Trending Clinical Topic: Chronic Fatigue Syndrome

Ryan Syrek


September 03, 2021

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Recently published consensus recommendations on the diagnosis and management of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), along with interest in its connections with long COVID, resulted in this week's top trending clinical topic. A week after the National Institute for Health and Care Excellence (NICE) delayed publication of updated guidance on ME/CFS, outraging a coalition of charities, the 23-member US ME/CFS Clinician Coalition published consensus recommendations. The document was published in Mayo Clinic Proceedings and is the culmination of work that began with a summit held in March 2018. The target audience is both generalist and specialist healthcare providers.

The guidance reviews and includes the 2015 US Institute of Medicine (now the National Academy of Medicine) ME/CFS diagnostic criteria, which are now also recommended by the Centers for Disease Control and Prevention (see Infographic below). Various nonpharmacologic and pharmacologic treatment and management approaches are also offered for each of the individual core and common ME/CFS symptoms. The document recommends against using the "outdated standard of care" cognitive-behavioral therapy and graded exercise therapy as primary treatments for the illness. Instead, the authors advocate for teaching patients "pacing," an individualized approach to energy conservation aimed at minimizing the frequency, duration, and severity of postexertional malaise.

The consensus recommendations also include a look at the evidence regarding the etiology of various symptoms and the condition overall. Last year, a study identified a potentially treatable origin of dysautonomia in ME/CFS. The single-site study identified an underlying autoimmune-associated small-fiber polyneuropathy (aaSFPN). Findings from the study show that in more than half of patients with ME/CFS, levels of at least one autoantibody were elevated. Most had comorbid postural orthostatic tachycardia or orthostatic intolerance, and over a third had biopsy-confirmed aaSFPN.

The cause of ME/CFS is of particular interest considering the condition's overlapping symptoms with long COVID. Individuals experiencing long-term symptoms following acute COVID-19 infection often meet the criteria for ME/CFS. In an international survey of 3762 COVID-19 "long-haulers" published in a preprint last December, the most frequent symptoms reported at least 6 months after illness onset were fatigue (78%), postexertional malaise (72%), and cognitive dysfunction ("brain fog") (55%). The National Institutes of Health appropriated $1.15 billion over the next 4 years to investigate long COVID, according to a February 5, 2021 blog from the National Institute of Neurological Disorders and Stroke. Given the similarities, experts hope that research may prove to be beneficial to those with ME/CFS as well.

From the eagerly anticipated release of consensus recommendations to ongoing interest in the similarities with post-acute COVID symptoms, interest in ME/CFS made it this week's top trending clinical topic.

Read more clinical information about ME/CFS.


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