Chronic fatigue syndrome

Question 1

Definition

Answer 1

AKA: myalgic encephalomyelitis (ME)
Chronic, debilitating illness characterised by severe fatigue

Question 2

Fatigue characteristics which occurs in CFS

Answer 2

• Is not the result of exertion
• Does not improve with a reduction in activity or rest
• Cannot be explained by any other medical condition

Question 3

Epidemiology

Answer 3

• Female
• Existing anxiety/depression
• Middle age ~ 40 yrs
• Lower socioeconomic status
• Recent infection

Question 4

Signs

Answer 4

CSF is considered a diagnosis of exclusion and physical examination will be unremarkable

Question 5

Symptoms

Answer 5

Severe fatigue
Sleep disturbances
Muscle or joint pain (without inflammation)
Palpitations (in the absence of CVD)
Headaches
Cognitive dysfunction e.g. difficulty concentrating
Painful lymph nodes without pathological englargement

Question 6

Chronic fatigue requirements

Answer 6

• New or a specific onset (that is, it is not lifelong)
• Persistent and/or recurrent
• Unexplained by other conditions
• Has resulted in a substantial reduction in activity
• Characterised by post-exertional malaise and/or fatigue (typically delayed, for example by at least 24 hours, with slow recovery over several days)

Question 7

Diagnostic criteria 1

Answer 7

Fatigue that has all of the following:
- Persistent +4m or recurrent.
- New or had a specific onset (that is, not lifelong).
- Unexplained by other conditions (including severe obesity with a body mass index [BMI] greater than 40 kg/m 2 , although this does not rule out CFS)
- Has resulted in a substantial reduction in activity level
- Characterized by post-exertional malaise and/or fatigue (typically delayed, for example by at least 24 hours, with slow recovery over several days)

Question 8

Diagnostic criteria 2

Answer 8

One or more of the following symptoms:
- Headaches
- Painful lymph nodes without pathological enlargement.
- Sore throat
- Cognitive dysfunction (such as difficulty thinking or inability to concentrate)
- Worsening symptoms on physical or mental exertion
- General malaise or flu-like symptoms
- Dizziness and/or nausea
- Difficulty with sleeping
- Palpitations in the absence of identified cardiac pathology

Question 9

Diagnosis

Answer 9

Diagnosis of exclusion:
- FBC
- CRP/ESR
- TFT
- LFT:
- Urea and electrolytes
- Blood glucose or HbA1c
- Coeliac serology

Question 10

Treatment

Answer 10

FIRST LINE:
- Education - condition, sleep hygiene, and diet
- Rest strategies
- Graded exercise therapy:
- CBT
Second line:
- Consider referral to pain management clinic
- Low-dose tricyclic antidepressants

Question 11

Complications

Answer 11

Social impact
Reduced QoL
Increased risk of anxiety and depression
Increased mortality risk