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Chronic fatigue syndrome an often debilitating condition

I had always been under the impression that chronic fatigue syndrome was a made-up illness, but my sister was diagnosed with it recently. What is chronic fatigue syndrome, and how will she be treated?

Chronic fatigue syndrome (CFS) is a chronic, often debilitating condition. Doctors diagnose CFS when a patient has a set of symptoms that sometimes include overwhelming fatigue, low-grade fever, pain, and cognitive disorders. Laboratory tests are generally all normal, although some researchers claim that subtle immune dysfunction is detectable.

The illness is largely unrecognized and remains controversial in the medical community, primarily because of the lack of any objective measure of the illness and the absence of a clear diagnostic test. In addition, controversy surrounds the possible association with psychiatric conditions, especially depression. It typically affects adults between the ages of 20 and 40, with less frequent diagnosis in children and adolescents. The percentage of women diagnosed with CFS is larger than that of men. Although much publicity has surrounded the topic, the disorder is still relatively difficult to diagnose and treat.

"This condition is puzzling because it defies diagnostic category, while at the same time it mimics the symptoms of many diseases," says Robert Simms, M.D., clinical director of the Rheumatology Section at Boston Medical Center (BMC) and associate professor of medicine at Boston University School of Medicine. "Due to this factor, physicians often have to eliminate numerous other diseases before they make a diagnosis of chronic fatigue syndrome."

To aid physicians in arriving at a diagnosis of CFS, the Centers for Disease Control and Prevention outline several criteria for the syndrome, including severe, unexplained fatigue for over six months that is of a new or definite onset, but is not due to continuing exertion and not resolved by rest. The fatigue must produce functional impairment and must also be accompanied by six or more of the following symptoms: low-grade fever, impaired memory or concentration, sore throat, tender lymph nodes, muscle pain, new pattern of headaches, pain in several joints, fitful sleep, and postexertion malaise lasting more than 24 hours.

"Chronic fatigue syndrome is defined by these symptoms, in spite of the fact that we have not as yet discovered how it afflicts patients, why it starts, or why it disappears," says Simms. "The cause remains a mystery. As a result, treatment is geared to relieving the patient's distress, rather than attacking the basic cause."

Simms says there is no standard course of treatment for CFS; however, most traditional treatments focus on symptoms. Many patients experience depression and other psychological problems with CFS, thus it also may be necessary for the physician to refer the patient to a mental health professional and/or prescribe antidepressants and other drugs to control anxiety.

According to Simms, chronic fatigue syndrome is not fatal, nor is it contagious. Although clinical evidence has shown a prevalence of CFS among family members and in community clusters, he says that it is far more common to see the syndrome in isolated cases.

Since both cause and cure for CFS are unknown, much research is currently being performed to learn more about this baffling disorder. Despite the many uncertainties surrounding CFS, the symptoms related to the illness are often treatable; thus a recovery is usually expected within six months to a year.

"Health Matters" is written in cooperation with staff members of Boston Medical Center. For more information on chronic fatigue syndrome or other health matters, call 617-638-6767.

23 March 2001
Boston University
Office of University Relations