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Prognosis for myalgic encephalomyelitis and chronic fatigue syndrome
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== Predictors of outcome == Several studies have looked at factors that influence the prognosis of ME/CFS, though results have generally been conflicting. === Age === Although some studies have found the age of adult ME/CFS patients to be associated with poorer outcomes (with older people having a worse prognosis), most studies did not find this correlation (see table below). {| class="wikitable" | colspan="2" |<small>Does age impact prognosis?</small> |- |<small>Yes</small> |<small>No</small> |- |<small>Jason et al., 2011.<ref name="Jason2011" /></small> |<small>Bombardier et al., 1995.<ref name="Bombardier1995" /></small> |- |<small>Tiersky et al., 2002.<ref name="Tiersky2002" /></small> |<small>Vercoulen et al., 1996.<ref name="Vercoulen1996" /></small> |- | |<small>Pheley et al., 1999.<ref name="Pheley1999" /></small> |- |<small> </small> |<small>Reyes et al., 1999.<ref name="Reyes1999" /></small> |- |<small> </small> |<small>Ciccone et al., 2010.<ref name=":16" /></small> |} Matthews & [[Anthony Komaroff|Komaroff]] were able to follow-up on 92 ME/CFS patients for a long period of nine years. The authors noted that “physical function tended to improve for many patients over time, despite the fact that they were aging.” This suggests age is not a predictor of poor outcomes in adult ME/CFS patients.<ref name="Matthews2007">{{Cite journal | last = Matthews | first = Rosalind M. | last2 = Komaroff | first2 = Anthony L. | date = Jan 2007 | title = Changes in Functional Status in Chronic Fatigue Syndrome Over a Decade|url=https://www.tandfonline.com/doi/abs/10.1300/J092v14n01_04|journal=Journal of Chronic Fatigue Syndrome|language=en|volume=14|issue=1|pages=33–42|doi=10.1300/j092v14n01_04|issn=1057-3321}}</ref> Kidd et al. segmented ME/CFS patients into two groups: those younger and those older than 55. A comparison showed few meaningful differences. But when limited to those patients who had been sick for a long time, younger patients did have more [[Autonomic nervous system|autonomic]] and [[Immune system|immune]]-related symptoms.<ref>{{Cite journal | last = Kidd | first=Elizabeth | last2 = Brown | first2 = Abigail | last3 = McManimen | first3 = Stephanie | last4 = Jason | first4 = Leonard A. | last5 = Newton | first5 = Julia L. | last6 = Strand | first6 = Elin Bolle | date = 2016-04-22 | title = The Relationship between Age and Illness Duration in Chronic Fatigue Syndrome|url=https://www.ncbi.nlm.nih.gov/pubmed/27110826|journal=Diagnostics (Basel, Switzerland)|volume=6|issue=2|doi=10.3390/diagnostics6020016|issn=2075-4418|pmc=4931411|pmid=27110826}}</ref> === Illness duration === Although many physicians believe that patients would benefit from earlier diagnosis and treatment, evidence for this is currently lacking.<ref>[https://kce.fgov.be/sites/default/files/atoms/files/d20081027358.pdf Stordeur S, Thiry N, Eyssen M. Chronisch Vermoeidheidssyndroom: diagnose, behandeling en zorgorganisatie. Health Services Research (HSR). Brussel: Federaal Kenniscentrum voor de Gezondheidszorg (KCE); 2008. KCE reports 88A (D/2008/10.273/58).]</ref> Studies have generally been inconsistent regarding the duration of illness as a predictor of outcome. (see table below). {| class="wikitable" | colspan="2" |<small>Does duration of illness impact prognosis?</small> |- |<small>Yes</small> |<small>No</small> |- |<small>Vercoulen et al., 1996.<ref name="Vercoulen1996" /></small> |<small>Wilson et al., 1994.<ref name="Wilson1994" /></small> |- |<small>Ray et al., 1997.<ref name="Ray1997" /></small> |<small>Bombardier et al., 1995.<ref name="Bombardier1995" /></small> |- |<small>Reyes et al., 1999.<ref name="Reyes1999" /></small> |<small>Pheley et al., 1999.<ref name="Pheley1999" /></small> |- |<small>Nisenbaum et al., 2003.<ref name="Nisenbaum2003" /></small> |<small>Hill et al., 1999.<ref name="Hill1999" /></small> |- |<small>Nyland et al., 2014.<ref name="Nyland2014" /></small> |<small>Anderson et al., 2004.<ref name="Andersen2004" /></small> |} The CDC information website has been criticized for suggesting early intervention leads to better outcomes. In a detailed critique [[Jaime Seltzer]] from #[[The MEAction Network|MEAction]] wrote: <blockquote>"Anyone who has gone undiagnosed for years or even decades understands that an accurate diagnosis and useful management strategies — such as avoiding overactivity and providing symptomatic relief — can improve quality of life. But there is no evidence that early intervention affects the likelihood of full recovery. When the CDC has been so cautious regarding what it recommends as treatment, this assertion, which is insupportable with current evidence, stands out."<ref name=":0" /></blockquote>[[Fred Friedberg|Friedberg]] et al. compared ME/CFS patients with a median length of illness of 18 years compared to a group of ME/CFS-patients who had been ill for less than three years. Few differences existed between the two groups; although those with long illness duration had more [[Cognitive dysfunction|cognitive difficulties]] (they also reported more sexual problems).<ref name="Friedberg2000">{{Cite journal | last = Friedberg | first = F. | last2 = Dechene | first2 = L. | last3 = McKenzie | first3 = M. J. | last4 = Fontanetta | first4 = R. | date = Jan 2000 | title = Symptom patterns in long-duration chronic fatigue syndrome|url=https://www.ncbi.nlm.nih.gov/pubmed/10750631|journal=Journal of Psychosomatic Research|volume=48|issue=1 | pages = 59–68|issn=0022-3999|pmid=10750631}}</ref> In a study by [Santamarina-Perez et al. (2011), no association was found between illness duration and neuropsychological test results.<ref>{{Cite journal | last = Santamarina-Perez | first = Pilar | last2 = Eiroa-Orosa | first2 = Francisco Jose | last3 = Freniche | first3 = Verónica | last4 = Moreno-Mayos | first4 = Aurea | last5 = Alegre | first5 = José | last6 = Saez | first6 = Naia | last7 = Jacas | first7 = Carlos| date = Jul 2011 | title = Length of illness does not predict cognitive dysfunction in chronic fatigue syndrome|url=https://www.ncbi.nlm.nih.gov/pubmed/21846221|journal=Applied Neuropsychology|volume=18|issue=3|pages=216–222|doi=10.1080/09084282.2011.595448|issn=1532-4826|pmid=21846221}}</ref> [[Mady Hornig|Hornig]] et al. did find a distinct an increase in [[cytokine]] expression in the plasma of ME/CFS patients with illness duration less than three years, an increase that was not present in patients with longer illness duration.<ref>{{Cite journal | last = Hornig | first = Mady | last2 = Montoya | first2 = José G. | last3 = Klimas | first3 = Nancy G. | last4 = Levine | first4 = Susan | last5 = Felsenstein | first5 = Donna | last6 = Bateman | first6 = Lucinda | last7 = Peterson | first7 = Daniel L. | last8 = Gottschalk | first8 = C. Gunnar | last9 = Schultz | first9 = Andrew F. | date = 2015-02-01 | title = Distinct plasma immune signatures in ME/CFS are present early in the course of illness|url=http://advances.sciencemag.org/content/1/1/e1400121|journal=Science Advances|language=en|volume=1|issue=1| pages = e1400121|doi=10.1126/sciadv.1400121|issn=2375-2548}}</ref> === Illness severity === Many studies have found that illness severity at baseline is associated poorer outcomes over time. Disagreement exists however on which measures of illness best predict a worse prognosis. While Pheley et al. (1999)<ref name="Pheley1999" /> found an association with [[fatigue]], Ray et al. (1997)<ref name="Ray1997" /> reported the broader concept of somatic symptoms to be associated with poor outcomes. In a [[Norway|Norwegian]] study that followed ME/CFS patients who got sick after [[mononucleosis]], [[arthralgia|joint pain]] was an important predictor of prognosis.<ref name="Nyland2014" /> {| class="wikitable" | colspan="2" |<small>Does illness severity impact prognosis?</small> |- |<small>Yes</small> |<small>No</small> |- |<small>Ray et al., 1997.<ref name="Ray1997" /> (somatic symptoms)</small> |<small>Anderson et al., 2004.<ref name="Andersen2004" /></small> |- |<small>Pheley et al., 1999.<ref name="Pheley1999" /> (fatigue)</small> | |- |<small>Van der Werf et al., 2002.<ref name=":19" /></small> | |- |<small>Jason et al., 2011.<ref name="Jason2011" /></small> | |- |<small>Nyland et al., 2014.<ref name="Nyland2014" /> (arthralgia)</small> | |- |<small>Ciccone et al., 2010.<ref name=":16" /></small> | |} === Psychiatric comorbidity === Though some studies have reported it, no convincing evidence exists that a comorbid psychiatric diagnosis worsens the prognosis of ME/CFS. One well-controlled study ([[Lana Tiersky|Tiersky]] et al. 2002) even found an inverse relationship; patients with a concurrent psychiatric history showed more improvement over time.<ref name="Tiersky2002" /> The authors attributed this to varied presentations of symptoms in patients meeting the [[Fukuda criteria]], which allows some patients with an underlying psychiatric etiology to be diagnosed with ME/CFS. {| class="wikitable" | colspan="2" |<small>Does a psychiatric diagnosis impact prognosis?</small> |- |<small>Yes</small> |<small>No</small> |- |<small>Bombardier et al.,1995.<ref name="Bombardier1995" /> (Dysthymia)</small> |<small>Vercoulen et al., 1996.<ref name="Vercoulen1996" /></small> |- |<small>Pheley et al., 1999.<ref name="Pheley1999" /></small> |<small>Ray et al., 1997.<ref name="Ray1997" /></small> |- |<small>Nyland et al., 2014. (Depression)<ref name="Nyland2014" /></small> |<small>Hill et al. (1999)<ref name="Hill1999" /></small> |- |<small> </small> |<small>Tiersky et al., 2002.<ref name="Tiersky2002" /> (inverse relationship)</small> |} === Infectious onset === A [[Japan|Japanese]] study indicated that the prognosis of [[postinfectious]] ME/CFS patients is better than in ME/CFS patients without an [[Infection|infectious onset]].<ref>{{Cite journal | last = Masuda | first=Akinori | last2 = Nakayama | first2 = Takashi | last3 = Yamanaka | first3 = Takao | last4 = Koga | first4 = Yasuyuki | last5 = Tei | first5 = Chuwa | date = Oct 2002 | title = The prognosis after multidisciplinary treatment for patients with postinfectious chronic fatigue syndrome and noninfectious chronic fatigue syndrome|url=https://www.ncbi.nlm.nih.gov/pubmed/12442563|journal=Journal of Behavioral Medicine|volume=25|issue=5 | pages = 487–497|issn=0160-7715|pmid=12442563}}</ref> Though the sample size was small, results were in line with other studies. A Norwegian team for example followed up on ME/CFS patients who had developed ME/CFS after infectious mononucleosis. After 6.5 years a large increase in employment status was seen.<ref name="Nyland2014" /> ===Sudden/gradual onset === DeLuca et al. (1997) compared patients with a sudden and gradual onset and found relatively few differences, except that the gradual onset group had more psychiatric comorbidity.<ref name="DeLuca1997">{{Cite journal | last = DeLuca | first=J. | last2 = Johnson | first2 = S.K. | last3 = Ellis | first3 = S.P. | last4 = Natelson | first4 = B.H. | date = Jan 1997 | title = Sudden vs gradual onset of chronic fatigue syndrome differentiates individuals on cognitive and psychiatric measures|url=https://www.ncbi.nlm.nih.gov/pubmed/9201650|journal=Journal of Psychiatric Research|volume=31|issue=1 | pages = 83–90|issn=0022-3956|pmid=9201650}}</ref> Two studies ([[Michele Reyes|Reyes]] et al. 1999<ref name="Reyes1999" />; Hill et al. 1999<ref name="Hill1999" />) found that the type of illness onset was not a significant predictor of prognosis in ME/CFS. === Comorbid fibromyalgia === Ciccone et al. reported that ME/CFS patients with comorbid [[fibromyalgia]] have a worse prognosis than ME/CFS patients without fibromyalgia.<ref name=":16" /> Other studies had already shown that patients with both diseases are more physically impaired than patients who only have ME/CFS.<ref name="Meenus2016">{{Cite journal | last = Meeus | first = Mira | last2 = Ickmans | first2 = Kelly | last3 = Struyf | first3 = Filip | last4 = Kos | first4 = Daphne | last5 = Lambrecht | first5 = Luc | last6 = Willekens | first6 = Barbara | last7 = Cras | first7 = Patrick | last8 = Nijs | first8 = Jo| date = Jan 2016 | title = What is in a name? Comparing diagnostic criteria for chronic fatigue syndrome with or without fibromyalgia|url=https://www.ncbi.nlm.nih.gov/pubmed/25308475|journal=Clinical Rheumatology|volume=35|issue=1|pages=191–203|doi=10.1007/s10067-014-2793-x|issn=1434-9949|pmid=25308475}}</ref><ref name="Ickmans2014">{{Cite journal | last = Ickmans | first = Kelly | last2 = Meeus | first2 = Mira | last3 = De Kooning | first3 = Margot | last4 = Lambrecht | first4 = Luc | last5 = Nijs | first5 = Jo| date = Feb 2014 | title = Recovery of upper limb muscle function in chronic fatigue syndrome with and without fibromyalgia|url=https://www.ncbi.nlm.nih.gov/pubmed/24313704|journal=European Journal of Clinical Investigation|volume=44|issue=2|pages=153–159|doi=10.1111/eci.12201|issn=1365-2362|pmid=24313704}}</ref> === Being diagnosed with CFS === In the community-study in Wichita, Kansas, researchers<ref name="Nisenbaum2003" /> were able to compare the prognosis of ME/CFS patients who were diagnosed versus those than weren't. [[Gijs Bleijenberg]] summarized the results as follows: <blockquote>"Remission was also not associated with the report of being ever diagnosed as CFS. Although the number of CFS diagnosed subjects was very low, it may mean that the diagnosis of CFS cannot be seen as unfavourable for remission. This is contrary the idea of some family doctors who are reluctant to diagnose their patients as having CFS, as they are afraid that this will facilitate an unfavourable course of the condition."<ref name="Bleijenberg2003">{{Cite journal | last = Bleijenberg | first = Gijs| date = 2003-10-06 | title = Chronic fatigue and chronic fatigue syndrome in the general population|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC269992/|journal=Health and Quality of Life Outcomes|volume=1 | pages = 52|doi=10.1186/1477-7525-1-52|issn=1477-7525|pmid=14613570}}</ref></blockquote>Bell et al. (2001) were able to dispel another myth, namely the idea that ME/CFS symptoms persist because of encouragement by sympathetic physicians who might reinforce illness beliefs. In their 13-year follow-up study, the longest to date in ME/CFS, clinical empathy was not a prognostic factor.<ref name=":20" /> ===ME worse prognosis than CFS? === Hamilton et al. (2005) were able to probe the data of 18,000 patients who had been diagnosed by primary care physicians with either CFS, ME, fibromyalgia or [[postviral fatigue syndrome]] (PVFS). To estimate prognosis they looked at the percentage of patients who retained the label of any of these "[[Chronic fatigue|fatiguing illnesses]]" at follow-up. Patients with ME were found to have a worse prognosis than patients with CFS, fibromyalgia or PVFS.<ref>{{Cite journal | last = Hamilton | first = William T. | last2 = Gallagher | first2 = Arlene M. | last3 = Thomas | first3 = Janice M. | last4 = White | first4 = Peter D. | date = Aug 2005 | title = The prognosis of different fatigue diagnostic labels: a longitudinal survey|url=https://www.ncbi.nlm.nih.gov/pubmed/15805126|journal=Family Practice|volume=22|issue=4|pages=383–388|doi=10.1093/fampra/cmi021|issn=0263-2136|pmid=15805126}}</ref> === Sex === Most studies have not found gender to be a significant predictor of prognosis (more references needed).<ref>{{Cite journal | last = Reyes | first = Michele | last2 = Dobbins | first2 = James G. | last3 = Nisenbaum | first3 = Rosane | last4 = Subedar | first4 = Nazerah S. | last5 = Randall | first5 = Bonnie | last6 = Reeves | first6 = William C. | date = Jan 1999 | title = Chronic Fatigue Syndrome Progression and Self-Defined Recovery|url=https://www.tandfonline.com/doi/abs/10.1300/J092v05n01_03|journal=Journal of Chronic Fatigue Syndrome|language=en|volume=5|issue=1|pages=17–27|doi=10.1300/j092v05n01_03|issn=1057-3321}}</ref>{{Citation needed|reason=| date = Jul 27, 2020}} Matthews & Komaroff (2007) did find women to have consistent higher physical function than men.<ref name="Matthews2007" />
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