This is the third part of a 4-part series from an annotated PubMed free full text article:
Management of pain and fatigue in the joint hypermobility syndrome (a.k.a. Ehlers–Danlos syndrome, hypermobility type): Principles and proposal for a multidisciplinary approach – Castori – 2012 – American Journal of Medical Genetics Part A – Wiley Online
Chronic fatigue is a persistent overwhelming sense of tiredness, lack of energy, and feeling of exhaustion
Such a mixture of unpleasant perceptions is nearly universal in adults with JHS/EDS-HT.
Manifestations of fatigue-related features in JHS/EDS-HT are wide and overlap criteria for the chronic fatigue syndrome (CFS) in more than 80% of the patients
The correlation between JHM and CFS was explored by various research groups, which inconstantly demonstrate a unexpected higher rate of generalized JHM in patients with CFS.
It is possible that JHS/EDS-HT really affects a significant number of CFS patients with primary musculoskeletal dysfunction and a lower rate of symptoms related to impairment of the immune system (e.g., tender lymph nodes and sore throat). This anticipates etiological heterogeneity for CFS and the possible role for JHM in characterizing a specific subtype of CFS
The cause(s) of fatigue in JHS/EDS-HT is(are) debated
five major determinants of fatigue are delineated, namely
- sleep disturbances,
- concentration problems,
- social functioning,
- self-efficacy concerning fatigue, and
Besides concentration problems, which are likely a result of chronic fatigue, all the remaining are possible causes for fatigue combining together in different ways case by case
Furthermore, muscle weakness has been recently outlined as a contributing factor to fatigue in EDS, maybe in term of post-exertional malaise.
On a pathogenic perspective, additional systemic characteristics of JHS/EDS-HT can be involved in generating a persistent feeling of exhaustion. In particular, the link between JHM and dysautonomia is a relatively consolidated concept
In addition, an increased rate of celiac disease was demonstrated in JHS/EDS-HT and this evidence may indicate intestinal malabsoption as a possible trigger for fatigue, at least in a subset of patients
an increased rate of asthmatic symptoms and atopy associated with increased lung volumes, impaired gas exchange, and an increased tendency of both the lower and upper airways to collapse in JHS/EDS-HT.
In light of the recent findings, various disease characteristics may be identified as contributors to fatigue in JHS/EDS-HT (Table II. Contributing Factors to Fatigue).
Outline of this series of posts:
- Pain and fatigue in EDS-JHS – Part I: Intro and Quality of Life
- Pain and fatigue in EDS-JHS – Part 2: Pain
- Pain and fatigue in EDS-JHS – Part 3: Fatigue
- Pain and fatigue in EDS-JHS – Part 4: Tables and Conclusion