Longitudinal study of outcome of chronic fatigue syndrome

Abstract:

OBJECTIVE: To examine the predictors of long term outcome for patients with the chronic fatigue syndrome.

DESIGN: Cohort study.

SUBJECTS: 139 subjects previously enrolled in two treatment trials; 103 (74%) were reassessed a mean of 3.2 years after start of the trials.

SETTING: University hospital referral centre.

MAIN OUTCOME MEASURES: Age at onset, duration of illness, psychological and immunological status at initial assessment. Ongoing symptom severity, levels of disability, and immunological function at follow up.

RESULTS: 65 subjects had improved but only six reported no current symptoms. An alternative medical diagnosis had been made in two and psychiatric illness diagnosed in 20. The assignment of a primary psychiatric diagnosis at follow up and the strength of the belief that a physical disease process explained all symptoms at entry to the trials both predicted poor outcome. Age at onset of illness, duration of illness, neuroticism, premorbid psychiatric diagnoses, and cell mediated immune function did not predict outcome.

CONCLUSION: Though most patients with the chronic fatigue syndrome improve, a substantial proportion remain functionally impaired. Psychological factors such as illness attitudes and coping style seem more important predictors of long term outcome than immunological or demographic variables.

Comment in:

Chronic fatigue syndrome. Distinguish between syndromes… [BMJ. 1994]

Chronic fatigue syndrome. Immunological findings vary between populations. [BMJ. 1994]

Chronic fatigue syndrome. Role of psychological factors overemphasised. [BMJ. 1994]

 

Source: Wilson A, Hickie I, Lloyd A, Hadzi-Pavlovic D, Boughton C, Dwyer J, Wakefield D. Longitudinal study of outcome of chronic fatigue syndrome. BMJ. 1994 Mar 19;308(6931):756-9. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2539669/

You can read the full article here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2539669/pdf/bmj00432-0032.pdf

 

Chronic fatigue syndrome: prevalence and outcome

This week’s journal contains two papers from multidisciplinary teams that shed light on syndromes of chronic fatigue and so move us towards resolving the often bitter controversy over myalgic encephalomyelitis. A large community survey by Pawlikowska and colleagues provides estimates of the prevalence of the symptom of fatigue,’ operationally defined chronic fatigue syndrome,2 and self declared (possibly self diagnosed) chronic fatigue syndrome in young and middle aged adults in south east England (p 763).1

They found that fatigue was common, occurred as a continuum, and was highly correlated with emotional distress. Most people attributed their fatigue to social or psychological factors. While 02% of the respondents reported that they had chronic fatigue syndrome, as many as 1% of respondents satisfied several of the criteria for the syndrome. As with many illnesses, the cases were found at the severe end of the continuum of fatigue, without any sharp cut off. Associations of self reported chronic fatigue syndrome with female sex and upper social class confirm what has been found in primary care and hospital studies 34 but are less typical in community surveys.’ 6 Previous studies have consistently identified a strong association between emotional morbidity and chronic fatigue syndrome,7 but this “is inevitable given the similarities of the criteria and the measures used to define them.”‘ Interestingly, the closer cases fulfil the definition of chronic fatigue syndrome the stronger the association with emotional morbidity.

Comment in:

Chronic fatigue syndrome. Prevalence study overlooked. [BMJ. 1994]

Chronic fatigue syndrome. …and study them separately. [BMJ. 1994]

Chronic fatigue syndrome. ME Association is honest about prognosis. [BMJ. 1994]

Comment on: Professional and popular views of chronic fatigue syndrome. [BMJ. 1994]

 

Source: Lawrie SM, Pelosi AJ. Chronic fatigue syndrome: prevalence and outcome. BMJ. 1994 Mar 19;308(6931):732-3. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2539646/

You can read the full article here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2539646/pdf/bmj00432-0006.pdf

 

Population based study of fatigue and psychological distress

Abstract:

OBJECTIVES: To determine the prevalence of fatigue in the general population and the factors associated with fatigue.

DESIGN: Postal survey.

SETTING: Six general practices in southern England.

SUBJECTS: 31,651 men and women aged 18-45 years registered with the practices.

MAIN OUTCOME MEASURES: Responses to the 12 item general health questionnaire and a fatigue questionnaire which included self reported measures of duration, severity, and causes of fatigue.

RESULTS: 15,283 valid questionnaires were returned, giving a response rate of 48.3%, (64% after adjustment for inaccuracies in the practice registers). 2798 (18.3%) of respondents reported substantial fatigue lasting six months or longer. Fatigue and psychological morbidity were moderately correlated (r = 0.62). Women were more likely to complain of fatigue than men, even after adjustment for psychological distress. The commonest cited reasons for fatigue were psychosocial (40% of patients). Of 2798 patients with excessive tiredness, only 38 (1.4%) attributed this to the chronic fatigue syndrome.

CONCLUSION: Fatigue is distributed as a continuous variable in the community and is closely associated with psychological morbidity.

Comment in:

Patients with a self diagnosis of myalgic encephalomyelitis. [BMJ. 1995]

Twists in the tale of impossible means. The reviewer shows that the gremlins might have attacked on several fronts. [BMJ. 2000]

Twists in the tale of impossible means. In which a copy of the original manuscript is found safe in Norway. [BMJ. 2000]

Fatigue and psychological distress. Statistics are improbable. [BMJ. 2000]

 

Source: Pawlikowska T, Chalder T, Hirsch SR, Wallace P, Wright DJ, Wessely SC. Population based study of fatigue and psychological distress. BMJ. 1994 Mar 19;308(6931):763-6. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2539651/

You can read the full article here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2539651/pdf/bmj00432-0041.pdf

 

The ocular signs and symptoms of chronic fatigue syndrome

Abstract:

BACKGROUND: Chronic Fatigue syndrome (CFS) is a relatively newly defined clinical entity that affects multiple systems including the ocular system. These effects have not been well documented.

METHODS: 25 consecutive CFS patients were evaluated and the ocular signs and symptoms were described.

RESULTS: Significant ocular symptoms were present in all 25 patients. The most common clinical findings were abnormalities of the preocular tear film and ocular surface (19 patients) and reduced accommodation for age (18 patients).

CONCLUSIONS: CFS affects the ocular system in many ways. Eye care practitioners should pay particular attention to accommodative needs, ocular surface disease and tear film dysfunction when examining these patients. Further research into the pathophysiology of these ocular findings may lead to a better understanding of the pathophysiology of CFS.

 

Source: Caffery BE, Josephson JE, Samek MJ. The ocular signs and symptoms of chronic fatigue syndrome. J Am Optom Assoc. 1994 Mar;65(3):187-91. http://www.ncbi.nlm.nih.gov/pubmed/8201170

 

Single fibre EMG studies in chronic fatigue syndrome: a reappraisal

Abstract:

Single fibre EMG studies were carried out on the right extensor digitorum communis muscle in 30 subjects with chronic fatigue syndrome and in 30 age and sex matched controls. Abnormal jitter was seen in five patients with chronic fatigue syndrome. Slight but significant differences between the mean consecutive differences in the remainder of the chronic fatigue subjects and the control subjects were recorded. Overall the differences were so minor that it seems unlikely that a disturbance of neuromuscular function as reflected by jitter measurement has a pathogenetic role. It is suggested that the increased jitter seen may be explained by the effects of the variability of motor unit firing rates on the myogenic component of the jitter.

Comment in: Single fibre EMG studies in chronic fatigue syndrome: a reappraisal. [J Neurol Neurosurg Psychiatry. 1994]

 

Source: Roberts L, Byrne E. Single fibre EMG studies in chronic fatigue syndrome: a reappraisal. J Neurol Neurosurg Psychiatry. 1994 Mar;57(3):375-6. http://www.ncbi.nlm.nih.gov/pubmed/8158191

You can read the full article here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1072834/pdf/jnnpsyc00033-0119.pdf

 

Mild adrenocortical deficiency, chronic allergies, autoimmune disorders and the chronic fatigue syndrome: a continuation of the cortisone story

Abstract:

The possibility that patients with disorders that improve with administration of large, pharmacologic dosages of glucocorticoids, such as chronic allergies and autoimmune disorders, might have mild deficiency of cortisol production or utilization has received little attention.

Yet evidence that patients with rheumatoid arthritis improved with small, physiologic dosages of cortisol or cortisone acetate was reported over 25 years ago, and that patients with chronic allergic disorders or unexplained chronic fatigue also improved with administration of such small dosages was reported over 15 years ago, suggesting that these disorders might be associated with mild adrenocortical deficiency.

The apparent reasons for the failure of these reports to be confirmed or mentioned in medical textbooks and the facts needed to restore perspective are reviewed, and the need for further studies of the possible relationship of a mild deficiency of the production or utilization of cortisol and possibly other normal adrenocortical hormones to the development of these disorders is discussed.

 

Source: Jefferies WM. Mild adrenocortical deficiency, chronic allergies, autoimmune disorders and the chronic fatigue syndrome: a continuation of the cortisone story. Med Hypotheses. 1994 Mar;42(3):183-9. http://www.ncbi.nlm.nih.gov/pubmed/8057974

 

Fibromyalgia, chronic fatigue syndrome, and myofascial pain syndrome

Abstract:

No major pathophysiologic or therapeutic findings have appeared over the past year regarding fibromyalgia, chronic fatigue syndrome, and myofascial pain syndrome, three poorly understood, controversial, and overlapping syndromes. The frequent prevalence of these disorders in association with Lyme disease and other medical and psychiatric illness was emphasized. New studies demonstrated the potential role for central nervous system activation in fibromyalgia and chronic fatigue syndrome.

 

Source: Goldenberg DL. Fibromyalgia, chronic fatigue syndrome, and myofascial pain syndrome. Curr Opin Rheumatol. 1994 Mar;6(2):223-33. http://www.ncbi.nlm.nih.gov/pubmed/8024971

 

Effects of mild exercise on cytokines and cerebral blood flow in chronic fatigue syndrome patients

 

Abstract:

Chronic fatigue syndrome (CFS) is an idiopathic disorder characterized by fatigue that is markedly exacerbated by physical exertion. In the present study, we tested the hypothesis that mild exercise (walking 1 mph [1 mile = 1.609 km] for 30 min) would provoke serum cytokine and cerebral blood flow abnormalities of potential pathogenic importance in CFS.

Interleukin-1 beta, interleukin-6, and tumor necrosis factor alpha were nondetectable in sera of CFS patients (n = 10) and healthy control subjects (n = 10) pre- and postexercise. At rest, serum transforming growth factor beta (TGF-beta) levels were elevated in the CFS group compared with the control group (287 +/- 18 versus 115 +/- 5 pg/ml, respectively; P < 0.01). Serum TGF-beta and cerebral blood flow abnormalities, detected by single-photon emission-computed tomographic scanning, were accentuated postexercise in the CFS group.

Although these findings were not significantly different from those in the control group, the effect of exercise on serum TGF-beta and cerebral blood flow appeared magnified in the CFS patients. Results of this study encourage future research on the interaction of physical exertion, serum cytokines, and cerebral blood flow in CFS that will adopt a more rigorous exercise program than the one used in this study.

 

Source: Peterson PK, Sirr SA, Grammith FC, Schenck CH, Pheley AM, Hu S, Chao CC. Effects of mild exercise on cytokines and cerebral blood flow in chronic fatigue syndrome patients. Clin Diagn Lab Immunol. 1994 Mar;1(2):222-6. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC368231/

You can read the full article here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC368231/pdf/cdli00002-0112.pdf

 

Chronic fatigue syndrome: have flawed assumptions been derived from treatment-based studies?

Abstract:

Chronic fatigue syndrome is a disabling disorder that has been studied primarily in clinical settings. In the absence of an adequate epidemiological database, cultural stereotypes have influenced the characterization of chronic fatigue syndrome as “the yuppie flu,” similar to the 19th century characterization of neurasthenia as a disease of the affluent. The limited epidemiological data available and the overall medical-sociological literature call this assumption into question. Only a community “true” prevalence study that is unbiased by help seeking and access to health care can provide an accurate assessment of the risk factors for and the public health ramifications of this disease.

 

Source: Richman JA, Flaherty JA, Rospenda KM. Chronic fatigue syndrome: have flawed assumptions been derived from treatment-based studies? Am J Public Health. 1994 Feb;84(2):282-4. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1615008/

You can read the full article here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1615008/pdf/amjph00453-0124.pdf

 

 

High titers of anti-Epstein-Barr virus DNA polymerase are found in patients with severe fatiguing illness

Abstract:

Forty-one patients with chronic fatigue syndrome (CFS), 76 healthy controls matched with the patient group for age range, sex, race, and socioeconomic class, and 22 symptomatic patients with seasonal affective disorder (SAD) had serum sampled for antibodies against 2 Epstein-Barr virus (EBV) replicating enzymes.

Abnormal titers of antibodies were found twice as often in CFS patients as controls (34.1% vs. 17.1%), with SAD patients having an intermediate frequency (27.3%). Stratifying for disease severity sharpened the differences considerably, with the sicker CFS and SAD patients having 52% and 50% abnormal tests, respectively; more mildly afflicted CFS and SAD patients had a frequency of abnormal tests in the normal range.

Antibodies to EBV DNA polymerase (DNAP) were the more sensitive of the two tests in that they were positive in all cases but one. These findings suggest that antibodies against EBV DNAP may be a useful marker in delineating a subset of patients with severe fatiguing illness for appropriate treatment trials and for monitoring their outcomes.

 

Source: Natelson BH, Ye N, Moul DE, Jenkins FJ, Oren DA, Tapp WN, Cheng YC. High titers of anti-Epstein-Barr virus DNA polymerase are found in patients with severe fatiguing illness. J Med Virol. 1994 Jan;42(1):42-6. http://www.ncbi.nlm.nih.gov/pubmed/8308519