EDITORIAL Differing case definitions point to the need for an accurate diagnosis of ME/CFS

[AndyPR]

Symptoms vs. diagnosis
While symptoms such as fatigue, pain and cognitive dysfunction can be described as representing a continuum of severity, to advance the discussion of disease entities such as ME/CFS (as opposed to description of symptoms), it is good clinical and research practice to dichotomise individuals according to diseased and non-diseased status. Using two simple examples, hypertension and diabetes would be difficult to identify as diseases without dichotomising the continuous variables of blood pressure and glycaemia. Determining the right cut-off points for disease status is more feasible once we have identified a small number of key variables. We argue that a reasonable starting point for this type of research in ME/CFS should be compliance with multiple criteria as indicated above.

Finally, it is difficult for both researchers and those with ME/CFS not to be left with a sense of frustration and loss when reflecting on the time and resources invested in studies using more generalised, and we argue, less productive criteria such as that contained in the Oxford definition. If ME/CFS participants who are more likely to be ‘true cases’ are recruited with standardised procedures and robust data collection for clinical phenotyping across research groups, significant advances in the understanding of ME/CFS are likely to follow.

http://www.tandfonline.com/doi/full/10.1080/21641846.2017.1273863

 

[A.B.]

I wonder if pre and post exertion lactate would make a suitable biomarker. Take blood, have the patient walk until they feel exhausted, then take blood again.

 

[AndyPR]

It seemed to me, reading this, that they are making a strong argument against the type of broad criteria that MEGA intend to use.

I wonder if pre and post exertion lactate would make a suitable biomarker. Take blood, have the patient walk until they feel exhausted, then take blood again.

Particularly if the low initial lactate levels reported in another thread recently are a commonalty to all/most PwME, then it could be used as an initial screen, along with reported symptoms.

 

[Sasha]

This is a UK-based team from the London School of Hygiene and Tropical Medicine: Luis Nacul, Caroline Kingdon, Erinna Bowman, Hayley Curran & Eliana Lacerda.

Good to see them speaking up against Oxford nonsense.

 

[alex3619]

I wonder if pre and post exertion lactate would make a suitable biomarker. Take blood, have the patient walk until they feel exhausted, then take blood again.

As Ron Davis pointed out, you only need the blood. Measure lactate, or some other marker, both pre- and post- a cell stress test and you have a simple blood test. Of course it has to be shown that this is reliable, has high specificity and sensitivity, and we have to use a good marker set.

 

[Forbin]

As Ron Davis pointed out, you only need the blood. Measure lactate, or some other marker, both pre- and post- a cell stress test and you have a simple blood test.

Yes, Ron Davis mentioned the development of a chip that could measure electrical impedance to evaluate cellular changes. Healthy cells and ME/CFS cells showed the same impedance until they were stressed by creating "a demand for ATP." After about 2-hours, the ME/CFS cells showed a reproducible increase in impedance.

It's also been mentioned that healthy cells start acting like ME/CFS cells when exposed to an ME/CFS patient's blood (serum?), and vice versa. That would seem to imply an existing knowledge of how ME/CFS patient cells differ from normal cells (possibly via a test such as mentioned above). At any rate, if ME/CFS patient blood consistently altered healthy cells performance on some kind of test, that too might be a test for ME/CFS.

 

[alex3619]

It's also been mentioned that healthy cells start acting like ME/CFS cells when exposed to an ME/CFS patient's blood (serum?), and vice versa.

Serum.

 

[lansbergen]

At any rate, if ME/CFS patient blood consistently altered healthy cells performance on some kind of test, that too might be a test for ME/CFS.

Makes sense to me.

 

[Dolphin]

For patients selected using more restrictive definitions, cognitive behavioural therapy (CBT), graded exercise therapy (GET) and other forms of non-drug management approaches to ME/ CFS are most appropriate as adjunct therapies rather than restorative treatments, when provided by therapists with a good understanding of ME/CFS. These forms of behavioural intervention have been shown to support the well-being and rehabilitation of those suffering from many chronic and disabling conditions [6]. However, it is very important that the use of behaviourally based management strategies does not deter researchers, physicians and other health professionals from the overarching goal of investigating the causes and pathophysiology of ME/CFS in various sub-groups and the development of specific treatments.

The adjunct point (underlined) I think is good. I don't think the comparison with other conditions is exact. For example, the CBT is not the same. Also there is an abnormal response to exercise in ME/CFS which makes it more difficult to design suitable graded activity and exercise regimes.

But there is always a chance with peer-reviewed papers that the authors were pressurised by a peer reviewer to say something they might prefer not to.

 

[Kati]

I wonder if pre and post exertion lactate would make a suitable biomarker. Take blood, have the patient walk until they feel exhausted, then take blood again.

It is much more complicated than measuring lactate pre and post exercise.

Note that athletes will have high lactate following maximal CPET and if they are in overtraining, their pre-exercise lactate will show elevated.

If it were this simple, we'd already have a biomarker.