Journal of IiME Volume 2 Issue 1 www.investinme.org Essential investigations for people with ME/CFS? By Margaret Williams On 14th January 2008 Fred Springfield drew attention on Co-Cure to a Review Article associated with inflammation in medically ill patients (“Identification and treatment of symptoms associated with inflammation in medically ill patients”; Robert on Dantzer inflammation, neurosciences and psychoneuroimmunology, attended by experts from the US, France, the UK and Israel. As noted by Fred Springfield, whilst not relating specifically to ME/CFS, the Review may nevertheless be of interest to the ME/CFS community, whose members may be aware that there is evidence of low-grade (but still important) inflammation in ME/CFS -see, example, “Low grade inflammation and arterial wave reflection in patients with CFS”; VA Spence et al, Clin Sci 2007, Epub ahead of print: doi:10.1042/CS20070274, which contains 54 references and demonstrates that, despite the recent reporting that markers of postinfective fatigue syndromes are not sustained into the chronic phase of the illness and play no role in persisting symptoms, hsCRP indicative inflammation. levels of chronic, low-grade, (Within the last ten years, in (ME)CFS are indeed sub-clinical researchers have developed a high sensitivity immunoassay known as hsCRP, which is a much better assay and a more sensitive marker than CRP, as it can measure levels below 10mg/L. Whilst some clinicians may still regard low levels as unimportant, nevertheless at these levels, measurement of conditions indicative of chronic, lowgrade inflammation are now possible). The Review recommends testing for a standardised set of inflammatory biomarkers, but the NICE Guideline on “CFS/ME” issued in August 2007 specifically proscribes such tests. The following are quotations that might be relevant for people with ME/CFS: “The most harmful and costly health problems in the Western World are originating from a few diseases (and) in addition to the specific symptoms that are characteristic of each of these conditions, most patients experience non-specific symptoms that are similar in all these conditions and include depressed mood, altered cognition, fatigue, and sleep disorders”. “The possibility that immune-to-brain communication pathways represent the main biological mechanism for symptom burden experienced by medically ill patients has now gained credibility in the medical community”. “Making fatigue a somatisation disorder overlooks the fact that fatigue has both mental and physical components, thereby denying a possible organic aetiology to explain such fatigue”. “Furthermore, this emphasis on the lack of an organic basis favours missed diagnoses (e.g. fatigue and thyroid abnormalities, or fatigue and inflammation)”. (continued on page 34) Invest in ME (Charity Nr. 1114035) Page 33/34 for et al; Psychoneuroendocrinology 2008:33:18-29). The Review was the result of a meeting on 28th and 29th May 2007 in Bordeaux, France, psychiatry, “This meeting brought together clinicians and basic scientists with a common interest in understanding inflammation and associated symptoms in medically ill patients (and it) focused on: (a) predominant symptoms associated with inflammation, (b) markers of inflammation at the periphery, (c) possible markers of brain inflammation associated with low-grade peripheral inflammation in humans, (d) animal models of inflammation-associated symptoms, and (e) domains of intervention for controlling inflammation-associated symptoms”. “Among the myriad of questionnaires that are available to categorise or assess fatigue, sleep disorders, altered cognition and pain, none specifically refers to inflammation-associated neurobehavioural alterations”. “The diagnostic tools that are favoured by psychiatrists are clearly not the best ones. As pointed out by Joel Dimsdale (San Diego, CA), the concept of somatisation that is used for characterising symptoms in the absence of any detectable disease is of little operational value, if not misleading”. “For instance, the enduring fatigue experienced by the vast majority of breast cancer survivors could easily be labelled as somatisation disorder according to the 4th Edition of the Diagnostic and Statistical Manual of Mental Disorders”. Margaret Williams is a well respected authority on ME as well as being an ME patient advocate. Margaret Williams formerly held senior clinical posts in the NHS.

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