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IMMUNOLOGY
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Demettre, E., Bastide, L., D'Haese, A., De Smet, K., De Meirleir, K., Tiev, KP., Englebienne, P and Lebleu, B. Ribonuclease L proteolysis in peripheral blood mononuclear cells of chronic fatigue syndrome patients. Journal of Biological Chemistry, 2002, epubl. 12th July.
A 37 kDa binding polypeptide accumulates in peripheral blood mononuclear cells (PBMC) extracts from CFS patients and is being considered as a potential diagnostic marker.
We establish here that this low molecular weight 2-5A binding polypeptide is a truncated form of the native 2-5A dependent ribonuclease L (RNase L), generated by an increased proteolytic activity in CFS PBMC extracts. RNase L proteolysis in CFS PBMC extracts can be mimicked in a model system in which recombinant RNase L is treated with human leukocyte elastase (HLE).
RNase L proteolysis leads to the accumulation of two major fragments with molecular weights of 37 and 30 kDa. The 37 kDa fragment includes the 2-5A binding site and the N-terminal end of native RNase L. The 30 kDa fragment includes the catalytic site in the C-terminal part of RNase L.
Interestingly, RNase L remains active and 2-5A dependent when degraded into its 30 kDa and 37 kDa fragments by proteases of CFS PBMC extract or by purified HLE. The 2-5A dependent nuclease activity of the truncated RNase L could result from the association of these digestion products, as suggested in pull down experiments.
Shetzline, SE., Martinand-Mari, C., Reichenbach, NL., Buletic, Z., Lebleu, B., Pfleiderer, W., Charubala, R., De Meirleir, K., De Becker, P., Peterson, DL., Herst, CV., Englebienne, P and Suhadolnik RJ. Structural and functional features of the 37-kDa 2-5A-dependent RNase L in chronic fatigue syndrome. Journal of Interferon and Cytokine Research, 2002, 22, 4, 443-456.
A 2',5'-oligoadenylate (2-5A)-dependent 37-kDa form of RNase L has been reported in extracts of PBMC from individuals with CFS. In the current study, analytic gel permeation FPLC, azido photoaffinity labeling, two-dimensional (2-D) gel electrophoresis, and matrix-assisted laser desorption/ionization mass spectrometry (MALDI-MS) have been used to examine the biochemical relationship between the 80-kDa RNase L in healthy control PBMC and the 37-kDa RNase L in PBMC from individuals with CFS.
Like the 80-kDa RNase L, the 37-kDa RNase L is present as a catalytically inactive heterodimer complex with the RNase L inhibitor (RLI). Formation of a 37-kDa RNase L-RLI complex indicates that the 37-kDa RNase L is structurally similar to the 80-kDa RNase L at the N-terminus, which contains the 2-5A binding domain. The enzymatically active monomer form of 37-kDa RNase L resolved by 2-D gel electrophoresis has a pI of 6.1. RT-PCR and Southern blot analyses demonstrated that the 37-kDa RNase L is not formed by alternative splicing. In-gel tryptic digestion of the 37-kDa RNase L that was excised from 2-D gels and subsequent MALDI-MS analysis identified three peptide masses that are identical to three predic-ted peptide masses in the 80-kDa RNase L. The electrophoretic mobility of 2-5A azido photolabeled/immunoprecipitated 37-kDa RNase L was the same under reducing and nonreducing conditions.
The results presented show that the 37-kDa form of RNase L in PBMC shares structural and functional features with the native 80-kDa RNase L, in particular in the 2-5A binding and catalytic domains.
Snell, CR., Vanness, JM., Strayer, DR and Stevens, SR. Physical performance and prediction of 2-5A synthetase/RNase L antiviral pathway activity in patients with chronic fatigue syndrome. In Vivo, 2002, 16, 2, 107-109.
The elevated RNase L enzyme activity observed in some CFS patients may be linked to the low exercise tolerance and functional impairment that typify this disease. The purpose of this investigation was to determine if specific indicators of physical performance can predict abnormal RNase L activity in CFS patients.
Seventy-three CFS patients performed a graded exercise test to voluntary exhaustion. Forty-six patients had elevated RNase L levels. This measure was employed as the dependent variable in a discriminant function analysis, with peak V02, exercise duration and Karnofsky Performance Scores (KPS) serving as the independent variables.
All three variables entered the single significant function (p<0.001). The elevated RNase L group had a lower peak V02 and duration than the normal group, but a higher KPS.
The results suggest that both exercise testing and the RNase L biomarker have potential to aid in the diagnosis of CFS.
Palaniappan, R and Sirimanna, T. Peripheral vestibular dysfunction in chronic fatigue syndrome. International Journal of Pediatric Otorhinolaryngology, 2002, 31, 64, 1, 69-72.
This reports left-sided peripheral vestibular failure as the cause of dizziness in a 12-year-old boy diagnosed as having CFS. Setting was a tertiary children's hospital.
We recommend proper vestibular assessment for CFS patients presenting with dizziness, as effective treatment for peripheral vestibular disorder exists in the form of balance rehabilitation exercises.
Metzger, FA and Denney, DR. Perception of cognitive performance in patients with chronic fatigue syndrome. Annals of Behavioral Medicine, 2002, 24, 2, 106-112
This study examined discrepancies between perceived and actual performance by patients with CFS confronted with a challenging cognitive task. Before and after completing a modified version of the Stroop task, 40 patients and 40 healthy control participants estimated their own performance and the performance that would normally be achieved by someone of equal age and education level.
After correcting for differences between the groups in depression, we found no differences in actual performance on the Stroop. However, patients with CFS consistently underestimated their performance relative to normal performance. This difference was observed for both depressed and nondepressed subgroups of patients, persisted after adjusting the results for depression, and correlated with patients' ratings of the mental effort and fatigue evoked by the task.
The results are discussed in light of cognitive models of CFS that suggest the setting of impossibly high standards of personal performance may contribute to the dynamism of this disease.
Silver, A., Haeney, M., Vijayadurai, P., Wilks, D., Pattrick, M and Main CJ. The role of fear of physical movement and activity in chronic fatigue syndrome. Journal of Psychosomatic Research, 2002, 52, 6, 485-493.
Objective: To examine beliefs in relation to avoidance of activity in CFS.
Methods: The first phase consisted of modifying an existing chronic pain measure of kinesiophobia-fear of physical movement and activity- and validating it on the CFS population [Tampa Scale of Kinesiophobia-Fatigue (TSK-F); n=129; test-retest: r=.89, p<.001; alpha=.68]. Subscales of Illness Beliefs (alpha=.78) and Beliefs about Activity (alpha=.70) were identified. The second phase consisted of evaluating whether behavioural persistence was predicted by the TSK-F (n=33). Participants were asked to ride an exercise bike for as long as they felt able.
Results: Analyses indicated that behavioural persistence did not correlate with maximal heart rate or resting heart rate, level of tiredness, symptom severity, illness identity or emotional distress. However, the TSK-F did correlate highly with distance travelled and added a significant 15% of the variance in distance after adjustments for gender and physical functioning (PF). The TSK-F Beliefs about Activity subscale appears to be the predictive factor, explaining 12% of the variance in excise performance or rather 12% of the avoidance of exercise.
Conclusion: Beliefs about Activity appear to be an important variable in predicting behaviour and avoidance of exercise. As avoidance has been suggested as a key to the maintenance of symptoms, disability and distress in CFS patients, this research has important theoretical, clinical and research implications.
Van Houdenhove, B., Neerinckx, E., Onghena, P., Vingerhoets, A., Lysens, R and Vertommen, H. Daily hassles reported by chronic fatigue syndrome and fibromyalgia patients in tertiary care: a controlled quantitative. Psychotherapy and Psychosomatics, 2002, 71, 4, 207-213.
Background: This study aimed at providing insight in the frequency, emotional impact and nature of daily hassles, experienced by patients suffering from CFS and/or fibromyalgia (FM), compared with patients with a chronic organic disease.
Methods: One hundred and seventy-seven CFS/FM patients, 26 multiple sclerosis (MS) and 26 rheumatoid arthritis (RA) patients were investigated within 2-6 months after diagnosis. All patients completed a self-report questionnaire assessing daily hassles and associated distress, a visual analogue scale assessing fatigue and pain and a depression and anxiety questionnaire.
Results: CFS/FM patients show a higher frequency of hassles, higher emotional impact and higher fatigue, pain, depression and anxiety levels compared with MS/RA patients. Three hassle themes dominate in the CFS/FM group: dissatisfaction with oneself, insecurity and a lack of social recognition. In contrast, hassles reported by MS/RA patients show a much larger diversity and are not focused on person-dependent problems.
Conclusions: Patients recently diagnosed as suffering from CFS and/or FM are highly preoccupied and distressed by daily hassles that have a severe impact on their self-image, as well as their personal, social and professional functioning. An optimal therapeutic approach of CFS and FM should take account of this heavy psychosocial burden, which might refer to core themes of these patients' illness experience.
See also Van Houdenhove, B. Listening to CFS . Why we should pay more attention to the story of the patient. Journal of Psychosomatic Research, 2002, 52, 2, 495-499.
Herrell, R., Goldberg, J., Hartman, S., Belcourt, M., Schmaling, K and Buchwald D. Chronic fatigue and chronic fatigue syndrome: a co-twin control study of functional status. Quality of Life
Research, 2002, 11, 5, 463-471.
CFS and the symptom of chronic fatigue may be accompanied by substantial functional disability. A volunteer sample of twins discordant for fatigue was identified from throughout the US. Fatigued twins were classified using three increasingly stringent definitions: (1) > or = 6 months of fatigue (119 pairs); (2) CFS-like illness based on self-report of the CDC research definition criteria (74 pairs); and (3) CFS assessed by clinical examination (22 pairs).
Twins with chronic fatigue were compared with their unaffected co-twins on the eight standard scales and two physical and mental component summary scales from the medical outcomes study short-form health survey (SF-36).
Substantial impairment was observed for fatigued twins across all levels of fatigue, while scores in the healthy twins were similar to US population values. Mean scores among fatigued twins on the physical and mental component summary scales were below 97 and 77%, respectively, of the US population scores.
Diminished functional status was found across increasingly stringent classifications of fatigue and was associated with a dramatic decrement in physical functioning. The symptom of fatigue has a pronounced impact on functional status, especially in the domain of physical functioning.
Jason, LA and Taylor, R. Applying cluster analysis to define a typology of chronic fatigue syndrome in a medically evaluated, random community sample. Psychology and Health, 2002, 17, 3, 323-337.
This study involved a randomly selected, medically-evaluated, community-based sample of 166 individuals with chronic fatigue. Participants diagnosed with CFS and medically-explained chronic fatigue reported significantly more severe fatigue following exertion than the idiopathic chronic fatigue group, and participants with medically-explained chronic fatigue also reported significantly more severe fatigue following exertion than the psychiatrically-explained chronic fatigue group. A cluster analysis was performed to define a typology of chronic fatigue symptomatology for participants diagnosed with CFS.
Three clusters emerged. Cluster 1 contained only one participant with CFS and was characterized by relatively low post-exertional fatigue. Cluster 2 contained a small proportion of individuals with CFS and was characterized by most severe post-exertional fatigue and most improvement in fatigue following rest. Cluster 3 contained the highest proportion of individuals with CFS, and was characterized by high post-exertional fatigue and fatigue not alleviated by rest.
Severity of fatigue does not differentiate CFS from less severe conditions e.g. psychiatrically-explained chronic fatigue.
[Ed.note: This research provides empirical support for the London criteria.]
Wildman, MJ., Smith, EG., Groves, J., Beattie, JM., Caul, EO and Ayres, JG. Chronic fatigue following infection by Coxiella burnetii (Q fever): ten-year follow-up of the 1989 UK outbreak cohort. Quarterly Journal of Medicine, 2002, 95, 527-538.
Of 108 Q-exposed subjects, 64.8% had fatigue and 37 idiopathic chronic fatigue. A more detailed study of exposed and non-exposed subjects showed fatigue in 66.7% of exposed patients and CFS in 19.4% (4.2% of controls). More exposed patients were GHQ cases compared to controls.
See also Ayres, JG et al, ibid 539-546. Long-term follow-up of patients from the 1989 Q fever outbreak: no evidence of excess cardiac disease in those with fatigue. This study found three cases of cardiomyopathy in the ten years since the initial illness. the report mentions that prevalence of CFS fell in the 108 patients from 20% to 8.2% when those with co-morbidities were excluded. Six of the 7 patients with CFS had gated cardiac scans: all were within normal limits.
Lim, A and Lubitz, L. Chronic fatigue syndrome: successful outcome of an intensive inpatient programme. Journal of Paediatric and Child Health, 2002, 38, 3, 295-299.
Objective: To study the outcome of adolescents with CFS (CDC criteria '94) following an intensive multi-disciplinary inpatient programme.
Methods: A follow-up questionnaire was distributed to all 57 adolescents (aged 10-19) who had completed a four-week CFS inpatient programme at the Austin and Repatriation Medical Centre.
Results: Forty-two adolescents (74%) returned follow-up questionnaires (average 3.5 years later). Immediately following the programme and up to five years after the programme, the majority of participants had returned to school and were functioning better in terms of physical activity and social interactions as compared with before the programme. Before the programme, 94% of adolescents were attending school half-time or less. Up to 5 years after the programme, 78% of adolescents were attending school full-time or with occasional absences only.
Conclusions: A multidisciplinary inpatient programme for CFS was successful in helping to rehabilitate this group of adolescents who were significantly incapacitated prior to entering the inpatient programme.
[Ed. note: There is no information about the type of somatic symptoms reported by this sample.]
Natelson BH, Haghighi MH, Ponzio NM. Evidence for the presence of immune dysfunction in chronic fatigue syndrome. Clinical and Diagnostic Laboratory Immunology, 2002, 9, 4, 747-752.
Jason, LA., Taylor, RR & Richman, JA. The role of science and advocacy regarding a chronic health condition: The case of chronic fatigue syndrome. In V. Ottati, R.S. Tindale, J. Edwards, F.B. Bryant, L. Heath, D.C. O'Connell, Y. Suarez-Balcazar, & E.J. Posavac (Eds.). Social Psychological Applications to Social Issues: The Social Psychology of Politics. 2002, Vol. 5. (pp. 157-172). New York: Kluwer Academic/Plenum Publishers.
This chapter explores CFS, an illness that is ambiguous in nature and has engendered problematic, stigmatizing societal responses to it. In addition, it offers research strategies to prevent the stigmatization caused by biases and unexamined assumptions about the nature and likely etiology of this disorder.
In the area of CFS, key decisions regarding the name, case definition, epidemiology and treatment were made many years ago within a sociopolitical context in which CFS was assumed to be a psychologically-based problem). In part, some of the decisions may have been due to the predominance of female patients with this illness, whose medical complaints have historically been discredited by the predominantly male establishment.
Many physicians and other professionals have continued to believe that most individuals with this syndrome have a predominant psychiatric illness. Many CFS activists have argued that the current name contributes to the invalidation and stigmatization process.
Due to the controversy surrounding the name, etiology, and diagnosis of CFS, people with the illness frequently face disbelieving attitudes from their doctors, family and/or friends, and many experience profound losses in their support systems.
The focus of the paper is on how those in decision making positions regarding health issues (e.g., medical personnel, CDC officials, and grant funders) have impacted the name of the syndrome (and its implications), its definition, funding, research and treatment.
Hammond, C. A poorly understood condition: Disability living allowance and people with CFS/ME. Social Policy & Administration, 2002, 36, 3, 254-274.
This paper questions the adequacy of administrative responses to poorly understood disabling conditions in the UK. An illustrative case study, the administration of the Disability Living Allowance (DLA) to people with CFS or myalgic encephalomyelitis (CFS/ME), is examined. Controversies surrounding CFS/ME and institutional responses to the condition are summarized. The history and purposes of DLA are outlined, and research evaluating its administration and impact is reviewed. Quantitative data from the DSS are combined with qualitative data obtained from interviews with claimants and non-claimants of DLA with CFS/ME and with benefits advisers. Additional data from a national survey of people with CFS/ME are incorporated into the analysis. The findings show how the adjudication of DLA is particularly problematic in relation to people with CFS/ME. Decisions are likely to be based on inadequate evidence. These and other relevant findings are discussed in the context of the stigma attached to CFS/ME and other poorly understood disabling conditions, and socio-legal research and theory.
Janu, L. The effect of care on patients with chronic fatigue syndrome. The open randomized comparison of three antidepressants. Journal of Psychosomatic Research, 2002, 52, 5, 328, no. 344.
Comparison of sertraline, moclobemide and Li (St. John's Wort) found no difference (n=33 patients with CFS, CDC criteria '94).
Jones, NL and Heigenhauser, GJF. VO2max and lactate production are not normal in all patients with chronic fatigue. Medicine and Science in Sports and Exercise, 2002, 34, 7, 1215.
Letter relating to study by Sargent and Scroop (ibid 34, 51). With reply by Sargent, C and Scroop, G (p. 1215-1216).
Jou, N-T, Chia, J K-S., Louie, JS and Liebling Torrance, MR. Enterovirus in chronic fatigue syndrome (CFS). Arthritis & Rheumatism, 2001, 44, Issue S9, Page S351. Arthritis & Rheumatism, 2001 Annual Scientific Meeting Abstracts, November 10-15, 2001, San Francisco, CA.
Ongoing infection with enterovirus has been proposed as one cause for CFS. The role for enterovirus in this syndrome has been controversial with both positive and negative results reported. Extrapolating from the chronic enteroviral model in mice, we hypothesized that evidence for ongoing infection in humans might be found by exploring the possibility of a mononuclear cell reservoir.
To examine this hypothesis, we developed a powerful single-tube, nested, RT-PCR using primers directed at the highly conserved 5' untranslated region of the enterovirus genome. Peripheral blood mononuclear cells (PBMC) and plasma were simultaneously collected from patients who fulfilled CDC criteria for CFS following a flu-like illness but tested negative for serologic evidence of CFS-associated pathogens (other than enterovirus).
Controls included healthy individuals without a history of fatigue or recent respiratory or gastrointestinal symptoms, patients with CFS who were positive for antibodies to C. pneumoniae but negative for enteroviral antibodies, and patients with fatigue accompanying SLE. Samples were blinded by coding prior to RT-PCR.
On a molecular level the assay was found to be quite sensitive, detecting as little as 5.79 attomoles of coxsackie B3 RNA. At the time of submission, 26 CFS patients with symptoms for 8 months to 20 years and 12 controls were enrolled in the clinical portion of the study. The sensitivity and specificity of the assay using RNA extracted from PBMC was 70 and 100%, respectively, while the sensitivity and specificity employing plasma as a source of RNA was 30 and 75%, respectively. No patient whose PBMC were negative was found to have a positive plasma sample. Three of the samples with positive amplification products were sequenced and showed a minimum of 98.5% sequence identity with the same region of coxsackievirus B3.
Intriguingly, of 11 patients with multiple samples, 6 converted to negative, some while taking antiviral therapy. Correlation with clinical status is not yet available. No patient has as yet converted from negative to positive.
These preliminary data suggest that an ongoing enteroviral infection may exist in some patients with CFS, that mononuclear cells may serve as one reservoir for this infection and that a sensitive RT-PCR assay is capable of detecting enteroviral RNA in a significant proportion of these patients.
Kisely, S. Treatments for chronic fatigue syndrome and the Internet: a systematic survey of what your patients are reading. Australian and New Zealand Journal of Psychiatry, 2002, 36, 2, 240-245.
Objective: To evaluate the type, quality, and focus of patient information on the treatment of CFS on the Internet using simple search techniques.
Design: The search phrase 'chronic fatigue syndrome' was entered into nine common Internet search engines. The 25 most highly ranked pages identified by each of the nine search engines were analysed using a standardized pro forma. The following outcome measures were used: balance of content, consistency of content with evidence-based practice, declared authorship with credentials, information sources including the presence of references, the declaration of any potential conflict of interest, and the need to clarify information with an appropriate health professional.
Results: Two hundred and twenty-five websites were reviewed during a 2-week period in September 2000. A further 15 sites (6.3%) were inaccessible. Agreement between websites and systematic reviews of treatment for CFS ranged from 4 to 68%, the greatest agreement being for recommendations for graded exercise and the avoidance of prolonged rest. Most sites (64%) had a named author. Only a quarter to a third contained a declaration of interest, advised readers to clarify information with an appropriate health professional, or avoided inaccurate statements.
Conclusions: The Internet contains a great deal of information on CFS that is neither balanced nor consistent with evidence-based practice. Doctors individually, and as a profession, should provide guidance on which Internet sites to trust.
Larkins RG and Molesworth SR. Chronic fatigue syndrome clinical practice guidelines. Medical Journal of Australia, 2002, 1, 177, 1, 51-52.
Response to Australian guidelines (ibid, 2002, 176, 6 May Suppl. S17-56).
Lehman, AM., Lehman, DR., Hemphill, KJ., Mandel, DR and Cooper, LM. Illness experience, depression, and anxiety in chronic fatigue syndrome. Journal of Psychosomatic Research, 2002, 52, 6, 461-465.
The researchers considered two possible correlates of anxiety and depression: lack of illness legitimization and beliefs about limiting physical activity.
Method: A total of 105 people diagnosed with CFS reported on their experiences with medical professionals and their beliefs about recovery and completed the depression and anxiety subscales of the Brief Symptom Inventory.
Results: Those who said that their physician did not legitimize their illness (36%) had higher depression and anxiety scores (p<.05) than their counterparts. Those who believed that limiting their physical exertion was the path to recovery (55%) had lower depression and anxiety scores (p<.01) than their counterparts.
Conclusion: Lack of illness legitimization ranked high as a source of dissatisfaction for CFS patients, and it may aggravate psychiatric morbidity. Many CFS patients believed that staying within what they felt to be their physical limits would improve their condition. This belief, and possibly an accompanying sense of control over their symptoms, may alleviate psychiatric morbidity.
Nijs, J., Vaes, P., Van Hoof, E., McGregor, N and De Meirleir, K. Reliability and convergence validity of the chronic fatigue syndrome activities and participation questionnaire. Journal of Psychosomatic Research, 2002, 52, 5, 327, no. 129. See also p. 379.
Panerai, AE., Vecchiet, J., Panzeri, P., Meroni, P., Scarone, S., Pizzigallo. E., Giamberardino, MA and Sacerdote, P. Peripheral blood mononuclear cell beta-endorphin concentration is decreased in chronic fatigue syndrome and fibromyalgia but not in depression: Preliminary Report. Clinical Journal of Pain, 2002, 18, 4, 270-273.
Repka-Ramirez, S., Naranch, K., Park, YJ., Clauw, D and Baraniuk, JN. Cytokines in nasal lavage fluids from acute sinusitis, allergic rhinitis, and chronic fatigue syndrome subjects. Allergy and Asthma Proceedings, 2002, 23, 3, 185-190.
The aim of this study was to compare the degree of inflammation present in varioyus patient groups by measuring cytokine concentrations in nasal lavage fluids.
The concentrations of total protein (TP; Lowry assay), nerve growth factor (NGF), tumor necrosis factor (TNF) alpha, and interleukin (IL)-8 were measured by ELISA in nasal lavage fluids from acute sinusitis (n=13), active allergic rhinitis (n=16), CFS (n=95), and non-CFS (n=89) subjects. CFS and non-CFS groups were subdivided further using allergy skin test and rhinitis score results.
Acute sinusitis subjects had significantly higher TP (p=0.011), TNF-alpha (p=0.00071), and IL-8 (p=0.0000027) concentrations and IL-8/TP ratios (p=0.0030) than the other three patient groups. There were no differences based on skin test or rhinitis score severity within either the CFS or non-CFS groups. The muco-purulent discharge of acute sinusitis contained significantly higher TNF-alpha and IL-8. Neutrophils were a likely source for these cytokines.
There were no differences between CFS and non-CFS subjects, making it unlikely that the rhinitis of CFS has an inflammatory component.
Rowe, PC. Orthostatic intolerance and chronic fatigue syndrome: new light on an old problem. [Editorial] Journal of Pediatrics, 2002, 140, 4, 387-389.
Chronic fatigue is a prominent symptom in a variety of overlapping syndromes of circulatory dysfunction, the most notable examples of which are neurally mediated hypotension (NMH) and postural tachycardia syndrome (POTS). An early suggestion that such abnormalities were treatable causes of symptoms in what we now call CFS was made in 1940 by Alexander MacLean and Edgar Allen. They described a group of patients who experienced excessive acceleration of the heart and hypotension after moving from the recumbent to the erect posture, usually associated with symptoms of orthostatic exhaustion, blurring of vision, weakness on exercise, and syncopal episodes. McLean and Allen attributed the tachycardia to a reduced venous return to the heart, in part because symptoms and hemodynamic changes could be provoked within 10 seconds by Flack's test, which involved forced expiration into a tube to maintain a mercury column at 40 mm, thereby reducing blood flow into the thorax. They concluded that this orthostatic tachycardia syndrome seemed similar to "effort syndrome, irritable heart, or neurocirculatory asthenia" the synonyms of the day for what we now call CFS. McLean and Allen reported that patients improved by increasing their intake of fluids and sodium, and by sleeping with the head of the bed elevated. The head-up bed may have helped to conserve intravascular volume by reducing blood flow to the kidney at night. It is a medical curiosity that these detailed observations were largely ignored for several decades.
Servaes P, Prins J, Verhagen S and Bleijenberg G. Fatigue after breast cancer and in chronic fatigue syndrome. Similarities and differences. Journal of Psychosomatic Research, 2002, 52, 6, 453-459.
Fatigue is investigated in 57 severely fatigued disease-free breast cancer patients and in 57 gender- and age-matched patients with CFS using multidimensional and multimethod assessment. A comparison between these groups of patients is important to determine whether a cognitive behavioural intervention to reduce fatigue in CFS patients would be appropriate as well for severely fatigued disease-free breast cancer patients.
Methods: Measurement included computerised questionnaires and a standardised neuropsychological test. Furthermore, patients filled out a daily Self-Observation List (SOL) and wore an actometer during a period of 12 days.
Results: In comparison to severely fatigued disease-free breast cancer patients, CFS patients score more problematic with regard to the level of fatigue, functional impairment, physical activity, pain and self-efficacy. However, a subgroup of severely fatigued disease-free breast cancer patients reports the same amount of problems as CFS patients with regard to psychological well-being, sleep and concentration. Finally, CFS patients and severely fatigued breast cancer patients score equal on measures of social support.
Conclusion: There seem to be some similarities but also many differences between severely fatigued breast cancer survivors and females with CFS. Therefore, cognitive behaviour therapy (CBT) to reduce fatigue after treatment for cancer should also differ in certain aspects from cognitive behaviour therapy as it has been developed for patients with CFS.
Shapiro, CM and Moller, HJ. Chronic fatigue: listen and measure. Journal of Psychosomatic Research, 2002, 52, 6, 427-436.
Editorial.
Sharpe, M. The English Chief Medical Officer's Working Parties' report on the management of CFS/ME: Significant breakthrough or unsatisfactory compromise? Journal of Psychosomatic Research, 2002, 52, 6, 437-438.
Editorial.
Sharpe M. Treatment of chronic fatigue syndrome: why not? European Psychiatry, 2002, 17, Suppl 1:48.
Short, K., McCabe, M and Tooley, G. Cognitive functioning in chronic fatigue syndrome and the role of depression, anxiety, and fatigue. Journal of Psychosomatic Research, 2002, 52, 6, 475-483.
Objective: This study was designed to investigate the role of depression, anxiety, and fatigue in CFS sufferers' objective and subjective cognitive performance.
Methods: Twenty-three CFS sufferers and 23 healthy control participants were compared on objective and subjective assessments of cognitive performance. Depression, anxiety, and fatigue were also evaluated.
Results: CFS sufferers did not demonstrate any impairment in objective cognitive functioning compared to the control group, and objective performance was not related to their higher levels of depression or their level of fatigue. Depression scores only accounted for a small amount of the variance in CFS sufferers' lower subjective assessment of their cognitive performance compared to control participants. There were no differences between the groups on anxiety scores.
Conclusion: The results are discussed in terms of the heterogeneity of the CFS population and the complex interaction of symptomatological factors that characterise CFS.
Skowera, A., Stewart, E., Davis, ET., Cleare, AJ., Unwin, C., Hull, L., Ismail, K., Hossain, G., Wessely SC and Peakman, M. Anti-nuclear autoantibodies (ANA) in Gulf War-related illness and chronic fatigue syndrome (CFS) patients. Clinical and Experimental Immunology, 2002, 129, 2, 354-358.
CFS was recently associated with a novel subtype of antinuclear autoantibody (ANA) that reacts with nuclear envelope (NE) antigens. NE autoantibodies are not known to be linked with any distinct clinical condition, but have been observed in patients with unusual mixed chronic auto-immune disorders and connective tissue diseases.
In this study we examined whether NE ANAs are a feature of patients with CFS and symptomatic Gulf War veterans (sGWV). We studied the prevalence of ANA in 130 sGWV, 90 well Gulf War veterans (wGWV), 128 symptomatic Bosnia and Era veterans (sBEV), 100 CFS patients, and 111 healthy control subjects matching for age and sex.
We found no significant difference in the prevalence of ANAs between any of the groups. None of the patients or veterans we studied had ANA of the NE type. Our results show that multisymptom illness due to CFS or related to Gulf War service is not associated with antinuclear autoimmunity.
Stanley, I., Salmon, P and Peters, S. Doctors and social epidemics: the problem of persistent unexplained physical symptoms, including chronic fatigue. British Journal of General Practice, 2002, 52, 478, 355-356.
Editorial suggesting that CFS is a social epidemic, as opposed to a discrete syndrome. The authors imply that the CMO's report recognised CFS\ME despite the evidence and that this was an example where consumerism defined the illness.
[Ed. note: The article is consistent with previous articles on somatisation (e.g. Barsky and Borus).]
Tanaka, H., Matsushima, R., Tamai, H and Kajimoto, Y. Impaired postural cerebral hemodynamics in young patients with chronic fatigue with and without orthostatic intolerance. Journal of Pediatrics, 2002, 140, 4, 412-417.
Objectives: To measure postural changes in cerebral hemodynamics in young patients with chronic fatigue with and without orthostatic intolerance.
Study design: We studied 28 patients (age, 10 to 22 years) and 20 healthy control subjects (age, 6 to 27 years). Cerebral oxygenated hemoglobin (oxy-Hb) and deoxygenated Hb were non-invasively and continuously measured with near infrared spectroscopy during active standing. Beat-to-beat arterial pressure was monitored by Finapres.
Results: Orthostatic intolerance determined by cardiovascular responses to standing was observed in 16 of 28 patients: instantaneous orthostatic hypotension in 8, delayed orthostatic hypotension in 2, and postural orthostatic tachycardia in 6. A rapid recovery of oxy-Hb by near infrared spectroscopy at the onset of active standing was not found in 15 of 16 patients with chronic fatigue and orthostatic intolerance and in 6 of 12 patients with chronic fatigue without orthostatic intolerance but only in 2 of 20 control subjects. Thirteen of 16 patients with orthostatic intolerance showed prolonged reduction in oxy-Hb during standing.
Conclusions: Impaired cerebral hemodynamics in patients with CFS and postural orthostatic tachycardia suggest a link between impaired cerebral oxygenation and chronic fatigue. However, this cannot explain the symptoms in patients meeting the criteria of chronic fatigue without orthostatic intolerance.
Tamizi far, B and Tamizi, B. Treatment of chronic fatigue syndrome by dietary supplementation with omega-3 fatty acids - a good idea? Medical Hypotheses 2002, 58, 3, 249-250.
Minor alterations of immune, neuroendocrine, and autonomic function may be associated with the CFS. Omega-3 fatty acids decrease the production of putative mediators of inflammation, including interleukin-1, and tumor necrosis factor. Since interleukin-1 and tumor necrosis factor are the principal polypeptide mediators of immunoregulation, reduced production of these cytokines by dietary supplementation with omega-3, may be a possible mechanism for the treatment of CFS.
Taylor, RR and Jason, LA. Chronic fatigue, abuse-related traumatization, and psychiatric disorders in a community-based sample. Social Science & Medicine, 2002, 55, 247-256.
Results of this study of people meeting the criteria for CFS (1994) but who have not had the diagnosis confirmed by a doctor revealed that reports of childhood abuse during adolescence or adulthood predicts chronic fatigue, a diagnosis of PTSD and anxiety disorders. The authors assessed physical ad sexual abuse as well as death threat and total number of abuse events.
[Ed. note: This research supports other studies which have identified an association between early stress and trauma and adverse health outcomes. Interestingly, abuse did not predict either somatoform disorders or depression within the CF group. It would be interesting to assess cortisol in abused patients and to see if there is a correlation between cortisol and fatigue.]
Van Hoof, De Meirleir, K and Cluydts, R. Hyperbaric oxygen therapy for chronic systemic infections in chronic fatigue syndrome. Journal of Psychosomatic Research, 2002, 52, 5, 391-392.
Study of 15 patients with CFS (CDC criteria '94) plus infection with mycoplasma hominis and 14 patients with no infection. Therapy was once daily for a week. Pain decreased and after a week, there was a significant reduction in fatigue. There was also a reduction in perceived health and activity, possibly due to increased opportunistic infections.
Zachrisson, O., Regland, B., Jahreskog, M et al. A rating scale for fibromyalgia and chronic fatigue syndrome (the FibroFatigue Scale). Journal of Psychosomatic Research, 2002, 52, 6, 501-509.
Hickie, I., Davenport, T., Issakidis, A and Andrews, G. Neurasthenia: prevalence, disability and health care characteristics in the Australian community. British Journal of Psychiatry, 2002, 181, 56-61.
Study of 10641 people which identified 1.5% as meeting the criteria for neurasthenia 'sometime in the past year' and 13.2% as suffering from prolonged or excessive fatigue.
[Ed. note: The results show again that all patients with CFS (CDC '94) will also meet the current criteria for neurasthenia. Indeed, the criteria overlap significantly, with only the optional complaints of sore throats and lymph glands differentiating the two. People only need to have one symptom out of six to be diagnosed with neurasthenia.]
Richards, SCM and Scott, DL. Prescribed exercise in people with fibromyalgia: parallel group randomized controlled trial. British Medical Journal, 2002, 325, 185-189.
Patients (n=132) with fibromyalgia were randomly assigned to receive either 12 weeks of twice weekly aerobic graded exercise or relaxation and flexibility. Significantly more patients (24\69, 35%) rated themselves better or much better after exercise compared to relaxation (12\67, 18%). Benefits were maintained at 12 months follow-up.
Williams, DA., Cary, MA., Groner, KH., Chaplin, W., Glazer, LJ., Rodriguez, AM and Clauw, DJ. Improving physical functional status in patients with fibromyalgia: a brief cognitive behavioral intervention. Journal of Rheumatology, 2002, 29, 1280-1286.
Objective. Sustained improvement in physical functional status was the primary goal of a brief, 6 session cognitive behavioral therapy (CBT) protocol for fibromyalgia (FM).
Methods. One hundred forty-five patients with FM were randomly assigned to either (1) standard medical care that included pharmacological management of symptoms and suggestions for aerobic fitness, or (2) the same standard medical treatment plus 6 sessions of CBT aimed at improving physical functioning. Outcome measures included the Medical Outcome Study Short Form-36 Physical Component Score and McGill ratings of pain.
Results. Twenty-five percent of the patients receiving CBT were able to achieve clinically meaningful levels of long-term improvement in physical functioning, whereas only 12% of the patients receiving standard care achieved the same level of improvement. There were no lasting differences on pain ratings between groups.
Conclusion. These data suggest that the inclusion of CBT to a standard medical regimen for FM can favorably influence physical functioning in a subset of patients.
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