Thread by @Rheumat_Aravind

🧵 “10 Hidden Causes of Fatigue Every Doctor Should Consider”

Not all fatigue is “just stress.”
Here are 10 often-missed causes of chronic fatigue with autoimmune clues 👇
#Rheumatology #MedTwitter #ClinicalPearls #Autoimmune @DrAkhilX @IhabFathiSulima

1️⃣ Early Systemic Lupus (SLE)
✅ Fatigue + arthralgia + mild anemia + positive ANA.
✅ Many cases present this way before organ involvement is obvious.

2️⃣ Iron Deficiency Without Overt Bleeding
✅ Think celiac disease or autoimmune gastritis.
✅ Always check ferritin and screen for relevant antibodies.

3️⃣ Hypothyroidism (Autoimmune)
✅ Hashimoto’s thyroiditis is a classic cause.
✅ TSH and anti-TPO antibodies confirm diagnosis.

4️⃣ Inflammatory Myopathies
✅ Fatigue + proximal muscle weakness (difficulty climbing stairs or lifting arms).
✅ Check CK and a myositis antibody panel.

5️⃣ Primary Sjögren’s Syndrome
✅ Severe fatigue + dry eyes and mouth.
✅ Anti-SSA/Ro antibodies and Schirmer’s test support diagnosis.

6️⃣ Anemia of Chronic Inflammation
✅ Normocytic anemia + elevated CRP or ESR.
✅ Often seen in RA, SLE, and vasculitis.

7️⃣ Adrenal Insufficiency
✅ Fatigue + hypotension + hyponatremia.
✅ Consider secondary causes (e.g., chronic steroid use).

8️⃣ Antiphospholipid Syndrome (APS)
✅ Chronic fatigue + livedo reticularis + recurrent miscarriage or thrombosis.
✅ Screen for antiphospholipid antibodies if suspicion is high.

9️⃣ Early Sarcoidosis
✅ Fatigue + arthralgia + bilateral hilar lymphadenopathy.
✅ ACE levels and chest imaging help confirm.

🔟 Chronic Infection in Immunosuppressed Patients
✅ TB, CMV, and EBV reactivation can mimic autoimmune fatigue.
✅ Always rule out infection before escalating immunosuppression.

💬 Final Take:
Fatigue isn’t always “functional.”
✅ Learn these patterns—early recognition makes a big difference.

🩺 Follow @Rheumat_Aravind for clear, practical autoimmune insights.

#Fatigue #Rheumatology #Autoimmune #MedEd #ClinicalPearls #MedTwitter