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Chronic Fatigue Chronic Fatigue Syndrome/Myalgic Syndrome/Myalgic
EncephalomyelopathEncephalomyelopathyy
Christopher Chiu MRCP PhDChristopher Chiu MRCP PhD
IntroductionIntroduction
Common conditionCommon condition– 1 in 250 sufferers1 in 250 sufferers– 80% undiagnosed80% undiagnosed– More common in women & middle-aged/elderlyMore common in women & middle-aged/elderly– Cause unclear despite >3000 research papersCause unclear despite >3000 research papers
CausesCauses DefinitionsDefinitions Other causes of fatigueOther causes of fatigue TreatmentsTreatments
CausesCauses
GeneticGenetic– More common within familiesMore common within families– More likely in identical twinsMore likely in identical twins
InfectiousInfectious– Many pathogens linkedMany pathogens linked– Chronic or post-infectiveChronic or post-infective
EndocrineEndocrine PsychosocialPsychosocial
DefinitionsDefinitions Center for Disease ControlCenter for Disease Control
– Unexplained, persistent fatigue not due to Unexplained, persistent fatigue not due to ongoing exertion, not substantially relieved by ongoing exertion, not substantially relieved by rest, of new onset and resulting in significant rest, of new onset and resulting in significant reduction in previous levels of activity ANDreduction in previous levels of activity AND
– Four or more for 6 months or moreFour or more for 6 months or more Impaired memory/concentrationImpaired memory/concentration Postexertional malaisePostexertional malaise Unrefreshing sleepUnrefreshing sleep Muscle painMuscle pain Multijoint pain without swelling/rednessMultijoint pain without swelling/redness Headaches of new type/severityHeadaches of new type/severity Sore throatSore throat Tender lymph nodesTender lymph nodes
NICE guidelines 2007NICE guidelines 2007 Additional symptomsAdditional symptoms
– DizzinessDizziness– NauseaNausea– PalpitationsPalpitations
Symptoms fluctuate & change over timeSymptoms fluctuate & change over time Signs of other serious conditionsSigns of other serious conditions
– Neurological signsNeurological signs– Inflammation of jointsInflammation of joints– Heart/lung diseaseHeart/lung disease– Weight lossWeight loss– Enlarged lymph nodesEnlarged lymph nodes
Other causes of fatigueOther causes of fatigue
InfectiousInfectious– EBV, CMV, HHV-6, EBV, CMV, HHV-6,
HIV, InfluenzaHIV, Influenza– Lyme disease, TBLyme disease, TB– ToxoplasmosisToxoplasmosis
EndocrineEndocrine– HypothyroidismHypothyroidism– DiabetesDiabetes– Adrenal diseaseAdrenal disease
Vitamin deficiencyVitamin deficiency– B12, folate, D, ironB12, folate, D, iron
HaematologicHaematologic– AnaemiaAnaemia– Occult malignancyOccult malignancy
AutoimmuneAutoimmune PsychiatricPsychiatric
DiagnosisDiagnosis
HistoryHistory ExaminationExamination UrinalysisUrinalysis Blood testsBlood tests
– Liver & thyroid function testsLiver & thyroid function tests– GlucoseGlucose
RadiologyRadiology
ManagementManagement
Acknowledgement of the conditionAcknowledgement of the condition Shared decision-makingShared decision-making No known pharmacological treatmentNo known pharmacological treatment Symptom relief if necessarySymptom relief if necessary Sleep managementSleep management Rest periods & relaxation techniquesRest periods & relaxation techniques DietDiet Attempt to maintain work/educationAttempt to maintain work/education Graded Exercise TherapyGraded Exercise Therapy
Cognitive Behavioural Cognitive Behavioural TherapyTherapy
Individualised programmeIndividualised programme Psychological therapyPsychological therapy Used widely in other settings Used widely in other settings
including cardiac rehab & diabetes including cardiac rehab & diabetes managementmanagement
Addresses situations can cause Addresses situations can cause thoughts, actions & feelings that thoughts, actions & feelings that perpetuate problemsperpetuate problems
Not recommendedNot recommended
Most drugsMost drugs Unstructured vigorous exerciseUnstructured vigorous exercise Prolonged/complete daytime restProlonged/complete daytime rest Rigid schedule of activity & restRigid schedule of activity & rest
ConclusionConclusion
CFS/ME is difficult to diagnose & treatCFS/ME is difficult to diagnose & treat Underlying causes are not knownUnderlying causes are not known Important to rule out other severe Important to rule out other severe
conditionsconditions May have prolonged course with May have prolonged course with
relapsesrelapses Most improve over time & return to Most improve over time & return to
workwork