Mycoplasmal Infections In Other Diseases
There is some preliminary evidence that mycoplasmal infections are associated with various autoimmune diseases. In some mycoplasma-positive GWI cases the signs and symptoms of Multiple Sclerosis , Amyotrophic Lateral Sclerosis , Lupus, Gravesâ Disease and other complex autoimmune diseases have been seen. Such usually rare autoimmune responses are consistent with certain chronic infections, such as mycoplasmal infections, that penetrate into nerve cells, synovial cells and other cell types. The autoimmune signs and symptoms could be the result of intracellular pathogens, such as mycoplasmas, escaping from cellular compartments and incorporating into their own structures pieces of host cell membranes that contain important host antigens that can trigger autoimmune responses. Alternatively, mycoplasma surface components, sometimes called âsuperantigens,â maydirectly stimulate autoimmune responses . Perhaps the most important event, the molecular mimicry of host antigens by mycoplasma surface components, may explain, in part, their ability to stimulate autoimmune responses .
Asthma, airway inflammation, chronic pneumonia and other respiratory diseases are known to be associated with mycoplasmal infections . For example, M. pneumoniae is a common cause of upper respiratory infections , and severe Asthma is frequently associated with mycoplasmal infections .
Which Facts Do Not Fit Into The Explanatory Model
Even if ME/CFS is of autoimmune origin, is it the metabolic block or the autoantibodies to hormone receptors which are most important for pathogenesis?
The mechanism behind the flare after exercise is obscure. Maybe a mitochondrial defect can lead to an increased activity in the innate immune network.
The disturbance in one-carbon metabolism may or may not be related to the disturbed transition between glycolysis and TCA cycle. It is indicative of a wider metabolic derangement than a block of PDH would be expected to lead to. There are several papers on hormones , including glucocorticoids and transient receptor potential channel hormones , and their receptors , in ME/CFS. It is conceivable that parts of the autonomic dysfunction can be explained in this way.
Signs And Symptoms Analysis
Some chronic illnesses, such as Rheumatoid Arthritis , are well established in their clinical profile , whereas others, such as CFS, FMS and GWI, have rather nonspecific but similar overlapping, multi-organ signs and symptoms. A major difference between these illnesses appears to be in the severity of specific signs and symptoms. For example, CFS patients most often complain of chronic fatigue and joint pain, stiffness and soreness, whereas FMS patients have as their most major complaint muscle and overall pain, soreness and weakness. For the most part, the clinical profiles of these illnesses are similar, and this can be easily seen when the signs and symptoms of CFS, FMS, and GWI patients are compared . Thus although chronic illnesses are considered to be complex, they do display certain similarities, suggesting that these illnesses are related and not completely separate syndromes . In addition, these chronic illness patients often show increased sensitivities to various environmental irritants and chemicals and enhanced allergic responses.
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How To Manage Ra Fatigue
You may need a mix of treatments, lifestyle changes, and a new attitude to keep fatigue under control.
Recognize that fatigue is a part of life with RA. You canât always control it or predict when youâll be too tired to work or join a social event. Listen to your body. Youâll feel better if you take the time to rest when you need to. Take breaks if you have a task that takes a lot of energy.
Tune out the guilt. Your friends and family may not really get how bad you feel. You arenât lazy. Youâre exhausted by your arthritis. Donât feel guilty if you have to rest instead of going out or leave early because youâre too tired. Explain that fatigue is a symptom of your disease.
Donât push yourself to keep up with everyone else. If you need help with household chores that exhaust you, ask others to give you a hand. Cut out any steps you donât need to complete a task. Set your own pace. You decide what you can and canât do on days when fatigue is high.
Get regular exercise. The last thing you may want to do is work out. But studies show that aerobic activity — the kind that makes your heart beat faster — cuts fatigue in people who have an immune system disorder like RA.
Exercise also strengthens the muscles around your joints, keeps your bones strong, and boosts your mood.
Try to do something, even if itâs just stretching, on days when youâre really tired.
Two or three short periods of downtime may give you the boost you need.
Chronic Infections In Ra
The causes of rheumatic diseases are not known, but RA and other autoimmune diseases could be triggered or more likely exacerbated by infectious agents . In some animal species infection by certain species of mycoplasmas can result in remarkable clinical and pathological similarities to RA and other rheumatoid diseases. Aerobic and anaerobic intestinal bacteria, viruses and mycoplasmas have been proposed as important agents in RA , and there has been increasing evidence that mycoplasmas may play a role in the initiation or progression of RA . Mycoplasmas have been proposed to interact nonspecifically with B-lymphocytes, resulting in modulation of immunity, autoimmune reactions and promotion of rheumatic diseases , and mycoplasmas have been found in the joint tissues of patients with rheumatic diseases, suggesting their pathogenic involvement .
When Haier et al. and Vojdani and Franco examined RA patientsâ blood leukocytes for the presence of mycoplasmas, it was found that approximately one-half were infected with various species of mycoplasmas. The most common species found was M. fermentans, followed by M. pneumoniae and M. hominis and finally M. penetrans . Similar to what we reported in CFS/FMS patients , there was a high percentage of multiple mycoplasmal infections in RA patients when one of the species was M. fermentans .
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Ask Your Doctor About Medications To Treat Fatigue
Certain medications may help chronic fatigue, such as modafinil. However, you need to use these with caution, because once you start taking them, it may be hard to stop, Ali says.
Another option, a low-dose antidepressant, also given at bedtime, has been shown to reduce pain, increase sleep, and reduce fatigue in some people with RA, he says.
Cytokine Patterns In Blood And Csf In Me/cfs
The immune system is engaged in ME/CFS . Several studies have found changes in cytokine pattern in blood and CSF, and in expression of cytokine genes , especially after exercise , concomitant with an increase in reactive oxygen species levels and a decrease of HSP70 concentration , often in connection with a flare, an acute exacerbation of ME/CFS symptoms . A difficulty is that cytokine patterns are inherently variable. The cytokine profiles may be different in different stages of the disease .
Table 5. A selective list of cytokines whose concentrations were reported to change in ME/CFS.
A more permanent dysregulation of cytokines in plasma has also been reported , see Table 5. A correlation with disease duration was seen . A meta-analysis showed that an increased level of TGF in plasma in ME/CFS versus controls was the most consistent finding . Cytokines in CSF were also deranged in ME/CFS .
Table 5 is a compilation from recent publications on cytokine abnormalities in ME/CFS. A recent meta-analysis concluded that many of the reported findings are not reproducible . This could reflect different levels of physical activity, the volatile nature of cytokine levels and methodological problems, such as collection, handling, and preparation of samples. There could also be a heterogeneity within the ME/CFS group which blurs the patterns, see, e.g., Ref. .
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Immunological Aspects Of Me/cfs
How does autoreactivity develop? Much remains to be learned. The adaptive portion of the immune system has a formidable task, to distinguish self from non-self, i.e., autoantigens from antigens of invading microbes. After an infection the immune response is initially relying on players of the innate immune system with natural antibodies, receptors for pathogen-associated molecular patterns, danger-associated molecular patterns, and DNA sensors for exogenous pathogens. However, within a few weeks the immune system acquires a higher precision with the developing adaptive immune B and T cells ensuring that only the targeted microbe is destroyed. The target selection may go wrong. Some microbial targets are very similar to self-molecules. This is the basis for the so-called molecular mimicry theory, although the evolutionary lines for microbes and humans diverged long ago. There are still some structures, such as HSP, which have hardly changed at all since then. An immune defense against them thus constitutes a risk of promoting an autoreactive response.
A symptomatic variant of gut dysbiosis, IBS , a common comorbidity in ME/CFS, may influence mucosal tolerance induction. Indeed, ME/CFS with IBS was suggested to be a distinct subset of ME/CFS .
How Can I Help Myself
There are a number of things you can do to help manage your fatigue.
Planning your time wisely to spread your energy over the course of a day or week can help. Its also important to factor some gentle exercise into your day and to have a healthy diet.
Theres a strong link between getting enough good quality sleep and fatigue. And there are several positive steps you can take to improve your chances of sleeping well.
Stress and worry can make your fatigue feel worse, so its a good idea to spot anything that is causing you stress and try to deal with them in good time.
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Me/cfs: What Do We Know
Researchers have long believed that ME/CFS could involve chronic inflammation. Studies reveal several biomarkers of inflammation and a sustained immune response in the blood of ME/CFS patients. Some researchers now consider ME/CFS to be a neuroimmune or neuroendocrineimmune disease.
However, we’re still learning about the specific role of inflammation in the condition. Recent research paints a growing picture of autoimmunity as well. And when autoimmunity is involved, the major question is: what is its target?
Are There Also Epigenetic Changes In Me/cfs
DNA modification of promoters of some genes associated with immune cell regulation glucocorticoid receptors, ATPase and IL6 receptor, respectively, was reported to differ between ME/CFS and controls . DNA methylation depends on the one-carbon metabolism, where ME/CFS changes have been recorded. Although the reason for such hypomethylation can only be speculated upon, it is interesting that the combined action of the vitamins B12 and folic acid play a fundamental role in providing methyl groups to hundreds of substrates in various elementary cell processes .
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Role Of Inflammation In Altered Central Nervous System Activity
Stress was also associated with high levels of the pro-inflammatory intracellular transcription factors NFB and inhibitor of kB and modulated genome-wide expression levels . Thus, inflammation and depression seem to be linked, but which one affects the other is difficult to distinguish and probably there is an interaction between both.
Link Between Fatigue And Pain
Fatigue and pain are two common symptoms in RA, and the link between fatigue and pain in it has been described . In a cross-sectional study, VAS fatigue score was mainly correlated with VAS pain score pain was most strongly associated with the five variables explaining fatigue . Garip et al. confirmed this association, showing that fatigue intensity in RA patients was strongly correlated with VAS pain score and DAS28, with greater correlation between fatigue and pain scores than between fatigue score and DAS28. Moreover, after treatments , the decrease in VAS fatigue score was correlated with ameliorated pain and improved DAS28 score . For Wolfe et al. , pain was a strong independent predictor of fatigue with sleep disturbance, depression, tender joint count and disability by the health assessment questionnaire. Among the variables usually linked to fatigue, pain was a better predictor of fatigue .
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Fatigue Is Not Being Lazy
You wouldnt call someone recovering from a heart attack or undergoing cancer treatment lazy. Yet chronic fatigue which is due to underlying medical reasons has this way of making those it impacts appear lazy.
Fatigue robs us of our ability to think clearly and of our motivation. We are not being lazy when we cant get out of bed, go to work, run errands, or play with our children. We are physically and mentally unable to.
You would never call someone dealing with a debilitating illness lazy if you knew what they were going through on an everyday basis. Some of our most severe symptoms are invisible, which is part of the problem.
Is The Exercise Intolerance In Rheumatoid Arthritis And Me/cfs Similar
Talk about something coming out of left field. Chronic fatigue syndrome isnt the only condition that produces odd and puzzling responses to exercise. It turns out that people with rheumatoid arthritis have their own mysterious problems with exercise.
Exercise intolerance doesnt just occur in ME/CFS. Its also found in rheumatoid arthritis.
That doesnt make sense. Yes, the swollen and painful joints found in RA present impediments to exercise but the joints arent the problem for people. People with RA find that exercise often thought of as a universal healer leaves them feeling drained and fatigued. Just as people with ME/CFS do, people with RA are exhibiting some sort of systemic exercise intolerance.
Fatigue is a big and mysterious issue in RA as well. Fatigue is common, yet the medications which improve the joint problems in RA have small or quite modest effects on fatigue. Despite the the tremendous impact of fatigue on patient health and quality of life, the consensus seems to be that fatigue is not a product of the disease itself but is caused by outside factors such as obesity, physical inactivity, sleep disturbance, and depression. Indeed, little research has attempted to understand the cause of fatigue in RA, and things like exercise, cognitive behavioral therapy, and mindfulness are recommended to treat it.
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Invisible Disease: Rheumatoid Arthritis And Chronic Fatigue Survey
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Fatigue In Chronic Rheumatologic Diseases
Unusual and chronic fatigue with various etiologies was described for 27 % of patients in a primary care clinic . Fatigue is common in RA, SpA, Sjögren syndrome, systemic lupus erythematosus and vasculitis, although most publications concerned fatigue in RA or SpA . In RA and SpA, the frequency of fatigue ranged from 42 % to 80 % depending on the definition and methods of assessment . For 75 % of patients with ankylosing arthritis and 50 % of those with RA, fatigue was considered severe .
Several methods of evaluation have been used to investigate fatigue in rheumatologic diseases . The simplest and quickest scale is the visual analog scale , but this is a unidirectional scale. Multidirectional scales developed to include the different aspects of fatigue are the Medical Outcomes Study Short Form 36 vitality subscale , the Functional Assessment of Chronic Illness Therapy Fatigue Scale , the Profile of Mood States, the RA-specific Multidimensional Assessment of Fatigue scale, the Multidimensional Fatigue Inventory, the Brief Fatigue Inventory, and the Fatigue Severity Scale . With the VAS scale, the mean fatigue level in patients with RA was 42.1 .
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Why Does Ra Cause Fatigue
Antibodies that cause the inflammation of RA affect your central nervous system, not just your joints. High inflammation levels can lead to severe fatigue.
RA also causes long-term pain. It can leave you feeling worn out by the end of the day. But when your joints hurt, itâs hard to sleep. RA fatigue makes it hard to feel refreshed when you wake up in the morning.
When you have RA, fatigue, pain, and mood problems can become a vicious cycle. Doctors think high levels of inflammation might cause all three of these symptoms.
Current Care For Fatigue
There are no published studies on current care for RA fatigue. In a yet unpublished, postal survey about knowledge, attitude and current management of RA fatigue among 232 British and Dutch rheumatology nurses and 110 Dutch rheumatologists, it was shown that healthcare professionals have accurate knowledge of and a positive attitude towards RA fatigue. With regard to the management of fatigue in daily practice, the results revealed two main findings. First, rheumatology nurses seldom refer patients to other disciplines although they believe that other team members could help the patient with fatigue. Second, rheumatologists pay attention to fatigue in the first consultation and less often during follow-up consultations.
A combined qualitative and quantitative study, in which 20 patients were videotaped during their out-patient consultation at the Department of Rheumatology revealed four major results. First, patients more often use implicit cues instead of explicit concerns related to fatigue. Second, fatigue is communicated in almost all consultations with nurse specialists and in less than half of the medical consultations. Third, it is rather the patient than the healthcare professional who raises the issue of fatigue during the consultation. Fourth, in general, nurse specialists use more adequate responses to patients cues or concerns about fatigue than rheumatologists do.
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