COMMENTARY

Chronic Fatigue Syndrome: Wrong Name, Real Illness

Miriam E. Tucker

Disclosures

January 08, 2015

In This Article

What Is ME/CFS?

Experts in the field conceptualize ME/CFS as an abnormal immune system response to any of a number of infectious or environmental triggers, resulting in a chronic state of inflammation, autonomic dysfunction, impaired hypothalamic-pituitary-adrenal axis functioning, and neuroendocrine dysregulation.

"People do think it's a spectrum of disease. We've settled on that it's an immune-related disorder, and there is potentially a subset that's autoimmune, a subset that's virally triggered, a chronic viral infection, and perhaps other triggers or stressors...People are still kicking around whether it's autoimmune or chronic low-grade infection," Open Medicine Institute founder and director Andreas M. Kogelnik, MD, told Medscape Medical News.

Affecting about 1 million adults and children in the United States (by the CDC definition), the hallmarks of ME/CFS include severe fatigue for 6 months or longer (3 months in children), malaise—some patients describe it as a "crash"—lasting days to weeks following even modest physical or mental exertion, unrefreshing sleep, and cognitive dysfunction. Chronic pain is common and many patients also meet criteria for fibromyalgia.

Other frequent symptoms include orthostatic intolerance—particularly a postural orthostatic tachycardia syndrome that can be elicited by a tilt-table test—gastrointestinal dysfunction including irritable bowel syndrome, heat or cold intolerance, and persistent flulike symptoms. In addition to fibromyalgia, other common comorbid conditions include irritable bowel syndrome, joint hypermobility, interstitial cystitis, and migraines.

Women outnumber men in ME/CFS diagnosis, although about a quarter are male. The condition can appear at any age. Contrary to the "yuppie flu" characterization, ME/CFS appears to be more common among ethnic and racial minority groups and in those of lower socioeconomic status.[2]

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