Hidden Internal Medicine Concerns
In addition to structural and musculoskeletal concerns, these patients may suffer from internal medicine type concerns that may lead to incomplete diagnoses including:
- Fibromyalgia or central sensitization
- Chronic fatigue syndrome
- Postural orthostatic tachycardia syndrome
- Vasovagal syncope or vague neurologic spells
- Migraine
- Idiopathic urticaria or dermatitis
- Inflammatory polyarthritis
- Unspecified sleep disorders
- Irritable bowel syndromes
- Neurogenic bladder
- Asthma or reactive airway disease
- Anxiety or depressive disorders
- Endometriosis
Hypermobility Spectrum Disorders
Ehlers-Danlos Syndrome (EDS) A genetic condition where collagen is affected, leading to joint laxity, stretchy or fragile skin, and musculoskeletal instability. Joint Instability Patients may notice popping, cracking, or joints that feel “loose,” especially during flares. Musculoskeletal Concerns Frequent sprains, chronic pain, and early osteoarthritis are common challenges.
Mast Cell Activation Syndrome (MCAS)
What Is MCAS?
A condition where mast cells release inflammatory chemicals inappropriately, causing multi-system symptoms. Unlike systemic mastocytosis, MCAS often presents without obvious skin findings.
Possible Symptoms
- Hives or unexplained rashes
- Gastrointestinal upset (IBS-like symptoms)
- Respiratory issues (asthma or reactive airway disease)
- Neurologic symptoms (migraines, brain fog)
Dysautonomia
Definition
A group of disorders where the autonomic nervous system does not regulate properly, affecting heart rate, blood pressure, digestion, and more.
Common Types
- Postural Orthostatic Tachycardia Syndrome (POTS): rapid heart rate when standing
- Vasovagal Syncope: fainting or near-fainting spells
Associated Symptoms
Fatigue, dizziness, fainting, palpitations, and exercise intolerance.
Overlapping Conditions Often Seen
- Fibromyalgia / central sensitization
- Chronic fatigue syndrome
- Migraines
- Irritable bowel syndrome (IBS)
- Sleep disorders
- Neurogenic bladder
- Anxiety or depression
- Endometriosis
These overlaps can make diagnosis challenging and often delay treatment.