ME/CFS and Post-COVID syndrome – close relationship

Russian researchers analysed the wide range of symptoms in people with ME/CFS and in those with long COVID, many of  whom met the criteria for ME/CFS. The symptoms fell into the categories of PEM, immune dysfunction and disorder of the nervous system, leading them to agree with “the concept of ME/CFS as a disease with neuroimmune pathogenesis”.

Lab tests also found a reduction in blood circulation in the smallest blood vessels which affect blood pressure and responses to inflammation. In addition anxiety and depressive symptoms were no more common in patients with ME/CFS and healthy individuals.

Conclusions

1. Among patients with symptoms persisting for more than 12 weeks after recovery from acute COVID-19, 100% of individuals met the diagnostic criteria for ME/CFS, which confirms the presence of a close relationship between post-COVID syndrome and ME/CFS.
2. We found a statistically significant positive relationship between fatigue that does not get better with adequate rest and 20 other symptoms of ME/CFS related to the domains of “post-exertional exhaustion” (7 symptoms), “immune dysfunction” (4 symptoms), “sleep disturbances” (4 symptoms), “dysfunction of the autonomic nervous system” (2 symptoms), “neurological sensory/motor disorders” (2 symptoms), and “pain syndromes” (1 symptom). These data not only agree with the concept of ME/CFS as a disease with neuroimmune pathogenesis but also allow us to make assumptions about the approaches to the diagnosis, treatment, and organization of care for patients with ME/CFS. This confirms the validity of the [EUROMENE] treatment approach to ME/CFS… to reduce the severity of fatigue, patients are provided first of all with symptomatic help to normalize sleep and combat pain.
3. There was no correlation between anxiety/depressive symptoms and the severity of fatigue in ME/CFS. This can indirectly show that fatigue in ME/CFS is not a consequence of primary mental disorders.
4. Immune dysfunction was detected in 12/12 patients with ME/CFS (100%) based on the analysis of the results of the laboratory screening immunological evaluation.
5. The prevalence of POTS in patients with ME/CFS, especially with ME/CFS of the post-COVID-19 nature, is high. Still, POTS in this group of patients can be difficult to diagnose due to its delayed occurrence in the active orthostatic test.
6. Changes in microcirculation in ME/CFS (including ME/CFS of the post-COVID-19 nature) identified with the LDF method correspond to the hyperemic form of microcirculation disorders which is generally observed in acute inflammatory response or in case of the systemic vasoconstriction failure. It seems that increased vascular resistance may occur later in the disease course due to the chronic inflammatory process.

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome and Post-COVID Syndrome: A Common Neuroimmune Ground?, by Varvara A Ryabkova, Natalia Y Gavrilova, Tamara V Fedotkina, Leonid P Churilov, Yehuda Shoenfeld in Diagnostics (Basel). 2022 Dec 26;13(1):66 [doi: 10.3390/diagnostics13010066]

Research abstract:

Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a debilitating chronic disease of unknown etiology, sharing a similar clinical presentation with the increasingly recognized post-COVID syndrome.

We performed the first cross-sectional study of ME/CFS in a community population in Russia. Then we described and compared some clinical and pathophysiological characteristics of ME/CFS and post-COVID syndrome as neuroimmune disorders.

Of the cohort of 76 individuals who suggested themselves as suffering from ME/CFS, 56 were diagnosed with ME/CFS by clinicians according to ≥1 of the four most commonly used case definitions.

Of the cohort of 14 individuals with post-COVID-19 syndrome, 14 met the diagnostic criteria for ME/CFS. The severity of anxiety/depressive symptoms did not correlate with the severity of fatigue either in ME/CFS or in post-COVID ME/CFS.

Still, a positive correlation was found between the severity of fatigue and 20 other symptoms of ME/CFS related to the domains of “post-exertional exhaustion”, “immune dysfunction”, “sleep disturbances”, “dysfunction of the autonomic nervous system”, “neurological sensory/motor disorders” and “pain syndromes”.

Immunological abnormalities were identified in 12/12 patients with ME/CFS according to the results of laboratory testing. The prevalence of postural orthostatic tachycardia assessed in the active orthostatic test amounted to 37.5% in ME/CFS and 75.0% in post-COVID ME/CFS (the latter was higher than in healthy controls, p = 0.02). There was a more pronounced increase in heart rate starting from the 6th minute of the test in post-COVID ME/CFS compared with the control group.

Assessment of the functional characteristics of microcirculation by laser doppler flowmetry revealed obvious and very similar changes in ME/CFS and post-COVID ME/CFS compared to the healthy controls. The identified laser doppler flowmetry pattern corresponded to the hyperemic form of microcirculation disorders usually observed in acute inflammatory response or in case of systemic vasoconstriction failure.