Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: essentials of diagnosis and management (see authors below) in Mayo Proceedings, Aug 25 2021 [doi.org/10.1016/j.mayocp.2021.07.004]
Consensus recommendations – introduction abstract:
Despite myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) affecting millions of people worldwide, many clinicians lack the knowledge to appropriately diagnose or manage ME/CFS.
Unfortunately, clinical guidance has been scarce, obsolete, or potentially harmful. Consequently, up to 91% of patients in the United States remain undiagnosed, and those diagnosed often receive inappropriate treatment.
These problems are of increasing importance because after acute COVID-19, a significant percentage of people remain ill for many months with an illness similar to ME/CFS. In 2015, the US National Academy of Medicine published new evidence-based clinical diagnostic criteria that have been adopted by the US Centers for Disease Control and Prevention. Furthermore, the United States and other governments as well as major health care organizations have recently withdrawn graded exercise and cognitive-behavioral therapy as the treatment of choice for patients with ME/CFS.
Recently, 21 clinicians specializing in ME/CFS convened to discuss best clinical practices for adults affected by ME/CFS. This article summarizes their top recommendations for generalist and specialist health care providers based on recent scientific progress and decades of clinical experience.
There are many steps that clinicians can take to improve the health, function, and quality of life of those with ME/CFS, including those in whom ME/CFS develops after COVID-19. Patients with a lingering illness that follows acute COVID-19 who do not fully meet criteria for ME/CFS may also benefit from these approaches.
Routine Diagnostic Tests Recommended for All Patients
- Complete blood count with differential
- Comprehensive metabolic panel (Chem20 panel)a
- Antinuclear antibody
- C-reactive protein
- Erythrocyte sedimentation rate
- Ferritin
- Rheumatoid factor
- Four-point salivary cortisol (eg, wakening, at noon, 4:00 pm, & bedtime), am cortisol
- Thyroid-stimulating hormone, free thyroxine
- Vitamin B12
- Vitamin D, 25-dihydroxy
- Urinalysis
[Adapted from Testing Recommendations for Suspected ME/CFS,104 with permission of the US ME/CFS Clinician Coalition.
a The Chem20 panel is a set of common laboratory tests ordered by health care professionals in the United States. It consists of 20 tests that provide information on the patient’s chemical balance and metabolism.
For more information, see https://www.ucsfhealth.org/medical-tests/003468]
Excerpt from Management Approach:
- Validate the Patient’s Experience
- Assess Needs and Provide Support
- Teach Pacing
- Treat the Symptoms of ME/CFS
- Treat Comorbidities
- Schedule Regular Follow-up Visits
- Address Questions on Prognosis
Authors – ME/CFS Clinician Coalition:
Lucinda Bateman, MD; Alison C. Bested, MD; Hector F. Bonilla, MD; Bela V. Chheda, MD; Lily Chu, MD, MSHS; Jennifer M. Curtin, MD; Tania T. Dempsey, MD; Mary E. Dimmock, BA; Theresa G. Dowell, DNP, MPT; Donna Felsenstein, MD; David L. Kaufman, MD; Nancy G. Klimas, MD; Anthony L. Komaroff, MD; Charles W. Lapp, MBME, MD; Susan M. Levine, MD; Jose G. Montoya, MD; Benjamin H. Natelson, MD; Daniel L. Peterson, MD; Richard N. Podell, MD, MPH; Irma R. Rey, MD; Ilene S. Ruhoy, MD, PhD; Maria A. Vera-Nunez, MD, MSBI; Brayden P. Yellman, MD
Articles:
US ME/CFS Clinician Coalition: Updated Clinical Guidance for ME/CFS may also help long COVID patients 25 Aug 2021
The updated clinical guidance from the U.S. ME/CFS Clinician Coalition focuses on adults and includes:
- New diagnostic criteria requiring post-exertional malaise and other key features to improve diagnostic accuracy
- Efficient use of interview questions, physical examination findings, and diagnostic testing
- Alternative diagnoses and co-existing conditions to consider
- Pharmacological and nonpharmacological treatments
- A discussion of why previously-recommended treatments-cognitive behavioral therapy and graded exercise therapy-can be harmful and are no longer recommended
Medscape: New Recommendations Address ME/CFS Diagnosis and Management by Miriam Tucker 27 February 2021
