CHRONIC FATIGUE SYNDROME

Report #7270

An article in the American Journal of Public Health shows that 10% of visits to a doctor's office are for chronic fatigue (1).

Half of the patients who complain of chronic fatigue are depressed, but the other half appear to have a physical cause that doctors are not able to diagnose (1). After a thorough medical evaluation, one in every 200 patients in a doctors office have chronic fatigue syndrome, that means that doctors do not know why they are tired and these patients spend on the average, $2,274 a year for treatments that do not help them very much (2).

If you are tired most of the time, check with your doctor who can order tests for infections (3,4) such as parvovirus B19 (5), hepatitis B and C, Lyme disease, cytomegalovirus, toxoplasmosis or the helicobacter that causes stomach ulcers;/ autoimmune diseases, such as rheumatoid arthritis, lupus, Crohn's disease or ulcerative colitis;/ hidden cancers such as those of the breast or prostate; hormonal diseases such as low thyroid/, nutritional deficiencies such as lack of B12 (16), or side effects from a medication or illicit drug. A diagnosis of chronic fatigue syndrome means that untreated, symptoms will continue for the rest of your life. (9,10,11). I have prescribed doxycycline 100 mg twice a day for several months, and sometimes azithromycin 500 mg twice a week, and some get better. However, this treatment is not accepted by most doctors. Please check with your doctor.

By Gabe Mirkin, M.D., for CBS Radio News

1) S Wessely, T Chalder, S Hirsch, P Wallace, D Wright. The prevalence and morbidity of chronic fatigue and chronic fatigue syndrome: A prospective primary care study. American Journal of Public Health 87: 9 (SEP 1997):1449-1455.

2) F Wolfe, J Anderson, D Harkness, RM Bennett, XJ Caro, DL Goldenberg, IJ Russell, MB Yunus. A prospective, longitudinal, multicenter study of service utilization and costs in fibromyalgia. Arthritis and Rheumatism 40: 9 (SEP 1997):1560-1570.

3) S Wessely. Chronic fatigue syndrome. Journal of the Royal College of Physicians of London. 30: 6 (NOV-DEC 1996):497-504.

4) MA Fitzcharles, JM Esdaile. The overdiagnosis of fibromyalgia syndrome. American Journal of Medicine 103: 1 (JUL 1997):44-50.

5) SK Jacobson, JS Daly, GM Thorne, K Mcintosh. Chronic parvovirus B19 infection resulting in chronic fatigue syndrome: Case history and review. Clinical Infectious Diseases 24: 6 (JUN 1997):1048-1051. Address SK Jacobson, Addenbrookes Hosp, Clin Microbiol & Publ Hlth Lab, Hills Rd, Cambridge CB2 2QQ, England.

6) AC Mawle, R Nisenbaum, JG Dobbins, HE Gary, JA Stewart,M Reyes, L Steele, DS Schmid, WC Reeves. Seroepidemiology of chronic fatigue syndrome: A case-control study. Clinical Infectious Diseases 21: 6 (DEC 1995):1386-1389. None found.

7) D Buchwald. Fibromyalgia and chronic fatigue syndrome: Similarities and differences. Rheumatic Disease Clinics of North America 22: 2:(MAY 1996):219. There are no diagnostic studies or widely accepted pathogenic,explanatory models for either illness.

8) A Sivri, A Cindas, F Dincer, B Sivri. Bowel dysfunction and irritable bowel syndrome in fibromyalgia patients. Clinical Rheumatology 15: 3 (MAY 1996):283-286.

9) JE Gomborone, DA Gorard, PA Dewsnap, GW Libby, MJG Farthing. Prevalence of irritable bowel syndrome in chronic fatigue. Journal of the Royal College of Physicians of London. 30: 6 (NOV-DEC 1996):512-513.

10) RW Simms. Is there muscle pathology in fibromyalgia syndrome? Rheumatic Disease Clinics of North America 22: 2(MAY 1996):245. muscles are not abnormal in the condition.

11) Bombardier CH, Buchwald D. Outcome and prognosis of patients with chronic fatigue vs chronic fatigue syndrome. Arch Intern Med 1995(Oct);155:2105-2110.

12) W Bruckle, J Lautenschlager. Treatment of Fibromyalgia Syndrome. Aktuelle Rheumatologie 20: 1 (JAN 1995):13-19.

13) O Miro, C Font, J Fernandezsola, J Casademont, E Pedrol, JM Grau, A Urbanomarquez. Chronic fatigue syndrome: Clinical and evolutive study of 28 cases. Medicina Clinica 108: 15 (APR 19 1997):561-565.

14) 200/100,000. PH Levine. Epidemiologic advances in chronic fatigue syndrome. Journal of Psychiatric Research 31: 1 (JAN-FEB 1997):7-18.

15) DJ Clauw, M Schmidt, D Radulovic, A Singer, P Katz, J Bresette. The relationship between fibromyalgia and interstitial cystitis. Journal of Psychiatric Research 31: 1 (JAN-FEB 1997):125-131. similar complaints.

16) B. Andersson, M Abrahamsson, L BaJ Dyrehag, L.E.; Gottfries, C.G.","Increased concentrations of homocysteine in the cerebrospinal fluid in patients with fibromyalgia and chronic fatigue syndrome","Scandinavian Journal of Rheumatology. We conclude that increased homocysteine levels in the central nervous system characterize patients fulfilling the criteria for both fibromyalgia and chronic fatigue syndrome." Fibromyalgia is a wastebasket. Some of these people will suffer from mycoplasma, chlamydia or ureaplasma infections and be cured by doxycycline 100 mg every morning and Azithromycin 500 mg at bedtime on Mondays and Thursdays.

Checked 8/9/05; see report #G115.