptoms belonged to her ME/CFS, though.
In the case of MCAS and ME/CFS, the two of them look to me like such twins in terms of the clinical manifestations associated with them that it's a little harder for me to understand the difference.
I remember reading the last page of
this document and going "Wait. Haven't we just essentially described the reality of a ME/CFS patient?"
The fact that MCAS patients often also suffer from dysautonomia (ex: POTS), fibromyalgia, and EDS strongly reminded me of the fact that ME/CFS patients are also often suffering from these same disorders as well...
Oddly enough, I have a better concept in my mind of what fibromyalgia v.s. ME/CFS is...
But when it comes to MCAS, it's like I just don't really see any clear difference between the two, especially when the ME/CFS patient suffers from any environmental and/or food intolerance (whether they fit the MCS criteria or not).
The thing I have found, too, is that when I talk about skin reactions to ME/CFS patients, a lot of them don't identify as having any...
But then, if I mention how I'll get some red plaques on my abdomen and/or stomach when I take a bath, they'll go "Oh yeah! I do that, too! And sometimes, it really itches but it's gone as soon as the bath is over!" They tend to think that's just normal vasodilatation and everyone has it.
Or they'll see pictures of the rosacea I have on my cheeks (that is slowly clearing up thanks to Xolair) and say they have the same, but for them it's just "rosacea", and so many healthy people have it that they never really considered it as having anything to do with their ME/CFS (even if it began appearing around the time they started developing other symptoms).
They will also have hot flushes a lot! But will think it's due to the fatigue and hormonal changes caused by ME/CFS...
I often find that there seems to be little clues pointing towards mast cell activation even in ME/CFS patients that don't report any "allergic" reactions to foods or their environment.
You do bring a very, very good point, I must say, regarding the fact that since we don't know enough about the etiology behind a lot of these disorders, and which one is causing the other and vice versa, it might not yet be that important to drop ME/CFS from our list of diagnosis when we get diagnosed with MCAS.
My immunologist seems to consider ME/CFS and MCAS diagnosis as mutually exclusive. But I haven't spoken to Dr. Hyde since I received my MCAS diagnosis and gotten the chance to ask him what he thought about it.
Actually, I'm not even sure he thought I was a true ME patient (since he has his very own proposed definition of ME)! Lol!
[Edit: I almost forgot!!! Thank you for the link to the article, too! It is indeed very interesting!
]