Question:
There is someone I am trying to give some support to in e-mail who
has taken thyroid hormone for presumed hypothyroid in the past but not
now( her thyroid tests are normal now and I wondered about something
that fluctuates like Hashimoto's) who suffers from chronic fatigue,
migraines, mild cognitive difficulties ("brain fog") and sharp pain on
breathing. She had tender trigger points in an exam for fibromyalgia.
The cognitive, migraine, and trigger points I have seen with fibro.
The breathing pains I have always assoiciated more with lupus (her
chest area has no tenderness; not costochondritis; her chest x-ray
normal so no pleural effusions or pneumonia).
She is seeing a primary care doc on a managed care plan. He feels her
chest pain is due to anxiety (and, in fact, she did improve on
Effexor, but of course if that is an antidepressant (I am not very
familiar with it) it might help with fibro or with pain control
whatever she has.
She has only one abnormal test--sed rate of 46. She has not had an
ANA test or anti-thyroid antibody test.
Her doc says sed rate is elevated due to fibro. I have never heard of
fibro elevating the sed rate. Her white blood count is normal so I
don't think an infection is all that likely?
I personally would feel a little better if she at least had an ANA
done. The quality of life issue is her biggest problem--she is
exhausted all the time.
On the other hand I sure don't want to encourage her to piss off her
primary care doc on a managed care plan! and my sense is he's a
little touchy.
Answer:
Fibromyalgia does NOT affect sed rate. You're right. With a sed
rate this high you have to start worrying about true rheumatic
inflammatory diseases, such as polymyalgia rheumatica. It's certainly
something to follow closely, and you need to make sure the tenderness
is at trigger points, and not actually thigh muscle or shoulder
muscular tenderness. Headache (her migraine?) associated with
polymyalgia can be due to temporal arteritis, and this needs to be kept
in mind since it can cause blindness if you miss it. In general, yes I
agree with the need for an ANA and rheumatology consult. If your
primary doc doesn't know enough to know that fibromyalgia doesn't
explain a high sed rate, then he doesn't know enough to NOT order such
a consult
