Inflammatory fatigue and sickness behavior – Lessons for the diagnosis and management of chronic fatigue syndrome – Source: Journal of Affective Disorders, May 11, 2012

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[Ed note: given the brevity of the abstract offered below, co-author Simon Arnett has kindly provided the following outline of key concepts that the full text article explores:

“This review is an attempt to provide an overview of what is known about the changes that occur in CFS, and how these changes might be explained by an inflammatory process. This explanation draws on what is known about a process called ‘cytokine-mediated sickness behavior’.

Sickness behavior is a very well studied cluster of neurological and behavioral changes that occur when the brain is exposed to increased inflammatory mediators, and is similar in many regards to CFS.

“It is therefore argued that CFS may be a syndrome in which the normal processes of sickness behavior malfunction to produce the debilitating lived experience of CFS.

“This review also discusses the search for a blood test for CFS. This discussion focuses on a test for increased oxidation, which has been proposed by several other authors. However, using this blood test could be dangerous, as it cannot distinguish chronic fatigue syndrome from other conditions such as cancer and autoimmune disease, which can cause symptoms very similar to CFS.

“Finally, the review argues that if CFS is the result of a similar process that produces cytokine mediated sickness behavior, then targeting this process with anti-cytokine therapy (using drugs such as etanercept and anakinra) should be effective in improving patient symptoms.”]

Abstract:
Persistent and severe fatigue is a common part of the presentation of a diverse range of disease processes. There is a growing body of evidence indicating a common inflammatory pathophysiology underlying many conditions where fatigue is a primary patient concern, including chronic fatigue syndrome.

This review explores current models of how inflammatory mediators act on the central nervous system to produce fatigue and sickness behavior, and the commonality of these processes in conditions as diverse as surgical trauma, infection, various cancers, inflammatory bowel disease, connective tissue diseases and autoimmune diseases.

We also discuss evidence indicating chronic fatigue syndrome may have important pathophysiological similarities with cytokine mediated sickness behavior, and what lessons can be applied from sickness behavior to chronic fatigue syndrome with regards to the diagnosis and management.

Source: Journal of Affective Disorders, May 11, 2012. Arnett SV, Clark IA. Research School of Biology, Australian National University, Canberra, Australia. [Email: simon.arnett@anu.edu.au]

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