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ALL / Rheumatology

Chronic fatigue syndrome

Chronic fatigue syndrome

Diagnosed after at least 3 months of disabling fatigue affecting mental and physical function more than 50% of the time in the absence of other disease which may explain symptoms

Epidemiology
  • more common in females
  • past psychiatric history has not been shown to be a risk factor

Fatigue is the central feature, other recognised features include
  • sleep problems, such as insomnia, hypersomnia, unrefreshing sleep, a disturbed sleep-wake cycle
  • muscle and/or joint pains
  • headaches
  • painful lymph nodes without enlargement
  • sore throat
  • cognitive dysfunction, such as difficulty thinking, inability to concentrate, impairment of short-term memory, and difficulties with word-finding
  • physical or mental exertion makes symptoms worse
  • general malaise or 'flu-like' symptoms
  • dizziness
  • nausea
  • palpitations

Investigation
  • NICE guidelines suggest carrying out a large number of screening blood tests to exclude other pathology e.g. FBC, U&E, LFT, glucose, TFT, ESR, CRP, calcium, CK, ferritin, coeliac screening and also urinalysis

Diagnosis
  • NICE publish diagnostic criteria NICE
  • a diagnosis is typically made if the symptoms persist for 3 months

Management
  • refer to a specialist CFS service if the diagnostic criteria are met and symptoms have persisted for 3 months
  • energy management
    • a self-management strategy that involves a person with ME/CFS managing their activities to stay within their energy limit, with support from a healthcare professional
  • physical activity and exercise
    • do not advise people with ME/CFS to undertake exercise that is not part of a programme overseen by an ME/CFS specialist team
    • should only be recommended if patients 'feel ready to progress their physical activity beyond their current activities of daily living'
    • graded exercise therapy used to be recommended but is now specifically not recommended by NICE
  • cognitive behavioural therapy
    • NICE stress this is 'supportive' rather than curative for CFS

CFS has a better prognosis in children.
+PassMedicine Notes

Diagnosed after at least 3 months of disabling fatigue affecting mental and physical function more than 50% of the time in the absence of other disease which may explain symptoms

Epidemiology
  • more common in females
  • past psychiatric history has not been shown to be a risk factor
Fatigue is the central feature, other recognised features include
  • sleep problems, such as insomnia, hypersomnia, unrefreshing sleep, a disturbed sleep-wake cycle
  • muscle and/or joint pains
  • headaches
  • painful lymph nodes without enlargement
  • sore throat
  • cognitive dysfunction, such as difficulty thinking, inability to concentrate, impairment of short-term memory, and difficulties with word-finding
  • physical or mental exertion makes symptoms worse
  • general malaise or 'flu-like' symptoms
  • dizziness
  • nausea
  • palpitations
Investigation
  • NICE guidelines suggest carrying out a large number of screening blood tests to exclude other pathology e.g. FBC, U&E, LFT, glucose, TFT, ESR, CRP, calcium, CK, ferritin, coeliac screening and also urinalysis
Diagnosis
  • NICE publish diagnostic criteria NICE
  • a diagnosis is typically made if the symptoms persist for 3 months
Management
  • refer to a specialist CFS service if the diagnostic criteria are met and symptoms have persisted for 3 months
  • energy management
    • a self-management strategy that involves a person with ME/CFS managing their activities to stay within their energy limit, with support from a healthcare professional
  • physical activity and exercise
    • do not advise people with ME/CFS to undertake exercise that is not part of a programme overseen by an ME/CFS specialist team
    • should only be recommended if patients 'feel ready to progress their physical activity beyond their current activities of daily living'
    • graded exercise therapy used to be recommended but is now specifically not recommended by NICE
  • cognitive behavioural therapy
    • NICE stress this is 'supportive' rather than curative for CFS

CFS has a better prognosis in children.



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