Entry: Immunologic Aspects of Chronic Fatigue Syndrome Sunday, November 07, 2004



Immunologic Aspects of Chronic Fatigue Syndrome

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Report on a Research Symposium Convened by The CFIDS Association of America and Co-Sponsored by the US Centers for Disease Control and Prevention and the National Institutes of Health.

Journal: Neuroimmunomodulation. 2004;11(6):351-7.

Authors: Gerrity TR, Papanicolaou DA, Amsterdam JD, Bingham S, Grossman A, Hedrick T, Herberman RB, Krueger G, Levine S, Mohagheghpour N, Moore RC, Oleske J, Snell CR.
Affiliation: Worcester Polytechnic Institute, Worcester, Mass., USA.
NLM Citation: PMID: 15467349

Chronic fatigue syndrome (CFS) is a serious health concern affecting over 800,000 Americans of all ages, races, socioeconomic groups and genders. The etiology and pathophysiology of CFS are unknown, yet studies have suggested an involvement of the immune system.

A symposium was organized in October 2001 to explore the possibility of an association between immune dysfunction and CFS, with special emphasis on the interactions between immune dysfunction and other abnormalities noted in the neuroendocrine and autonomic nervous systems of individuals with CFS.

This paper represents the consensus of the panel of experts who participated in this meeting. Data suggest that persons with CFS manifest changes in immune responses that fall outside normative ranges, but current research does not provide definitive evidence on whether these immune abnormalities are a cause or result of the illness.

It has become clear that CFS cannot be understood based on single measurements of immune, endocrine, cardiovascular, or autonomic nervous system dysfunction. This panel encourages a new emphasis on multidisciplinary research into CFS.

Copyright(c) 2004 S. Karger AG, Basel.

Introduction

Chronic fatigue syndrome (CFS), also known as chronic fatigue and immune dysfunction syndrome (CFIDS) and myalgic encephalomyelitis, is a serious health concern. A study by DePaul University estimates CFS prevalence at approximately 422 per 100,000 adults in the USA [1]. This means as many as 800,000 people nationwide suffer from the condition.

Studies show that 85–90% of people with CFS have not been diagnosed and are not receiving appropriate medical care for their illness. It is nearly twice as common in women as men.

To put CFS prevalence into perspective, systemic lupus erythematosus affects 50 per 100,000, multiple sclerosis affects 104 per 100,000, and rheumatoid arthritis affects 1,022 per 100,000 American adults.

CFS affects adults, adolescents and older children of all races and socioeconomic groups. Additional data from the DePaul study found a significantly increased prevalence in minorities and persons in lower-income brackets, two populations that have not been previously recognized as being at greater risk than non-minorities for CFS, and which are generally underserved by the medical community.

Of all the people with CFS identified in this study, only 10% had been previously diagnosed, lending extra impetus to efforts to increase knowledge and awareness of CFS.

There are as yet no sensitive and specific diagnostic markers for CFS. To exclude other mental and physical causes of their symptoms, persons with CFS often must undergo an extensive battery of tests before the CFS diagnosis is considered.

To be diagnosed with CFS, a person must meet the following 1994 International Research Case Definition criteria [2]:

* Unexplained persistent or relapsing fatigue for at least 6 months’ duration that is of new or definite onset, not the result of ongoing exertion, is not substantially alleviated by rest, and results in substantial reduction in previous levels of occupational, educational, social, or personal activities and

* Four or more of the following eight symptoms, persistent or relapsing, for at least 6 months: impairment of short-term memory or concentration; sore throat; tender cervical or axillary lymph nodes; muscle pain; multi-joint pain without joint swelling or redness; headaches of a new type, pattern or severity; unrefreshing sleep, and postexertional malaise lasting more than 24 h.

CFS seems to be a multi-system disorder. The etiology and pathophysiology of the syndrome is unknown. However, there have been a number of studies suggesting an involvement of the immune system in the pathophysiology of CFS. This symposium was designed to explore the possibility of an association between the immunologic system and CFS and, if so, what that association might be.

Following one day of presentations by experts, an independent panel composed of well-respected researchers and practitioners in the fields of biostatistics, immunology, infectious disease, rheumatology, endocrinology, psychiatry, exercise physiology, epidemiology, pediatrics, and internal medicine, as well as two patient representatives, weighed the scientific evidence and developed a draft statement in response to the following five key questions:

1. What is the evidence that there is dysregulation of the immune system in CFS?

2. What is the evidence of the involvement of infectious agents in CFS?

3. Are there examples or models of immune dysfunction that could lead to the symptoms of CFS?

4. What can we learn from the existing data on interactions among the immune system, HPA axis, and autonomic nervous system about the clinical presentations of CFS?

5.
(a) What are the recommendations for future research?

(b) What are the recommended opportunities for research collaboration?

(c) What methodological barriers are there to the careful study of these recommendations?

This statement was prepared by a panel of experts, based on (1) presentations by investigators working in areas relevant to the consensus questions during a 1-day scientific court session; (2) questions and statements from conference attendees during open discussion periods that are part of the scientific court session, and (3) closed deliberations by the panel during 11/2 days. This statement is an independent report of the panel and is not a policy statement of The CFIDS Association of America, the National Institutes of Health or the Centers for Disease Control and Prevention.

Copyright(c) 2004 S. Karger AG, Basel.


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