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Posted to Co-Cure Mon, 11 Oct 1999 17:59:09 -0400 by Fred Springfield

A Community-Based Study of Chronic Fatigue Syndrome

A Community-Based Study of Chronic Fatigue Syndrome
Arch Intern Med. 1999;159:2129-2137
Leonard A. Jason, PhD; Judith A. Richman, PhD; Alfred W. Rademaker, PhD; Karen M. Jordan, PhD; Audrius V. Plioplys, MD; Renee R. Taylor, PhD; William McCready, PhD; Cheng-Fang Huang, MS; Sigita Plioplys, MD

Abstract:
Background: Most previous estimates of the prevalence of chronic fatigue syndrome (CFS) have derived largely from treated populations, and have been biased by differential access to health care treatment linked with sex, ethnic identification, and socioeconomic status.

Objective: To assess the point prevalence of CFS in an ethnically diverse random community sample.

Design and Participants: A sample of 28,673 adults in Chicago, Ill, was screened by telephone, and those with CFS-like symptoms were medically evaluated.

Main Outcome Measures and Analyses: Self-report questionnaires, psychiatric evaluations, and complete medical examinations with laboratory testing were used to diagnose patients with CFS. Univariate and multivariate statistical techniques were used to delineate the overall rate of CFS in this population, and its relative prevalence was subcategorized by sex, ethnic identification, age, and socioeconomic status.

Results: There was a 65.1% completion rate for the telephone interviews during the first phase of the study. Findings indicated that CFS occurs in about 0.42% (95% confidence interval, 0.29%-0.56%) of this random community-based sample. The highest levels of CFS were consistently found among women, minority groups, and persons with lower levels of education and occupational status.

Conclusions: Chronic fatigue syndrome is a common chronic health condition, especially for women, occurring across ethnic groups. Earlier findings suggesting that CFS is a syndrome primarily affecting white, middle-class patients were not supported by our findings.

Data from this study indicate that CFS is a more common chronic condition, overall affecting 422 per 100,000 in the population, or about 836,000 people in the United States (based on the current US population count of 198,107,000 adults aged 18 years and older.42) It is possible that CFS rates may be higher than this estimate, given that some individuals with CFS may have escaped detection because of being too ill to undergo the evaluation process. Previous estimates using the current Centers for Disease Control and Prevention criteria1 have ranged widely, from 75 to 2600 per 100,000, suggesting significant methodological and sampling discrepancies between studies.43

Full text of the article

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Posted to Co-Cure Sun, 10 Oct 1999 00:04:49 -0400 by Fred Springfield

U.S. Case Definition of Chronic Fatigue Syndrome: Diagnostic and Theoretical Issues

U.S. Case Definition of Chronic Fatigue Syndrome: Diagnostic and Theoretical Issues
Journal of Chronic Fatigue Syndrome (The Haworth Medical Press, an imprint of The Haworth Press, Inc.) Vol. 5, No. 3/4, 1999
Leonard A. Jason, Caroline P. King, Judith A. Richman, Renee R. Taylor, Susan R. Torres, Sharon Song

SUMMARY. In 1994, researchers from the U.S. Centers for Disease Control and Prevention developed a revised case definition of chronic fatigue syndrome (CFS) (1), a complex illness characterized by debilitating fatigue and a number of accompanying flu-like symptoms. Although Fukuda and associates intended to resolve complexities surrounding the classification of individuals with CFS stemming from previous definitional criteria (1), significant problems with the revised criteria endure. This article highlights reliability issues and other conceptual and operational difficulties inherent in the current U.S. definition of CFS (1). We employ case studies derived from a community-based epidemiological study of chronic fatigue syndrome (2) to illustrate examples of the potential for misclassification of individuals with CFS using the current U.S. criteria (1). Moreover, we suggest alternative approaches to classification and ways to operationalize specific concepts embedded in the current U.S. criteria (1).

KEYWORDS. Epidemiology, fatigue

Historically, many chronic illnesses have been difficult to define, particularly when the exact causal agents of the illness are not known, physical signs and symptoms are nonspecific or variable, and diagnostic laboratory tests are not applicable, unavailable, or have poor specificity and sensitivity (3). With chronic illnesses of this nature, standard case definitions have had to be developed through the consensus of expert committees (e.g., carpal tunnel syndrome, rheumatoid arthritis, systemic lupus erythematosus, and various psychiatric disorders) (3,4). Chronic fatigue syndrome (CFS) is one of these difficult illnesses to define, and despite years of research, it remains a poorly understood and controversial syndrome (5). Even the classification of CFS has been controversial, and this might reflect the fact that some researchers consider CFS a medical-neurological illness, whereas others consider it a psychiatric disorder (6).

One factor that has confounded research on CFS is the lack of consensus among health care professionals regarding the interpretation and application of the diagnostic criteria for CFS. Criteria need to possess adequate sensitivity, identifying all those with CFS, and adequate specificity, distinguishing those who have other medical or immunological disorders from those who have CFS. Attempts to specify the diagnostic criteria for this syndrome have sparked considerable debate and controversy (6,7). Since its emergence as a new disease category in the 1980s, four definitions of CFS have been proposed, but none have been derived empirically (8). Perhaps as a result, clinicians and health care professionals working with chronically fatigued clients have noted a number of difficulties with each of these case definitions. One study that compared the original U.S. case definition (9) and the British and Australian case definitions (10,11) found major differences in criteria between each of the three case definitions. Tiersky and associates (12) have produced data indicating that the 1988 and 1994 U.S. CFS case definition criteria (9,1) identify distinct patient groups. These differences substantially affected the number of patients meeting the criteria of each definition (13).

Subtle changes in the wording, interpretation, and application of the diagnostic criteria used to identify people with CFS can critically influence prevalence rates and change the characteristics of the samples being defined. Several recent CFS community-based prevalence studies using the current U.S. criteria (1) produced prevalence estimates that differ by a factor of 10, thus suggesting that these investigators might be identifying different samples of people with CFS (14-16). Unclear criteria might be responsible for these discrepant rates. The present paper will focus specifically on the practical and theoretical issues in using the current U.S. case definition (1), as it is the most commonly used criteria for diagnosing CFS.

[ Article copies available for a fee from The Haworth Document Delivery Service: 1-800-342-9678. E-mail address: getinfo@haworthpressinc.com .]

Leonard A. Jason and Caroline P. King are affiliated with DePaul University.
Judith A. Richman is affiliated with the University of Illinois at Chicago.
Renee R. Taylor, Susan R. Torres and Sharon Song are affiliated with DePaul University.

Address correspondence to: Leonard Jason, PhD, Department of Psychology, DePaul University, 2219 N. Kenmore Avenue, Chicago, IL 60614.

The authors appreciate the financial support provided by NIAD grant # A136295.

The authors would like to express their appreciation to Erin Frankenberry, Susan Klein, and Guy Fricano for their constructive advice.

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Posted to Co-Cure Mon, 4 Oct 1999 20:47:48 -0400

Prevalence of chronic fatigue syndrome and chemical sensitivities in Gulf Registry Veterans

Prevalence of chronic fatigue [syndrome] and chemical sensitivities in Gulf Registry Veterans.
Authors: Kipen HM, Hallman W, Kang H, Fiedler N, Natelson BH
New Jersey Center for Environmental Hazards Research, East Orange, USA.
Jouranl: Archives of Environmental Health 1999 Sep-Oct;54(5):313-8
NLM citations: PMID: 10501146, UI: 99429254

The authors used a questionnaire study to analyze the symptoms of a random sampling from the 68000 veterans of the Gulf War have become members of the U.S Veterans Affairs' Gulf War Registry. Included were questions regarding symptoms of chronic fatigue syndrome (CFS) and multiple chemical sensitivities (MCS). 15.7% of registry veterans qualified for CFS (using the 1994 CDC definition); 13.1% qualified for MCS in accordance with a "widely used definition", and 3.3% of the respondents had both conditions. The authors suggest that CFS and MCS "may characterize an appreciable portion of the complaints of those who volunteered for the Veterans Affairs' Gulf War Registry".

The abstract may be viewed at:
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=10501146&form=6&db=m&Dopt=b

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Posted to Co-Cure Thu, 30 Sep 1999 11:21:08 -0400

Changes in Platelet Alpha-2-Adrenoceptors in Fibromyalgia: Effects of Treatment with Antidepressants

Changes in Platelet Alpha-2-Adrenoceptors in Fibromyalgia: Effects of Treatment with Antidepressants.
Authors: Maes M, Libbrecht I, Delmeire L, Lin A, De Clerck L, Scharpe S, Janca A
Clinical Research Center for Mental Health, Antwerp, Belgium.
Journal: Neuropsychobiology 1999 Sep;40(3):129-133
NLM citation: PMID: 10494047

The authors studied platelet alpha(2)-adrenergic receptor (alpha(2)-AR) binding sites in fibromyalgia before and after treatment with sertraline [Zoloft] or placebo. While the sertraline had no significant effects on the measurements used in the study, the authors did find that fibromyalgia, particularly in an early phase of illness, is accompanied by lowered affinity of platelet alpha(2)-ARs.

The abstract may be read at:
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=10494047&form=6&db=m&Dopt=b

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Posted to Co-Cure Fri, 24 Sep 1999 19:48:32 -0400

Periodic breathing during sleep in patients with fibromyalgia syndrome

Periodic breathing during sleep in patients affected by fibromyalgia syndrome.
Authors: Sergi M, Rizzi M, Braghiroli A, Puttini PS, Greco M, Cazzola M, Andreoli A
Servizio di Fisiopatologia Respiratoria, Azienda Ospedaliera--Polo Universitario L. Sacco, Milano, Italy.
Journal: European Respiratory Journal 1999 Jul;14(1):203-8
PMID: 10489852, UI: 99418384

[Note: "Periodic breathing" is a cycle of breathing in which one type of inhalation/exhalation is repeated several times, then a totally different type (or possibly a pause in breathing) is repeated several times, and then the two step process is repeated. It is common and normal in newborn infants and is a symptom of high-altitude sickness.]

In this study, the authors studied the sleep patterns of 17 patients with FMS and 17 matched healthy controls, using polysomnography, a sleep questionnaire and lung function tests. They found numerous differences between the groups and concluded that periodic breathing is linked to a reduction of transfer factor of the lung for carbon monoxide and could play a major role in the symptoms of poor sleep of fibromyalgia patients.

For more detail, see:
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=10489852&form=6&db=m&Dopt=b

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Posted to Co-Cure Sat, 18 Sep 1999 18:12:53 -0400

Natural history of severe chronic fatigue syndrome

Natural history of severe chronic fatigue syndrome
Authors: Hill NF, Tiersky LA, Scavalla VR, Lavietes M, Natelson BH
Chronic Fatigue Syndrome Center, Department of Neurosciences, University of Medicine and Dentistry-New Jersey Medical School, Newark, New Jersey, USA.
Journal: Archives of Physical Medicine and Rehabilitation 1999 Sep;80(9):1090-4
NLM citations: PMID: 10489014, UI: 99417139

The authors evaluated 23 patients with severe CFS (1988 CDC definition) who, at the beginning of the study, had been ill less than 4.5 years. They were evaluated three times over the next 4 years. The study showed that prognosis for recovery was extremely poor for the severely ill subset of CFS patients. The majority showed no symptom improvement and only 4% [1 patient] recovered during the study. Illness severity between evaluations 2 and 3 remained stable.

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Posted to Co-Cure Sat, 18 Sep 1999 18:40:11 -0400

Growth hormone (GH)-releasing hormone-GH-insulin-like growth factor-1 axis in FM

The growth hormone (GH)-releasing hormone-GH-insulin-like growth factor-1 axis in patients with fibromyalgia syndrome.
Authors: Leal-Cerro A, Povedano J, Astorga R, Gonzalez M, Silva H, Garcia-Pesquera F, Casanueva FF, Dieguez C
Department of Endocrinology, Hospital Universitario Virgen del Rocio, Sevilla, Spain.
Journal of Clinical Endocrinology and Metabolism 1999 Sep;84(9):3378-81
NLM citations: PMID: 10487713, UI: 99415654

The authors studied dysregulation of the GH-IGF-1 axis in patients with fibromyalgia. Study results suggest the existence of an alteration at the hypothalamic level in the neuroendocrine control of GH in these patients, as well as the possibility of therapeutic (treatment) potential of human growth hormone in patients with FM.

The abstract may be read at
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=10487713&form=6&db=m&Dopt=b

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Posted to Co-Cure Thu, 16 Sep 1999 16:15:18 -0400

Two articles on fibromyalgia from the Journal of Interferon and Cytokine Research

Both articles are from the Journal of Interferon and Cytokine Research, 1999 Aug;19(8). It is not clear if the two studies were done on the same group of patients. The journal's website is http://www.liebertpub.com/jir/default.htm


pages 961-968
Reduction of morning stiffness and improvement in physical function in fibromyalgia syndrome patients treated sublingually with low doses of human interferon-alpha.
Authors: Russell IJ, Michalek JE, Kang YK, Richards AB
Department of Medicine and The University Clinical Research Center, The University of Texas Health Science Center, San Antonio 78284-7868, USA. russell@uthscsa.edu
NLM citations: PMID: 10476944, UI: 99404594

The authors studied the effects of daily treatment with sublingual [under the tongue] placebo or interferon-alpha [IFN-alpha] at 15, 50, or 150 international units [IU]. The study showed no improvement of the tender point index with any IFN-alpha dose. However, significant improvement was seen in morning stiffness and in physical function with the 50 IU IFN-alpha dosage.

The full abstract may be read at:
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=10476944&form=6&db=m&Dopt=b


Pages 969-978
Lymphocyte markers and natural killer cell activity in fibromyalgia syndrome: effects of low-dose, sublingual use of human interferon-alpha.
Authors: Russell IJ, Vipraio GA, Michalek JE, Craig FE, Kang YK, Richards AB
Department of Medicine, University Clinical Research Center, The University of Texas Health Science Center, San Antonio 78284-7868, USA. russell@uthscsa.edu
NLM citations: PMID: 10476945, UI: 99404595

The authors studied the effects of daily treatment with sublingual [under the tongue] placebo or interferon-alpha [IFN-alpha] at 15, 50, or 150 international units [IU] upon the peripheral blood mononuclear leukocyte (PBML) subpopulations and natural killer activity patients with fibromyalgia syndrome (FMS) at baseline after 6 weeks. When the study began, FMS patients exhibited fewer lymphocytes and more CD25+ T lymphocytes than did normal controls. By week 6, the main significant and consistent change was a decrease in the HLA-DR+ CD4+ subpopulation [HLA=human leukocyte antigen] in the 15 IU and 150 IU treatment groups. The authors state that these data do not support an immunologically dysfunctional PBML phenotype among patients with FMS as has been observed in chronic fatigue syndrome.

The full abstract may be read at:
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=10476945&form=6&db=m&Dopt=b

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Posted to Co-Cure Sat, 11 Sep 1999 17:38:01 +0200 by Mette Marie Andersen, M.D.

Functional Somatic Syndrome - One or Many?

"Functional Somatic Syndrome - One or Many?" by Simon Wessely et al.

Wessely and Co. has moved from dualistic thinking (these syndromes are AIYH) to no mans land; he writes "...there is empirical evidence of a link between functional somatic syndromes and altered functioning of the central nervous system,...."

Interesting it should appear while the Brussels Conference is ongoing.

The article is now linked to my page (85 kb). Go to :
http://www.cfs.inform.dk/Somatisering/somatizing.lancet.html

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Posted to Co-Cure Tue, 7 Sep 1999 17:32:37 -0400

Function of the hypothalamic adrenal axis in patients with FM undergoing mud-pack treatment

Function of the hypothalamic adrenal axis in patients with Fibromyalgia syndrome undergoing mud-pack treatment.
Authors: Bellometti S, Galzigna L. Thermal Research Center P. d'Abano, Padua, Italy.
Journal: International Journal of Clinical Pharmacology Research 1999;19(1):27-33
NLM citations: PMID: 10450540, UI: 99379034

The authors suggest that mud packs together with antidepressant treatment are able to influence the HPA axis, stimulating increased levels of adrenocorticotropic hormone, cortisol and beta-endorphin levels in blood; and that the two treatments work together by "helping the physiological responses to achieve homeostasis and to rebalance the stress response system."

The abstract may be read at:
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=10450540&form=6&db=m&Dopt=b

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Posted to Co-Cure Mon, 6 Sep 1999 22:45:48 -0400

Two articles on pediatric fibromyalgia and chronic fatigue syndrome

Both articles are from the Journal of Developmental and Behavioral Pediatrics, August 1999; 20:4 (The journal's web page is http://www.wwilkins.com/esources/journdex/DBP)

pages 211-215
Pediatric fibromyalgia and dizziness: evaluation of vestibular function.
Authors Rusy LM, Harvey SA, Beste DJ
Medical College of Wisconsin Anesthesia Department, Children's Hospital of Wisconsin, Milwaukee 53201, USA.
NLM citations: PMID: 10475594, UI: 99402579

A study of 12 children with FM and chronic dizziness were evaluated for irregulatities in various types of central (brainstem) and inner ear mechanisms.

The abstract may be read at:
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=10475594&form=6&db=m&Dopt=b


pages 278-288
Review of juvenile primary fibromyalgia and chronic fatigue syndrome.
Authors: Breau LM, McGrath PJ, Ju LH
Department of Psychology, Dalhousie University, Halifax, Canada.
NLM citations: PMID: 10475602, UI: 99402587

Reviews the current literature and concludes that "fibromyalgia and chronic fatigue syndrome may be related in children and may not be duplicates of the adult disorders; that psychological and psychosocial factors are unlikely contributors to the etiology of these disorders; and that the evidence is increasingly pointing to a role for genetic factors in their etiology."

The abstract may be read at:
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=10475602&form=6&db=m&Dopt=b

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Posted to Co-Cure Tue, 31 Aug 1999 10:23:32 -0400 by Linda Clement

Oral ifn-a in Journal of Interferon and Cytokine Research

The August 1999 issue of the Journal of Interferon and Cytokine Research is a "special topics issue" devoted to oral interferon.

Included are several reviews of the literature and articles on mechanism of action, a number of animal studies, and seven human trials of oral interferon.

Two of the articles concern the fibromyalgia studies conducted by Dr. I. Jon Russell at the University of Texas, San Antonio, using the oral alpha interferon lozenges made by Amarillo Biosciences. It should be noted that these studies were completed prior to the Sjogren's syndrome study and others published in this issue which made it clear that the upregulation of the interferon pathway only lasts for 9 hours, and that these two fibromyalgia studies only used once-per-day dosages. Currently a second double-blind study is being conducted which compares different dosage levels and frequencies. This study is being conducted at four different sites by Dr. Russell, Dr. Robert Bennett at Oregon Health Sciences University, Dr. Stuart Kassan at Colorado Arthritis Associates in Denver, and Dr. Robert Katz at Rush-Presbyterian-St. Luke's in Chicago.

Six of the 21 articles in this issue were co-authored by persons connected in some way with Amarillo Biosciences. The other 15 articles are by independent researchers at various universities around the world.

The oral alpha interferon lozenges used in the fibromyalgia studies and the Sjogren's study are currently available by prescription. A diluted liquid form, derived from Interferon Sciences' Alferon-N, is also available in pre-measured doses at some pharmacies. All the CFIDS patients I know who are experiencing significant improvement in health due to oral interferon are taking three or four doses per day, although the optimum dosage level seems to vary a great deal from person to person. I take 225 IU four times per day, but another PWC I know who has experienced an equally dramatic improvement only takes 30 IU three times per day.

The Journal of Interferon and Cytokine Research is available online at http://www.liebertonline.com. I think there may be a charge for an online subscription, though. You can also contact the publisher, Mary Ann Liebert, Inc., by phone at (914) 834-3100, by fax at (914) 834-3688, or by email at info@liebertpub.com.

Linda Clement

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Note: All abstract summaries, unless otherwise noted, were prepared by Margaret Bailey.

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