Chronic Fatigue & Autoimmune

Is chronic fatigue syndrome an autoimmune condition?  What type of doctor would diagnose this disorder?

No one knows what causes chronic fatigue syndrome.  Indeed, this disorder may have more than one cause.  Various infectious agents—Epstein-Barr virus, for example—have been implicated at one time or another, but the link between these entities and chronic fatigue syndrome has never been confirmed.  Immunity appears to play a role in most patients, as evidenced by abnormally low levels of antibodies, impaired lymphocyte activity, decreased interferon levels, persistently swollen lymph, nodes, or high levels of circulating autoantibodies. However, these immune abnormalities aren’t present in all chronic fatigue sufferers, and no single immune marker defines chronic fatigue syndrome.  Most primary care physicians—family physicians, internists, pediatricians, etc.—are capable of diagnosing chronic fatigue syndrome, but you’ll probably be referred to a rheumatologist for a definitive diagnosis.

Is there a typical onset age or life event that can trigger chronic fatigue?

According to a 2010 review in International Journal of Immunopathology and Pathology, the peak age of onset for chronic fatigue syndrome is between 20 and 40 years, and women are six times more likely than men to suffer from chronic fatigue syndrome.  In most patients, some sort of environmental or internal insult (stress, infection, toxic exposure, etc) is identified as the inciting event.  Interestingly, the World Health organization classifies chronic fatigue syndrome as Post Viral Fatigue Syndrome (PVFS), which attests to the role viruses play in triggering chronic fatigue syndrome.

What are the signs and symptoms of chronic fatigue syndrome?

Chronic fatigue syndrome is characterized by unexplained, persistent, or recurring fatigue that cannot be explained by another illness; that has a definite onset; that is not the result of ongoing exertion; that is not relieved by rest; that interferes with activities of daily living; and that has been present for at least six months. A wide array of signs and symptoms can occur in people with CFS, but the Centers for Disease Control and Prevention, the National Institutes of Health, and the International Chronic Fatigue Study Group have developed a list of criteria that assist physicians in diagnosing this disorder. While it isn’t currently considered an autoimmune disease, CFS could one day be classified as such; researchers may yet uncover a specific immune anomaly that sets CFS apart from other autoimmune disorders. If and when that occurs, the diagnostic criteria for CFS will have to be modified.

Are there other commonly occurring autoimmune conditions that occur simultaneously with or following a diagnosis of chronic fatigue syndrome?

By definition, chronic fatigue syndrome cannot coexist with an autoimmune disease, because your symptoms could be explained by the autoimmune condition.  It’s conceivable that chronic fatigue syndrome could precede the diagnosis of an autoimmune disease, though, as some autoimmune disorders can elude diagnosis for several months or even years.  Once the autoimmune disease is confirmed, however, the diagnosis of chronic fatigue syndrome must be discarded.

Questions for your doctor:

  • Will I have to deal with chronic fatigue syndrome for the rest of my life?
  • Since many cases of chronic fatigue syndrome seem to be triggered by viruses, would an antiviral medication be helpful?
  • Is there a special diet or any particular supplement that would help reduce the symptoms of chronic fatigue syndrome?

References
E Capelli, et al. Chronic fatigue syndrome/myalgic encephalomyelitis: an update. International Journal of Immunopathology and Pathology. 2010;23(4):981-989

 

About the Author
Steve Christensen, MD – “Doom” to his close friends – was trained at the University of Utah School of Medicine. Since his premature retirement from medicine in 2003, Dr. Christensen has expanded his knowledge of alternative medicine: he is a certified herbalist; he has dabbled at the edges of Ayurvedism, shared ideas with Chinese physicians, rubbed shoulders with Native American healers and contemplated the healing powers of channeled energy.

 

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