Chronic fatigue syndrome (CFS) / myalgic encephalomyelitis (ME)

12/07/2013 by admin | Rheumatology

 

  1. Debilitating and distressing, prevalence 0.2-2.6%, women.
  2. Cause: unknown, follows virus (10% EBV), immunization, chemical toxins (e.g. organophosphates, CT)…
  3. p/c: unexplained fatigue for >6/12, not due to ongoing exertion, nor alleviated by rest, reduced activity and >4 of following = impaired memory/concentration, tender cervical/axillary LNs, post-exertional malaise lasting >24h (delayed: starting 1-2d after strenuous activity), headache, multi-joint pain without swelling, sore throatr, unrefreshing sleep, muscle pain.
  4. Other associations: postural dizziness, vertigo, altered temperature sensation, paraesthesiae, sensitive to light/sound, palpitations, IBS, food intolerance, fibromyalgia dyspnoea, mood swings, panic attacks, depression.
  5.  
  1. Exacerbated by: infection, immunization, drugs, caffeine, alcohol, stress.
  2. Mx: support and reassure, avoid exacerbating factors, graded exercise is helpful, amitriptyline 10-50mg nocte (TCA) to help sleep, relieve headaches and neuropathic pain, SSRIs for depression. Refer for CBT and to specialist chronic fatigue clinic. Only 6% of adults attending clinics return to pre-morbid functioning. Children generally do better. 
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