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Comorbidity in Chronic Fatigue Syndrome/Myalgic Encephalomyelitis

Discussion in 'Latest ME/CFS Research' started by Cheesus, Jun 10, 2017.

  1. Cheesus

    Cheesus Senior Member

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    Comorbidity in Chronic Fatigue Syndrome/Myalgic Encephalomyelitis: A Nationwide Population-Based Cohort Study
    Ph.D. Jesús Castro-Marrero, Mónica Faro, M.D., Luisa Aliste, Ph.D., Naia Sáez-Francàs, M.D., Ph.D., Natalia Calvo, Ph.D., Alba Martínez-Martínez, M.Sc, Tomás Fernández de Sevilla, M.D., Ph.D., Jose Alegre, M.D., Ph.D.

    Background

    Previous studies have shown evidence of comorbid conditions in chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME).

    Objective
    To estimate the prevalence of comorbidities and assess their associations using a nationwide population-based database of a Spanish CFS/ME cohort.

    Method
    A nationally representative, retrospective, cross-sectional cohort study (2008–2015) assessed 1757 Spanish subjects who met both the 1994 Centers for Disease Control and Prevention/Fukuda definition and 2003 Canadian Criteria for CFS/ME. Sociodemographic and clinical data, comorbidities, and patient-reported outcome measures at baseline were recorded.

    A cluster analysis based on baseline clinical variables was performed to classify patients with CFS/ME into 5 categories according to comorbidities.

    A multivariate logistic regression analysis was conducted adjusting for potential confounding effects such as age and sex; response and categorical predictor variables were also assessed.

    Results
    A total of 1757 CFS/ME patients completed surveys were collected. We identified 5 CFS/ME clusters: group 1—fibromyalgia, myofascial pain, multiple chemical hypersensitivity, sicca syndrome, epicondylitis, and thyroiditis; group 2—alterations of ligaments and subcutaneous tissue, hypovitaminosis D, psychopathology, ligamentous hyperlaxity, and endometriosis.

    These 2 subgroups comprised mainly older women, with low educational level, unemployment, high levels of fatigue, and poor quality of life; group 3—with hardly any comorbidities, comprising mainly younger women, university students or those already employed, with lower levels of fatigue, and better quality of life; group 4—poorly defined comorbidities; and group 5—hypercholesterolemia.

    Conclusion
    Over 80% of a large population-based cohort of Spanish patients with CFS/ME presented comorbidities.

    Among the 5 subgroups created, the most interesting were groups 1–3. Future research should consider multidisciplinary approaches for the management and treatment of CFS/ME with comorbid conditions.

    http://www.psychosomaticsjournal.com/article/S0033-3182(17)30118-4/fulltext
     
  2. Skippa

    Skippa Anti-BS

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    Group 3, mostly younger... not had enough time yet to "collect" extra ailments and/or diagnoses?
     
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  3. trishrhymes

    trishrhymes Senior Member

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    Can't decide whether I belong to group 1, 2 or 3. Older woman, well educated, no psychopathology... Seem to be such broad groupings as to be meaningless??? Maybe as I've got older I've moved from group 3 to group 1 and / or 2. Or group 4? Who cares? Is it helpful?
     
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  4. Manganus

    Manganus Senior Member

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    Well...
    Hmmm...
    ... well, maybe not. But still, I think one might appreciate the shown interest. ;)

    Writing from Spain, I must admit having a very sketchy understanding of this society. But I would assume governmental authorities in every country with tax financed health care (or similar systems) ought to care.
    The interest is legitimate.
     
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  5. Cheesus

    Cheesus Senior Member

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    I would be interested to know if group 4 (poorly defined co-morbidities) overlaps with the atypical subgroup.
     
  6. daisybell

    daisybell Senior Member

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    Hmmm - I think I'm like you @trishrhymes in that I started out as a 3, and I'm now probably a 1, with perhaps a feature of 2. To my mind this study just reflects two facts - 1/ overdiagnosis and misdiagnosis is common, and 2/ the illness changes over time, with other comorbidities appearing.
     
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  7. boombachi

    boombachi Senior Member

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    Conclusions - Young people with less fatigue and less comorbid conditions are more likely to be at university that older, sicker people with more fatigue. Oh and yes, you will have done badly at school and less likey to continue education if your fatigue is worse.

    I thought this study might have picked up clues like more autoimmune comorbidies or hormonal disturbances (no diabetes, thyroid conditions?) I am not in a position to criticise. I am not a scientist and would be hard pushed to say where exactly in my body my kidneys are so maybe they had a good reason. I am just disappointed. :(
     
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  8. Cheesus

    Cheesus Senior Member

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    Group 1 has thyroiditis.
     
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  9. Murph

    Murph :)

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    This looks like a good study that uses the appropriate contemporary symptom-based definitions of ME/CFS. It's not a biology paper and does not seek to find a cure. It is instead more like a public health study, showing prevalence of comorbidties.

    What makes it useful is the enormous sample. It means any fine differences noted may have real meaning and could really help elucidate subsets by coming at them from a clinical perspective.

    The full paper also notes that listing comorbidity rates is useful for making sure that people who do suffer from one of these other illnesses don't also miss out on a CFS diagnosis where it is warranted. This could help people who have, say, depression or anxiety not to be told that their depression or anxiety is causing the ME/CFS.

    It notes a few weaknesses, especially that it may have recruited especially severe and long-lasting cases, because the patients came from the top national centre for ME/CFS.

    "The main limitations of this study are the following: First, CFS/ME patients were referred from a specialist outpatient clinical service which is a national reference center for the diagnosis of CFS/ME across Spain. This means that these patients may present more severe fatigue, longer time of evolution of CFS/ME and higher incidence of comorbidities than their counterparts in a primary healthcare setting. Second, since this was a cross-sectional measures study in which patients were included retrospectively, we could not assess their evolution over time. For this reason, we have recently initiated a longitudinal study of comorbid conditions in CFS/ME patients."



    Here's some of the detail from the full paper. (Sci hub link).

    Screen Shot 2017-06-10 at 10.53.26 PM.png Screen Shot 2017-06-10 at 10.52.21 PM.png
     
    Last edited: Jun 10, 2017
  10. trishrhymes

    trishrhymes Senior Member

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    Just noticed it's published in a Journal called Psychosomatics, the journal of consultation and liaison psychiatry. Can't decide whether this is a good thing or not. At least it points to the fact that some of the patients have measurable physical conditions which should be being treated as well as ME/CFS.

    I'm afraid that any doctor / psychiatrist / psychologist reading the abstract may draw unwarranted conclusions - for example that being poor, uneducated and unemployed are somehow the cause of chronic fatigue symptoms, rather than the result of having ME/CFS. (ie blame the patient, it's all in their heads etc.). Am I being too cynical?

    I haven't read the full article as it appears to be behind a paywall. Not sure I'd bother anyway.

    Edit: Thanks @Murph for the additional information. I find their choice of symptoms and comorbidities odd - what about GI symptoms which seem to be pretty common in ME patients, and headaches, sore throats, swollen lymph nodes etc. And why highlight endometriosis and some of the other comorbidities that seem to be pretty uncommon in all groups.
    I appreciate the effort, but the data shows there is so much overlap between their subgroups, that it seems pretty pointless to me to do the mathematical exercise of trying to subgroup.
     
    Last edited: Jun 10, 2017
  11. boombachi

    boombachi Senior Member

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    Thanks for pointing that out. I glaze over a bit with medical terms. I am not well versed in the 'itises'. :D[/QUOTE]
     
  12. Basilico

    Basilico Florida

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    I might be making something out of nothing, but I find it really unsettling that in the conclusion they chose to describe a particular cohort as being "the most interesting".

    This sounds like a subjective judgment, not the kind of writing I would expect in a scientific paper. Anyone else agree with this or does this seem acceptable to others?
     
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  13. RogerBlack

    RogerBlack Senior Member

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    And why highlight endometriosis and some of the other comorbidities that seem to be pretty uncommon in all groups.
    [/QUOTE]
    Because any means of distinguishing subgroups is useful, and if it's real, this is quite a useful signal.
    Patients with EM are likely to be ~8% of groups 1 and 2, versus 3% of other groups.
     
  14. Barry53

    Barry53 Senior Member

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    I wish they had not bundled fatigue and PEM into the same statistic; would have been much more helpful to know if the majority of the 98.9% figure had the classic ME symptom of PEM or not.

    Also for those with hypothyroidism, would be helpful to know if this condition was being well managed or not. Is this clarified or not?

    Without the above, cannot really tell if the "fatigue" is a consequence of the hypothyroidism or not. Seeing as the hypothyroism prevalence must be much higher than the normal population, if the fatigue was (supposedly?) being well managed, is there something else going on here?
     
    Last edited: Jun 10, 2017
  15. Webdog

    Webdog Senior Member

    Interesting how I found this thread. It is the #1 result in a Google news search for the phrase "myalgic encephalomyelitis" (last 24 hours).

    Odd that PR forum threads show up in Google news searches.
     
  16. slysaint

    slysaint Senior Member

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    Haven't read the paper but two things spring to mind; how long had they been ill for, and did they have any of these conditions some time before they were diagnosed with ME (?)
     
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  17. TiredSam

    TiredSam The wise nematode hibernates

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    So sufferers with higher levels of fatigue are less likely to be able to take part in education or employment and more likely to have a lower quality of life. Those with less fatigue and fewer comorbidities are more likely to be able to attend university or be employed, and have a better quality of life.

    No shit.
     
  18. Barry53

    Barry53 Senior Member

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    Or r r ... maybe lots of :rolleyes:
     
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  19. Jill T

    Jill T

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    What about orthostatic intolerance (Lots have POTS!), IBS, interstitial cystitis (and other urinary issues), EDS, heart issues?
     
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