FM and ME/CFS – important disease entities

In parallel with the activities at the Gottfries Clinic during the last decade, medical society throughout the Western world has been paying increased attention to the vast health problem that is constituted by medically unexplained widespread pain and fatigue. Today, two separate symptom complexes (syndromes), both comprising chronic pain and fatigue, are described by internationally accepted criteria; FM and ME/CFS. These criteria are now established on such a level that the diagnoses can be easily made by any interested general practitioner (GP).

There are significant overlaps in the clinical features of FM and ME/CFS. Hence, the two disorders are often discussed together. ME/CFS is frequently observed in patients with distinct FM symptoms, and the pathophysiological mechanisms of the two disorders may be closely related. FM and ME/CFS share features including:
1. Symptomatology
2. Demographics
3. Disability
4. Poorly understood aetiologies
5. Absence of curative interventions
6. Low likelihood of recovery

Immunological abnormalities are frequently observed in these patients, such as defects in T cell activation, a shift in the Th1/Th2 cytokine balance to a Th2 pattern, and elevated antinuclear antibodies. Findings in agreement with our finding about HSP60.

It has long been suggested that these patients might benefit from immune-modulating therapy. The findings from the Norwegian group, showing therapeutic effect of cell toxic treatment with Rituximab is of very great interest.

FM is a common health problem. Community studies show a prevalence of 2-4% with more than 90% of adult cases occurring in women. For women, the prevalence increase with age from <1% for women aged 18-30 years to almost 8% in women aged 55-65 years. Thereafter, the prevalence declines. FM and ME/CFS frequently lead to occupational disability and low rates of employment, and a substantial part of the patients are on early retirement pension.

In Sweden, FM is the most common cause for early retirement pension in women.

There is no specific laboratory test to support the diagnosis of FM or ME/CFS.

Until today, it is a reality that there has been no significant progress towards an adequate treatment for the patients with FM and ME/CFS. Current treatments for FM and ME/CFS are symptom-based. Psychological, pharmacological and physical treatment procedures provide some relief but no cure.