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Source: CFS-NEWS Electronic Newsletter CFS is the focus of a special supplement of the American Journal of Medicine (AJM). The supplement contains 19 scientific articles and is intended to be a quick book on the state of the art on CFS. This 124-page supplement is available for purchase, and can also be viewed on the Internet. It has been distributed to 50,000 physicians who subscribe to the AJM. This edition of CFS-NEWS contains a summary of each of the articles presented. AJM is the journal of the Association of Professors of Medicine, which is comprised of the 125 chairs of all the medical schools in North America. The CFS supplement was based on the proceedings of the 1996 conference of the American Association for Chronic Fatigue Syndrome. However, the supplement does not merely contain the 1996 papers as presented at that conference, rather all of the papers have been revised to reflect a scientific understanding of CFS currently as of 1998. In addition, the AJM reviewers requested additional overview articles that would explain to the primary care physician the significance of these reports. The articles by Gudrun Lange, Mark Demitrack, and two by Paul Levine, were especially written for this supplement to summarize specific aspects that the AJM reviewers wanted covered. http://www.cais.net/cfs-news/ajm98.htm Dr. Phil Lee, the former U.S. Assistant Secretary for Health, gives a brief history of CFS and concludes that "The significant advances since 1990 in research related to CFS, as illustrated in this supplement, bode well for the eventual development of effective treatment. For patients who suffer from CFS this cannot come soon enough." ... Researchers from Johns Hopkins University describe their work which shows that many CFS patients have neurally mediated hypotension (NMH), and that treatment of this disorder has helped many of the patients. Tilt table testing in over 600 CFS patients has shown that approximately 77 percent test positive for the condition. ... The researchers comment that various neuroimaging studies usually show contradictory results. In this study, PET scans were applied to 18 CFS patients with psychiatric conditions excluded, 6 depressed patients and 6 healthy controls. Significant differences were found in several parts of the brain. The authors note that their finding of hypometabolism in the brain stem confirms an earlier study by Costa et al. This finding has not been seen in psychiatric conditions and they suggest that it "seems to be a marker for the in vivo diagnosis of CFS." The researchers conclude that their work supports an organic cause for CFS. ... CFS patients were tested for cognitive performance before and after a treadmill exercise and were found to be significantly worse than health controls. The study involved 19 CFS patients and 20 controls. ... Doctors CFS Web Page at http://www.cais.net/cfs-news/doctors.htm
 ... Scientists may have discovered a biomarker for Fibromyalgia, according to a study published in the February '99 Journal of Rheumatology. The study by Russell Wilson et al. shows that Fibromyalgia (FM) patients show a high prevalence of antipolymer antibodies (APA), while autoimmune illnesses that are often confused with FM show a much lower prevalence The study also showed a correlation between APA and the severity of the illness in the Fibromyalgia patients. APA was tested in blood from two sources: patients in trials, and from a blood bank. The trials involved 47 patients with FM, 16 with osteoarthritis and 13 with rheumatoid arthritis. Patients with implants of any kind or with concurrent autoimmune conditions were excluded from this study. Results were positive for 47% of FM patients, compared to 19% for osteoarthritis and 8% for rheumatoid arthritis. ... Russell also told CFS-NEWS that the definition of Fibromyalgia as set by the American College of Rheumatology is written narrowly in order to help scientific studies focus on patients who truly have only Fibromyalgia. That research definition is the basis for prevalence figures for FM that are much lower than the 19 percent indicated in the current study. Russell said that the true prevalence of Fibromyalgia is likely much higher than what may be seen by this strict research definition. Other studies show that chronic pain may be present at a 15-to-20 percent rate in the general population. The current APA assay results are likely reflecting the higher prevalence of Fibromyalgia. Since the lowest test score for a well-defined illness was 3 percent, therefore the APA assay's rate for false positive was likely 3 percent or less, Wilson concluded. Future studies by this research team will make comparisons to healthy controls. ... Autoimmune Technologies can be contacted by phone at 1-504-529-9944 and by fax at 1-504-568-0634. Further information can be seen at their web site at http://www.autoimmune.com A gene that may be linked to Fibromyalgia has been found by researchers at the University of Illinois College of Medicine in Peoria. In their study published in the February '99 Journal of Rheumatology, 85 affected and 21 unaffected members of 41 sibships were studied, drawn from 40 multicase families. The scientists concluded that they had found a possible gene for Fibromyalgia that is linked with the HLA region on human cells. The researchers cautioned that "Our results should be regarded as preliminary and their independent confirmation by other studies is warranted."
... Low-dose hydrocortisone was found to alleviate fatigue and disability more so than placebo and with little or no side effects in a trial of CFS patients, according to research conducted by Anthony Cleare, et al., of London and published in the Lancet of 6 Feb. 1999. Although a previous study at NIH had found hazardous adrenal suppression when hydrocortisone was administered to CFS patients, the current study used dosage levels of 5-10 mgs. whereas the NIH study used 25-35 mgs. The authors nonetheless cautioned against the widespread use of low-dose hydrocortisone as a treatment strategy until after more research has been conducted. http://www.thelancet.com
CFS patients do not show elevated substance P levels in cerebrospinal fluid, demonstrating that CFS is different from Fibromyalgia, according to a study by B. Evengard et al. of Sweden. Previous studies have found abnormally high levels of substance P in the cerebrospinal fluid of Fibromyalgia patients. The authors tested the cerebrospinal fluid of 15 CFS patients and found normal levels of substance P in all of them. Thirteen controls showed normal for all but two subjects. The researchers conclude that CFS and Fibromyalgia are different disorders, despite the similarity of their symptoms. Substance P is a neurochemical involved in pain modulation.
... Increased production of interleukin-6 (IL-6) was observed in CFS patients, but not during, according to a study published in the International Journal of Molecular Medicine. The authors conclude that: "These data suggest a role of IL-6 in natural symptomatology and perhaps in the pathogenesis of CFS. In addition, the data demonstrate that laboratory-induced fatigue (experimental fatigue) may not be a good model to study immunological changes in CFS; immunological parameters should be studied in a longitudinal manner during the natural course of the disease."
... Researchers at Osaka University Medical School tested the hypothesis that endocrine abnormalities could be a partial cause of CFS by checking their patients for serum dehydroepiandrosterone- sulfate (). They found that "the majority of Japanese patients with CFS had a serum DHEA-S deficiency."
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