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Had Chronic fatigue syndrome. Having symmetrical muscle ache, fatigue and tremors in the hand. Done with several tests. Treatment?

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General & Family Physician
Practicing since : 2009
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Hi, I have written several times over the last few months. I had a history of CFS in the 90s. My symptoms are symmetrical muscle ache, fatigue, tremors in the hand, and "ratcheting" in my joints, especially the shoulder and wrists. I have had MRIs, blood tests and EMGs to rule out ALS, MS, Lupus, arthritis, sjorgens, etc. I have found two or three things that fit better with my symptoms but Docs don't seem to listen. They are BFS, polymyositis, and Polymyalgia Rheumatica. All share the commonality of symmetrical muscle ache, fatigue, tremors, etc. What are your thoughts? thanks
Posted Sun, 15 Sep 2013 in Bones, Muscles and Joints
Answered by Dr. Shoaib Khan 53 minutes later
Brief Answer:
Agree, except for BFS

Detailed Answer:
Hello sir and welcome.

We are happy to see you here.

Based on the symptoms mentioned by you in your query, I would agree with you to include polymyositis, polymyalgia rheumatica in your list of differential diagnosis along with rheumatoid arthritis, peripheral neuropathy, electrolyte imbalances, other myositis (giant cell, ossificans, focal), myasthenia gravis, Cushing syndrome, thyroid abnormalities, fibromyalgia, etc.

But BFS (benign fasciculation syndrome) has one major and most common symptom of twitching of muscles which is quite obviously seen through a physical examination.

Hope this information helps. Please feel free to discuss anything with me or write back to me with any further clarifications.

Best wishes.
Above answer was peer-reviewed by
Follow-up: Had Chronic fatigue syndrome. Having symmetrical muscle ache, fatigue and tremors in the hand. Done with several tests. Treatment? 1 hour later
rheumatoid Arth, peripheral, neuropathy, Thyroid problems, electrolyte imbalances Cushings and Fibromyalgia have all been ruled out through blood tests and Neuro Doc tests. I do occasionally have BFS-like muscle twitches along with the muscle aches, all of which waxes and wanes. The symmetrical muscle aches are not painful, but they do bring on fatigue. I have had these symptoms for 5 or 6 months.
How does polymyositis normally present? I don't have any dermatological symptoms. Would not a normal EMG rule out polymyositis? I don't seem to have any evolving muscle weakness, just a feeling of fatigue in the muscle. As I said in my original question, symmetrical shoulder and arm aches that migrate are my main symptoms. Thanks
Answered by Dr. Shoaib Khan 20 minutes later
Brief Answer:
Polymyositis almost ruled out; CFS again?

Detailed Answer:
Hello once again sir.

So you do experience visible muscle twitching, which puts BFS back on the list.

Polymyositis commonly presents with the following symptoms:
-Muscle or joint tenderness/stiffness
-Difficulty in speech (not always)
-Difficulty in swallowing (not always)
-It is a progressive condition, which means symptoms only get worse
-Difficulty in breathing (not always)

A normal EMG does reduce the chances of polymyositis, but at times, some patients do test normal with an EMG, requiring tests like an MRI or even a muscle biopsy to confirm polymyositis.

Could it be possible that your CFS has returned?

Hope this information helps. Do write back to me for any further clarifications.

Best wishes.
Above answer was peer-reviewed by
Follow-up: Had Chronic fatigue syndrome. Having symmetrical muscle ache, fatigue and tremors in the hand. Done with several tests. Treatment? 3 hours later
I have never heard of CFS causing symmetrical muscle ache. I have heard of tremors with it. My tremors are kinetic and only appear as I am holding something or leaning on something. they are not intention tremors. Does polymyositis present with full scale bilateral muscle ache, tremors, and ratcheting? When I shrug my shoulders, they come down with a distinct ratcheting that is visible to anyone watching. BFS was my original thought since it has all the symptoms I have. But then so does polymyositis. I sometimes have balance problems too, no severe but enough that I notice. That may be a symptom of age. I am thinking of asking my neuro doc to try me on a few days of prednisone. If that helped a great deal, then it would point to polymyositis or Polymyagia rheumatica. your thoughts?
Answered by Dr. Shoaib Khan 5 hours later
Brief Answer:
Initiate prednisone and anti-anxiety medication

Detailed Answer:
Hello Sir.

CFS does not cause symmetrical muscle ache, but does have muscle pain (mostly unexplained) in the list of symptoms. These two could be the same? But this can be assumed only when all other conditions are ruled out.

Although I agree with polymyositis and BFS to be more likely in this scenario; sadly the tests have ruled them out.

Have you checked your serotonin levels? Correction of these levels can greatly help reduce/relieve you from symptoms of BFS. Treatment is usually initiated with 5-hydroxytryptophan. Also, have you been sleeping well? Lack of sleep can trigger or worsen symptoms of BFS and polymyositis. Please consult your doctor to help you sleep well, if you are currently not.

Yes, muscle aches (whether bilateral, symmetrical or not) are present with polymyositis; but tremors and ratcheting are not documented symptoms. Although, various cases of polymyositis have reported these symptoms as well. In polymyositis, which is a progressive condition, with time you do find it difficult to hold objects, climb stairs, etc; due to either a tremor, muscle weakness, or pain; which also matches your description.

Yes, initiation of prednisone and the response you experience might help to diagnose/rule out polymyositis. This is a good idea.

Also, BFS would require anti-anxiety medication and magnesium supplementation (if a deficiency is found); you could initiate anti-anxiety medication as well, which will help in relaxing you to quite an extent whether you have BFS or not, and might even help in reducing your symptoms. Check your magnesium levels as well.

Hope this helps. Feel free to write back to me for any further clarifications, I am always available for discussion.

God bless you.
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