From Fatigue: Biomedicine, Health & Behavior, 24 April 2015.
Findings from a clinical and laboratory database developed for discovery of pathogenic mechanisms in myalgic encephalomyelitis/chronic fatigue syndrome
N.G. Klimas(a*), G. Ironson(b), A. Carter©, E. Balbin(a,b), L. Bateman(d), D. Felsenstein(e), S. Levine(f), D. Peterson(g), K. Chiu(h), A. Allen(d), K. Cunningham(e), C.G. Gottschalk(g), M. Fletcher(a), M. Hornig(i), C. Canning(j) & A.L. Komaroff(k)
a) College of Osteopathic Medicine, Institute for Neuro-Immune Medicine, Nova Southeastern University, Ft Lauderdale, FL, USA
b) Department of Psychology and Behavioral Medicine, University of Miami, Miami, FL, USA
c) Department of Educational Research Methodology, University of North Carolina at Greensboro, Greensboro, NC, USA
d) Fatigue Consultation Clinic, Salt Lake City, UT, USA
e) Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
f) Levine Clinic, New York, NY, USA
g) Sierra Internal Medicine at Incline Village, Incline Village, NV, USA
h) Physicians for Peace, Norfolk, VA, USA
i) Mailman School of Public Health, Columbia University, New York, NY, USA
j) Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
k) Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
Abstract
BACKGROUND
Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a complex, chronic illness that is often disabling. This paper introduces the Chronic Fatigue Initiative, which conducted a large multi-center study to more fully characterize ME/CFS and ultimately to describe and understand the underlying mechanisms and pathogenesis of this illness.
METHODS
A total of 203 patients with ME/CFS (cases) and 202 matched healthy controls (HCs) were enrolled from 5 geographically different expert clinical sites to create a well-characterized population linked to a national biorepository. ME/CFS subjects were compared to a one-to-one matched HC population for analyses of symptoms and illness severity. Cases were further evaluated for frequency and severity of symptoms and symptom clusters, and the effects of illness duration and acute vs. gradual onset.
RESULTS
This study collected more than 4000 pieces of data from each subject in the study. Marked impairment was demonstrated for cases vs. controls. Symptoms of fatigue were identified, but also, nearly as frequent and severe, were symptoms of cognitive dysfunction, inflammation, pain and autonomic dysfunction. Potential subgrouping strategies were suggested by these identified symptom clusters: sleep, neurocognitive, autonomic, inflammatory, neuroinflammatory, gastrointestinal and endocrine symptoms.
CONCLUSIONS
Clearly, ME/CFS is not simply a state of chronic fatigue. These data indicate that fatigue severity is matched by cognitive, autonomic, pain, inflammatory and neuroinflammatory symptoms as the predominant clinical features. These findings may assist in the clarification and validation of case definitions. In addition, the data can aid clinicians in recognizing and understanding the overall illness presentation. Framing ME/CFS as a multisystem disorder may assist in developing therapies targeting the multifaceted domains of illness.
‘undiagnosed’ Ehlers Danlos Syndrome types in all patients majority have what is referred to as crossovers some having parts of Vascular no.4 types with 1.Classical or 2.Hypermobility or not…This is clearly why all of the following illnesses are involved here in some but not all have the complications associated with Ehlers Chiari, Stenosis, Chronic sinus issues MCAD Mast Cell Activation Disorder Systemic Mastosytosis Histamine Intolerance Fructose Intolerance Syncope & or P.O.T.S. all one has to do is examine all fatigued type patients in all these ‘label’ illnesses such as GWI,Lyme, M.E./CFS, Fibro even a percentage of Autism M.S. have both illnesses combined…High foods in Salt, salt intake vitamin c vitamind3 magnesium etc is the key there is no Cure…EDS is a multi system undiagnosed disorder I am even seeing these traits in photos of numerous stars including Avril Lavigne who was diagnosed with so called Lyme in the 80’s Cher was told she had chronic ebv she including her Mother have traits to EDS so does Morgan Fairchild & even George Bush Jr. who was also told he had Lyme disease…The most undiagnosed illness aside from Chiari is Ehlers Danlos Syndrome not ‘label’ named illnesses…Multifactoral complications come with EDS the best overall explanation of EDS aside from Journals is Wikipedia look up EDS to see all links on complications…Dehydration lack of Salt is crucial…