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Chronic fatigue syndrome

Other Names:

Systemic exertion intolerance disease; Chronic fatigue immune dysfunction syndrome

Chronic fatigue syndrome, also known as systemic exertion intolerance disease, is a condition that causes extreme, long-lasting fatigue which can limit the ability to participate in ordinary, daily activities.[1] It generally occurs in young adults (20 to 40 years of age) and is twice as common in women.[2][3] The main symptom is disabling fatigue that does not improve with rest.[2] Other signs and symptoms may include muscle pain, joint pain, concentration and memory problems, headaches, sleep problems, fever, sore throat, and/or tender lymph nodes.[1][2] The exact cause is not known.[3][2] There is still no cure or effective treatment for this condition but there are several clinical trials.[1][4]

There is controversy and debate in the medical literature about the relationship between myalgic encephalomyelitis and chronic fatigue syndrome and there is no consensus on nomenclature or classification for these disorders. Different countries, organizations, and researchers continue to use different names to describe these conditions.[5]

Last updated: 10/18/2016

 

Cause

The cause of chronic fatigue syndrome is not known. Some researchers have proposed that this condition is caused by viral infections or by immunological, hormonal or psychiatric problems. However, none of these possible explanations are proven.[3][2] It is also believed that there may be a genetic predisposition for this condition and stress-related events act as triggers.[3][4]

Last updated: 10/18/2016

 

Diagnosis

The Committee on the Diagnostic Criteria for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome, The Board of Select Populations and the Institute of Medicine proposed diagnostic criteria which requires that the patient have the following three symptoms:[3]

  1. Chronic fatigue that interferes with daily activities and work, which is often profound, is of new or definite onset (not lifelong), is not the result of excessive exertion or other medical conditions, and is not greatly alleviated by rest.
  2.  Post-exertional malaise.
  3.  Unrefreshing sleep.

At least one of the two following symptoms is also required:

  • Cognitive impairment (impairment of short memory or concentration).
  • Orthostatic intolerance (Onset of symptoms when standing upright that are improved by lying back down).

Other  symptoms include post exertion illness lasting more than 24 hours, muscle pain, pain in the joints, headaches, tender lymph nodes and sore throat.

These symptoms should have persisted or recurred during 6 or more consecutive months of illness and they cannot have first appeared before the fatigue.

The diagnosis can only be made after 6 months because many other causes of similar fatigue do not last beyond 6 months. The patients should be asked questions about the frequency and severity of their symptoms.  Questionnaires or clinical observations that may help the diagnosis should also be used, such as the Wood Mental Fatigue Inventory.

The following tests, together with the symptoms, support the diagnosis of CFS (these tests are not routinely required, nor do negative results rule out the diagnosis):[4]

  • Two cardiopulmonary exercise tests (CPETs) separated by 24 hours that show inability to repeat the same maximal or anaerobic threshold measures on the second day; this mean that the  values on the second CPET must be much lower than those on the first CPET (note that this test may worsen symptoms in these patients).
  • Standing test or tilt test to evaluate for postural tachycardia syndrome, neurally mediated hypotension, and orthostatic hypotension.

Sleep studies do not seem to help to the diagnosis of this disorder. Neurological or psychological testing is not required for diagnosis.

Other symptoms and testing that may support the diagnosis of CFS may include:[4]

  • History of  past infection from which patient never fully recovered with or without blood exams that show the presence of virus-specific immunoglobulin M (IgM), near the onset of illness.
  • History of having repeated infections with or without exams showing an abnormal immune function, such as decreased function of natural killer cells in those with severe disease.

Many patients with CFS have other disorders as well, some of which—including fibromyalgia, irritable bowel syndrome, metabolic syndrome, sleep disorders, and depression—may have symptoms that overlap with those of CFS. The diagnosis and treatment of these conditions is necessary when caring for patients.[4][3]

Last updated: 1/20/2017

 

Treatment

Treatment options for chronic fatigue syndrome (CFS) are limited.[3] Treatment is largely supportive and is focused on the specific symptoms present in each individual.[6] In most cases, symptoms of CFS lessen over time.[7]

Several therapies have been researched, but there is, unfortunately, no strong evidence to suggest that any of the studied therapies are beneficial to those affected by CFS. Although cognitive behavioral therapy (CBT) and graded exercise therapy initially appeared to show some promise, further evaluation utilizing better diagnostic criteria for the condition and separating CBT from other counseling and behavioral interventions suggests that the evidence for CBT and GET as effective treatments is of very poor quality.[8]

A number of medications, special diets and vitamin supplements have been evaluated in individuals with CFS, but none have been proven effective.[6][7] Although there have been a number of viruses that were initially reported to cause CFS, additional studies have not supported this.[3] Trials of antiviral agents have been ineffective in relieving the symptoms of CFS.[6] Several clinical trials aiming to find effective treatment are currently ongoing.

Other disorders that may be present, such as fibromyalgia, irritable bowel syndrome, metabolic syndrome, sleep disorders, and depression should be treated when caring for patients.[4][3]

Last updated: 10/18/2016

  1. Chronic fatigue syndrome. MedlinePlus. May 19, 2015; http://www.nlm.nih.gov/medlineplus/chronicfatiguesyndrome.html.
  2. Hatron PY. Chronic Fatigue Syndrome. Orphanet. April 2009; http://www.orpha.net/consor/cgi-bin/OC_Exp.php?lng=EN&Expert=1983.
  3. Gluckman SJ, Aronson MD & Park L. Clinical features and diagnosis of chronic fatigue syndrome (systemic exertion intolerance disease). UpToDate. June 29, 2015; http://www.uptodate.com/contents/clinical-features-and-diagnosis-of-chro….
  4. Committee on the Diagnostic Criteria for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome; Board on the Health of Select Populations; Institute of Medicine. Source Washington (DC): National Academies Press (US). Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Redefining an Illness. The National Academies Collection: Reports funded by National Institutes of Health. February, 2015; http://www.ncbi.nlm.nih.gov/pubmed/25695122.
  5. Twisk FN. Replacing Myalgic Encephalomyelitis and Chronic Fatigue Syndrome with Systemic Exercise Intolerance Disease Is Not the Way forward. Diagnostics (Basel). February 5, 2016; 6(1):
  6. Burke A Cunha. Chronic Fatigue Syndrome. Medscape Reference. February 15, 2015; http://emedicine.medscape.com/article/235980-overview. Accessed 8/4/2015.
  7. Margaret-Mary G. Wilson. Chronic Fatigue Syndrome. Merck Manuals. December 2008; http://www.merckmanuals.com/home/print/special_subjects/disorders_of_unk…. Accessed 8/4/2015.
  8. Diagnosis and Treatment of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. Agency for Healthcare Research and Quality. December 2014, Addendum July 2016; https://effectivehealthcare.ahrq.gov/ehc/products/586/2004/chronic-fatig….

 

Source:

https://rarediseases.info.nih.gov/diseases/7121/disease

Hyperlink:
https://rarediseases.info.nih.gov/diseases/7121/disease