Abstract

Background

Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is accompanied by activation of immuno-inflammatory pathways, increased bacterial translocation and autoimmune responses to serotonin (5-HT). Inflammation is known to damage 5-HT neurons while bacterial translocation may drive autoimmune responses. This study has been carried out to examine the autoimmune responses to 5-HT in ME/CFS in relation to inflammation and bacterial translocation.

Methods

We examined 5-HT antibodies in 117 patients with ME/CFS (diagnosed according to the centers for disease control and prevention criteria, CDC) as compared with 43 patients suffering from chronic fatigue (CF) but not fulfilling the CDC criteria and 35 normal controls. Plasma interleukin-1 (IL-1), tumor necrosis factor (TNF)α, neopterin and the IgA responses to Gram-negative bacteria were measured. Severity of physio-somatic symptoms was measured using the fibromyalgia and chronic fatigue syndrome rating scale (FF scale).

Results

The incidence of positive autoimmune activity against 5-HT was significantly higher (p<0.001) in ME/CFS (61.5%) than in patients with CF (13.9%) and controls (5.7%). ME/CFS patients with 5-HT autoimmune activity displayed higher TNFα, IL-1 and neopterin and increased IgA responses against LPS of commensal bacteria than those without 5-HT autoimmune activity. Anti-5-HT antibody positivity was significantly associated with increased scores on hyperalgesia, fatigue, neurocognitive and autonomic symptoms, sadness and a flu-like malaise.

Discussion

The results show that, in ME/CFS, increased 5-HT autoimmune activity is associated with activation of immuno-inflammatory pathways and increased bacterial translocation, factors which are known to play a role in the onset of autoimmune reactions. 5-HT autoimmune activity could play a role in the pathophysiology of ME/CFS and the onset of physio-somatic symptoms

In myalgic encephalomyelitis/chronic fatigue syndrome, increased autoimmune activity against 5-HT is associated with immuno-inflammatory pathways and bacterial translocation  Michael Maes et al     Journal of Affective Disorder  May 10 2013

Abstract

Purpose

Prevalence estimates have been based on several case definitions of chronic fatigue syndrome (CFS). The purpose of this work is to provide a rigorous overview of their application in prevalence research.

Methods

A systematic review of primary studies reporting the prevalence of CFS since 1990 was conducted. Studies were summarized according to study design, prevalence estimates, and case definition used to ascertain cases.

Results

Thirty-one studies were retrieved, and eight different case definitions were found. Early estimates of CFS prevalence were based on the 1988 Centers for Disease Control and Prevention, Australian, and Oxford. The 1994 Centers for Disease Control and Prevention, however, has been adopted internationally, as a general standard. Only one study has reported prevalence according to the more recent, Canadian Consensus Criteria. Additional estimates were also found according to definitions by Ho-Yen, the 2005 Centers for Disease Control and Prevention empirical definition, and an epidemiological case definition.

Conclusions

Advances in clinical case definitions during the past 10 years such as the Canadian Consensus Criteria have received little attention in prevalence research. Future assessments of prevalence should consider adopting more recent developments, such as the newly available International Consensus Criteria. This move could improve the surveillance of more specific cases found within CFS.

The adoption of chronic fatigue syndrome/myalgic encephalomyelitis case definitions to assess prevalence: a systematic review. Samantha Johnston et al  Annals of Epidemiology Vol 23, Issue 6 , Pages 371-376, June 2013

The High Court this week is considering 10 claims being brought against the Government’s ‘Bedroom Tax’ that came into force on 1 April this year.

The claims, made by a range of people affected by the Bedroom Tax, are being heard together over three days starting on Wednesday 15 May. Most of the claimants are disabled, or share their home with a disabled person. The changes to the regulations mean they are defined as under-occupying their properties and liable to benefit reductions of between 14 to 25 per cent.

The Equality and Human Rights Commission is also intervening as an independent third party expert to assist the court on discrimination law and human rights. It will submit that the new regulations potentially breach the right of people not to be discriminated against in the enjoyment of their rights (A.14) and their right to a family life (A.8).

It will also advise the court on the UK’s duty to provide reasonable accommodation for people with a disability under international law, particularly the obligations under the United Nations Convention on the Rights of People with Disabilities (UNCRPD). This requires the government to take steps to abolish or modify laws that discriminate against disabled people.

The Commission will also assist the court to determine whether the Department for Work and Pensions has met the Public Sector Equality Duty. An Equality Impact Assessment carried out by the Department found overall 420,000 disabled tenants were likely to be affected losing around £14 a week. However, the assessment did not calculate how many of those affected need a second bedroom due to their disability or a family member’s.

We are Spartacus report on bedroom tax hearing

Commission intervenes in judicial review of new housing benefit regulations

An ITV news report on 13th May 2013 highlighted the problems faced by people with ME in finding health and social care in Wales:

People with the condition ME in Wales say they suffer from an absence of specialist care, and have found a lack of sympathy and knowledge in the NHS and social services.

Michelle Penny is 28 and from Dinas Powys in the Vale of Glamorgan. She describes how her “day-to-day life is really difficult”, and that she has been “pushed to the back and ignored”.

“We have a growing recognition and a growing investment in conditions such as Alzheimer’s, but conditions such as ME are not so readily recognised or invested in” says Ana Palazon, Chair of the Wales Neurological Alliance. “We want parity and equity of recognition and services for all conditions.”

The Welsh Government says “progress has not been universal across Wales” since it published a care strategy for the treatment of patients with ME in 2011.

The Welsh Government requires Health Boards to put in place measures to ensure prompt diagnosis and treatment for patients with ME. A care pathway was set out in 2011, with the involvement of the Chronic Fatigue Syndrome Task and Finish Group commissioned by the Minister for Health and Social Services in 2010.

Last year, the Welsh Government asked all Health Boards for updates on service developments since the publication of this guidance. The responses received show that there have been some improvements, but that progress has not been universal across Wales.

Therefore the Task and Finish Group will be reconvened this year to consider how services can be further developed to meet the needs of people with CFS and ME in Wales.

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