Myalgic Encephalomyelitis / Chronic Fatigue Syndrome

Dr Nina Muirhead | Resource Author

"ME/CFS is one of the most fascinating and important diseases of our time. Scientific understanding of post-viral disease and associated symptoms and syndromes is making great leaps forward, and alongside the NICE guidelines, this is revolutionising how patients should be treated. Post-exertional malaise (PEM), characterised by disease and symptom exacerbation following slightly increased physical, mental, and emotional demand, is a cardinal feature which must be identified and managed with clinical advice on pacing.

Exercise has the potential to cause harm in ME/CFS; clinicians are now becoming increasingly aware of evidence demonstrating that patients have impairment of energy delivery on repeat exercise testing.

Very recent breakthroughs in this field include research based on DecodeME, which is starting to map reproducible genetic risk patterns and shared biology with long COVID. Endocrine meta-analyses show a hyporeactive cortisol system in ME/CFS. Cerebrospinal fluid proteomics and cytokine signatures strengthen the case for immune, vascular, and coagulation involvement, especially in more severe disease and POTS subgroups.

Both ME/CFS and long COVID often do not present with fatigue; patients may complain of a plethora of multisystem symptoms, including non-specific viral symptoms that reduce the ability to work, study or care for others and themselves. Taking a good history is paramount, particularly whilst we await more accurate and readily available clinical biomarkers. Research is revealing a variety of patient-specific biomarkers and genes that may predispose them to developing ME/CFS.

ME/CFS is no longer a diagnosis of exclusion. Patients should be reviewed regularly and new symptoms investigated as they would normally. ME/CFS, long COVID, Lyme disease, endometriosis, fibromyalgia, POTS (postural tachycardia syndrome), MCAS (mast cell activation syndrome), and other autoimmune and connective tissue diseases can often be recognised and diagnosed.

One of the most common mistakes clinicians make is underestimating ME/CFS. Evidence shows there is a huge impact on the quality of life of patients and their family members. Patients have been ignored and stigmatised, and those who are most severely impacted are least able to access the healthcare that they need. This is an evolving area of medicine, so any feedback or updates are welcome. I sincerely thank you for taking the time to learn about ME/CFS."

Dr Nina Muirhead BA(oxon) BMBCh(oxon) MRCS DOHNS MEd PGDipDerm.

Dr Muirhead is also associated with or an alumni of: Oxford University, Open University, Cardiff University, Buckinghamshire Healthcare NHS Trust, the Royal College of Surgeons and the Royal College of Physicians.