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