Gender differences in chronic fatigue syndrome

[Dolphin]

Reumatol Clin. 2016 Mar-Apr;12(2):72-77. doi: 10.1016/j.reuma.2015.05.007. Epub 2015 Jul 17.
Gender differences in chronic fatigue syndrome.
[Article in English, Spanish]
Faro M1, Sàez-Francás N2, Castro-Marrero J2, Aliste L2, Fernández de Sevilla T2, Alegre J2.
Author information

Abstract
BACKGROUND AND OBJECTIVES:
Chronic fatigue syndrome (CFS) is a chronic condition that predominantly affects women. To date, there are few epidemiologic studies on CFS in men. The objective of the study was to assess whether there are gender-related differences in CFS, and to define a clinical phenotype in men.

PATIENTS AND METHODS:
A prospective, cross-sectional cohort study was conducted including CFS patients at the time of diagnosis. Sociodemographic data, clinical variables, comorbid phenomena, fatigue, pain, anxiety/depression, and health quality of life, were assessed in the CFS population. A comparative study was also conducted between genders.

RESULTS:
The study included 1309 CFS patients, of which 119 (9.1%) were men. The mean age and symptoms onset were lower in men than women. The subjects included 30% single men vs. 15% single women, and 32% of men had specialist work vs. 20% of women. The most common triggering factor was an infection. Widespread pain, muscle spasms, dizziness, sexual dysfunction, Raynaud's phenomenon, morning stiffness, migratory arthralgias, drug and metals allergy, and facial oedema were less frequent in men. Fibromyalgia was present in 29% of men vs. 58% in women. The scores on physical function, physical role, and overall physical health of the SF-36 were higher in men. The sensory and affective dimensions of pain were lower in men.

CONCLUSIONS:
The clinical phenotype of the men with CFS was young, single, skilled worker, and infection as the main triggering agent. Men had less pain and less muscle and immune symptoms, fewer comorbid phenomena, and a better quality of life.

Copyright © 2014 Elsevier España, S.L.U. y Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.

KEYWORDS:
Calidad de vida; Chronic fatigue syndrome; Dolor; Fatiga; Fatigue; Fibromialgia; Fibromyalgia; Gender; Género; Pain; Quality of life; Síndrome de fatiga crónica

PMID:
26190206
DOI:
10.1016/j.reuma.2015.05.007
[PubMed - as supplied by publisher]

 

[Dolphin]

 

[sdmcvicar]

Fig. 1 seems pretty pointless without a comparison to non-CFS controls for both genders. Interesting that only 9.1% of their CFS population was male, as I thought the gender balance for prevalence was closer to 2/3 female, 1/3 male.

 

[PennyIA]

I took a second look at the figure after @sdmcvicar's post.

So... ummmm... what is "distress disorder"... I see Acute Respiratory Distress Syndrome. And a bunch of post tramautic Stress Disorder...

is there a conversion issue between Spanish & English?

 

[sdmcvicar]

I think they mean anxiety disorders.

 

[Jill]

THe men i know with ME often have it much worse and 3 have lost the use of their legs. I doubt they get it less severely. I wonder which defn they used. I get sicck kof research that doesn't really say anything. Can;t believe people get paid for this

 

[JES]

THe men i know with ME often have it much worse and 3 have lost the use of their legs. I doubt they get it less severely. I wonder which defn they used. I get sicck kof research that doesn't really say anything. Can;t believe people get paid for this

It tells me more than you knowing 3 men that lost use of their legs. They didn't say all men were functioning well, just that they were on average functioning better than the women and that men are less likely to get this illness, which, by the way is the case with almost all autoimmune diseases (and there is now a strong suspicion that CFS/ME may be autoimmune).

Obviously with 1309 patients included, it's one of the largest CFS/ME study I've seen, so it tells plenty of interesting things.

 

[Jill]

I'm not refuting what the study says. I'm just saying what I know and have seen over 35 years. Severe ME in my experience is often worse in men. I maybe wrong but it's my experience . I do know autoimmune diseases occur more often in women . Observation is a key tool that's forgotten so much

 

[PennyIA]

I'm not refuting what the study says. I'm just saying what I know and have seen over 35 years. Severe ME in my experience is often worse in men. I maybe wrong but it's my experience . I do know autoimmune diseases occur more often in women . Observation is a key tool that's forgotten so much

Do you that it's because men tend to live with the 'concept' that they just have to toughen up. So, they don't SEEK medical treatment nor diagnosis if it's mild to medium level, but instead will push themselves to the point of severe impact?

 

[Cheesus]

I find it interesting that men have a better quality of life than women. Presumably that is primarily because they (we) appear to have less severe symptoms on average, have fewer co-morbid conditions, and greater energy. However I wonder if there is also a social dimension whereby men are more likely to be believed by doctors, family members and peers. We may be looking in part at the influence on outcomes of medical misogyny.

 

[jepps]

This is another study, where infections reveal inequality between the sexes:

http://www.nature.com/news/infectio...een-the-sexes-1.20131?WT.mc_id=TWT_NatureNews

Women might have evolved a particularly fast and strong immune response to protect developing fetuses and newborn babies, says Marcus Altfeld, an immunologist at the Heinrich Pette Institute in Hamburg, Germany. But it comes at a cost: the immune system can overreact and attack the body. This might explain why more women than men tend to develop autoimmune diseases such as multiple sclerosis and lupus.
Yet very few studies assess men and women separately, so any sex-specific effects are masked. And many clinical trials include only men, because menstrual cycles and pregnancies can complicate the results. “It’s sort of an inconvenient truth,” says Linde Meyaard, an immunologist at University Medical Center Utrecht in the Netherlands. “People really don’t want to know that what they study in one sex is different from the other.”
Now, scientists are beginning to tease out some precise mechanisms. At the meeting, infectious-disease researcher Katie Flanagan at the University of Tasmania in Australia reported on a tuberculosis vaccine given to Gambian infants. She found that the vaccine suppressed production of an anti-inflammatory protein in girls, but not boys. This boosted the girls’ immune responses, and may have made the vaccine more effective.

Hormones also play a part. Oestrogen can activate the cells involved in antiviral responses, and testosterone suppresses inflammation.
Treating nasal cells with oestrogen-like compounds before exposing them to the influenza virus has revealed further clues, says Sabra Klein, an endocrinologist at Johns Hopkins University in Baltimore, Maryland. Only the cells from females responded to the hormones and fought off the virus (J. Peretz et al. Am. J. Physiol. http://doi.org/bj5w; 2016).

Genetic factors may also guide how the sexes deal with infection. Meyaard studies a protein called TLR7, which detects viruses and activates immune cells. Encoded by a gene on the X chromosome, the protein causes a stronger immune response in women than in men (G. Karnam et al. PLoS Pathogens http://doi.org/bj5x; 2012). Meyaard suspects that this is because it somehow circumvents the process whereby one of the two X chromosomes in women is shut down to avoid overexpression of proteins.