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Chronic fatigue syndrome: the current status and future potentials of emerging biomarkers

Bob

Senior Member
Messages
16,455
Location
England (south coast)
Chronic fatigue syndrome: the current status and future potentials of emerging biomarkers
David B. Fischer, Arsani H. William, Adam C. Strauss, Elizabeth R. Unger, Leonard A. Jason, Gailen D. Marshall, Jordan D. Dimitrakoff
Fatigue: Biomedicine, Health & Behavior
Vol. 2, Iss. 2, 2014
http://dx.doi.org/10.1080/21641846.2014.906066

Abstract

Background: Chronic fatigue syndrome (CFS) remains an incompletely characterized illness, in part due to controversy regarding its definition, biological basis, and diagnosis.

Purpose: Biomarkers are objective measures that may lead to improvements in our understanding of CFS by providing a more coherent and consistent approach to study, diagnosis, and treatment of the illness. Such metrics may allow us to distinguish between CFS subtypes – each defined by characteristic biomarkers – currently conflated under the single, heterogeneous condition of CFS. These delineations, in turn, may guide more granular, focused, and targeted treatment strategies based on more precise characterizations of the illness.

Methods: Here, we review potential CFS biomarkers related to neurological and immunological components of the illness.

Results, Conclusions: We discuss how these biomarkers may be used to move the field of CFS forward, emphasizing clinical utility and potential routes of future research.
 

SOC

Senior Member
Messages
7,849
Weirdly written abstract. The Purpose is more of a Background. The Methods don't actually describe the methods they used. The Results, Conclusions contain no actual results or conclusions. o_O Hopefully someone can get access to the full paper and tell us whether the methods were any good and what the conclusions actually are.
 

Kati

Patient in training
Messages
5,497
Weirdly written abstract. The Purpose is more of a Background. The Methods don't actually describe the methods they used. The Results, Conclusions contain no actual results or conclusions. o_O Hopefully someone can get access to the full paper and tell us whether the methods were any good and what the conclusions actually are.

I agree, the abstract format is weak and not much info is provided to entice to view paper or purchase a copy.
 

WillowJ

คภภเє ɠรค๓թєl
Messages
4,940
Location
WA, USA
Isn't that Fred Friedberg's new journal? I thought it was to be open access, or was that only the inagural issue?
 

Kati

Patient in training
Messages
5,497
I don't remember it being free access but quite honestly it should be. It's just that publishers need to be rewarded for publishing

The name of the journal sucks.

Lastly, sometimes physicians need to be paid to actually read content.
 

Snow Leopard

Hibernating
Messages
5,902
Location
South Australia
Conclusion
Recent research efforts have resulted in recommendations for minimal elements in
research papers on CFS.[3] Research and clinical management of CFS will benefit
from a more objective system of characterization, just as the CP/CPPS benefited
from the DABBEC phenotyping method.[11] Based on the current state of research
on the topic, biomarkers offer a strong potential for characterizing CFS subgroups in
terms of clinical phenotypes, endophenotypes, prognosis, and response to therapy.
We have categorized reliable but disparate markers of the disease into distinct categories
that can be used to delineate etiologically distinct subtypes of CFS, which
can, in turn, be used to develop a more nuanced definition of the disease and more customized
approaches to treatment.
Of course, this proposed framework cannot be utilized effectively without remaining
amenable to future research developments. First, the criteria for using these biomarkers
in diagnosis must be defined, along with the phenotypes that they
accompany. Then, the reliability and effectiveness of these biomarkers must be
tested for diagnostic and/or prognostic capacity, to propel our understanding and treatment
of disease forward. Moreover, if biomarkers are going to be practically useful to
assist in diagnosis, CFS patients with other comorbidities such as multiple sclerosis,
lupus, depression, and other comorbid disorders with CFS must be included in these
studies (“ill controls” or comparison groups) to allow evaluation of the specificity of
the proposed biomarkers for CFS.
Second, as novel biomarkers are discovered and the biological underpinnings of
CFS are elucidated, these contributions to the existing body of knowledge must be
incorporated into the proposed framework. Only by continuously evolving with the
research on which it depends can this proposed model accurately reflect the true
nature of the disease. Hopefully, as future studies are performed and validated, the
current model will retain its flexibility and will allow incorporation of new knowledge
into the working framework of CFS. It is only by developing a more
nuanced and granular framework for CFS – one that can be shared by researchers
and clinicians alike – that our knowledge of the disease, and of potential treatments,
can progress.
 

A.B.

Senior Member
Messages
3,780
Short version: We need to start doing what we should have started doing 30 years ago.

Hopefully they'll learn the lesson and abandon the concept of psychosomatic illness alltogether in order to prevent the same thing happening again in other areas. A psychosomatic diagnosis is on the same level as a diagnosis of demonic possession, the only difference is that one of them is out of fashion.
 
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biophile

Places I'd rather be.
Messages
8,977
http://www.lastwordonnothing.com/20...cal-unhelpful-about-chronic-fatigue-syndrome/

Klimas, my doctor (now at Nova University), was among those who signed the letter requesting that HHS cancel its contract with the Institute of Medicine. I asked her why she was concerned. “I’m afraid they’re about a year early,” she said. If HHS had waited, she explained, they could have developed a disease definition grounded in data, and that’s what will give a definition the heft needed to change attitudes. Just a year would be enough: Several large studies are now collecting tissues from more than a thousand patients and controls, looking for the telltale biological indicators that most effectively distinguish the two groups. Furthermore, Klimas said, without that evidence, a skeptical committee might dismiss the results of the many small studies that are now most revealing — and could as a result develop a broad definition that would exacerbate the current confusion.
 
Messages
15,786
Since when are MS and lupus comorbid conditions to CFS? I thought they were exclusionary. Please tell me this research is not conflating ME/CFS with the symptom chronic fatigue.
There's often a lot of diagnostic uncertainty with Lupus, if someone has symptoms but not the usual autoimmune antibodies or whatever. And people with MS often start out with a diagnosis of CFS - approximately 30% in one study?

But those are both likely a matter of misdiagnosis, partially due to the bad CFS definition, not co-morbid diseases. I'd be curious to know how many that are supposedly co-morbid also have PEM.
 

Purple

Bundle of purpliness
Messages
489
Sometimes it seems some doctors use ME/CFS as a synonym for chronic fatigue and fibromyalgia as a synonym for chronic pain. So people end up with a diagnosis of e.g. lupus, CFS and fibro - when they could have lupus only with fatigue and pain being symptoms of lupus but being misdiagnosed as CFS and fibro.
 
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alex3619

Senior Member
Messages
13,810
Location
Logan, Queensland, Australia
Hopefully they'll learn the lesson and abandon the concept of psychosomatic illness alltogether in order to prevent the same thing happening again in other areas. A psychosomatic diagnosis is on the same level as a diagnosis of demonic possession, the only difference is that one of them is out of fashion.

Ummm, can I guess? Psychosomatic illness is out of fashion?

The history of psychogenic claims is a history of a mutable claim. As they are disproved, and they have been many many times, they simply move to the next disease group. They are not going to give up. Psychogenic medicine has to be tackled directly, and treated as it deserves (as pseudoscience) or its not going away. It has been proclaimed dead more than a few times, yet here it is.

What will happen though, is that like with diabetes, gastric ulcers, arthritis, MS etc., ME will join the list of diseases formerly considered by some to be psychogenic.
 

anciendaze

Senior Member
Messages
1,841
Since when are MS and lupus comorbid conditions to CFS? I thought they were exclusionary. Please tell me this research is not conflating ME/CFS with the symptom chronic fatigue.
Both illnesses have considerable margins for diagnostic error. Staff at a clinic specializing in MS told me about 20% of their patients don't actually meet strict diagnostic criteria. Lupus has a visible rash to distinguish it, but a very similar rash appears on some women after pregnancy who are not said to have lupus. Rashes and antibodies characteristic for SLE can also appear after treatment with some fairly common drugs. This can even go as far as causing nephritis, which is a serious complication of SLE. Is this drug-induced disease SLE? Who knows?

Absent rash, high levels of known autoantibodies and/or classic lesions on nerves there is a lot of commonality between these two autoimmune illnesses and ME/CFS. It is quite possible understanding any one of these may clarify the etiology of the others.

The problem we face here is that previous diagnostic criteria for ME/CFS were designed to treat any physiological difference as an exclusionary condition for what some involved were sure had to be a psychiatric problem. If you define something that way, this will necessarily result in a diagnostic wastebasket.

While much concern has been concentrated on psychiatric comorbidity, which is high for both MS and SLE, there are quite a number of important comorbid medical problems that are not considered psychological at all. You can check on incidence rates of specific cancers, cardiovascular disease and metabolic diseases. Curiously, some cancers are less common (inverse comorbidity), while others are more common. This indicates a profound physiological disturbance associated with disease, not simple a problem of "being sick". Even a dyed-in-the-wool psychobabbler might be embarrassed if asked to explain how these could be psychogenic, assuming such people are capable of embarrassment.

Some comorbid conditions parallel those suspected in ME/CFS, as much as current diagnostic confusion allows anyone to talk about comorbid conditions.
 

MeSci

ME/CFS since 1995; activity level 6?
Messages
8,231
Location
Cornwall, UK
Both illnesses have considerable margins for diagnostic error. Staff at a clinic specializing in MS told me about 20% of their patients don't actually meet strict diagnostic criteria. Lupus has a visible rash to distinguish it, but a very similar rash appears on some women after pregnancy who are not said to have lupus. Rashes and antibodies characteristic for SLE can also appear after treatment with some fairly common drugs. This can even go as far as causing nephritis, which is a serious complication of SLE. Is this drug-induced disease SLE? Who knows?

Absent rash, high levels of known autoantibodies and/or classic lesions on nerves there is a lot of commonality between these two autoimmune illnesses and ME/CFS. It is quite possible understanding any one of these may clarify the etiology of the others.

The problem we face here is that previous diagnostic criteria for ME/CFS were designed to treat any physiological difference as an exclusionary condition for what some involved were sure had to be a psychiatric problem. If you define something that way, this will necessarily result in a diagnostic wastebasket.

While much concern has been concentrated on psychiatric comorbidity, which is high for both MS and SLE, there are quite a number of important comorbid medical problems that are not considered psychological at all. You can check on incidence rates of specific cancers, cardiovascular disease and metabolic diseases. Curiously, some cancers are less common (inverse comorbidity), while others are more common. This indicates a profound physiological disturbance associated with disease, not simple a problem of "being sick". Even a dyed-in-the-wool psychobabbler might be embarrassed if asked to explain how these could be psychogenic, assuming such people are capable of embarrassment.

Some comorbid conditions parallel those suspected in ME/CFS, as much as current diagnostic confusion allows anyone to talk about comorbid conditions.

Just want to say that the full text is available now via the link in the first message, but the pdf will include your IP address.
 

MeSci

ME/CFS since 1995; activity level 6?
Messages
8,231
Location
Cornwall, UK
Just want to say that the full text is available now via the link in the first message, but the pdf will include your IP address.