Patients with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome and Dysautonomia May Have Treatable Underlying Autoimmune Disease

by Lauren Taylor from In The Cloud Copy

Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a complicated and debilitating condition in which affected individuals are unable to perform their daily activities and are often confined to their bed due to overwhelming fatigue. The fatigue is not usually improved with rest and may worsen after any sort of activity. Other symptoms often associated with ME/CFS include difficulty concentrating and thinking, pain, trouble sleeping, and dizziness.

The exact cause of ME/CFS is yet to be identified by scientists, but best theories point toward changes in the immune system, such as low-functioning natural killer cells, chronic production of cytokines, or different markers in T-cell activation. Infections (like Epstein-Barr virus and Ross River virus) may also play a role, and stress or possibly a genetic link may be involved as well. There is no known cure for this condition and treatment is focused on managing symptoms. Affected individuals might also find benefit from counseling, nutritional supplementation, eating a balanced diet, and other therapies, like massage and relaxation therapy.

A Possible Underlying Cause Identified

A recent study presented at the virtual meeting of the International Association for Chronic Fatigue Syndrome/Myalgic Encephalomyelitis found that there may be an underlying autoimmune associated disease that is treatable in patients that also present with dysautonomia, including postural orthostatic tachycardia (POTS).

The study, which included 61 patients with ME/CFS, found evidence that in at least half of the patients’ studies, at least one of their autoantibodies was elevated. Many of the patients also had comorbidities with POTS and/or orthostatic intolerance (OI). Over one third of the studied patients also had a biopsy-confirmed diagnosis of autoimmune-associated small-fiber polyneuropathy (aaSFPN).

An additional 364 medical records were analyzed by researchers of patients with ME/CFS to look for any potential patients who also had aaSFPN. The identification of these patients was done by analyzing physician progress notes that discuss autonomic dysfunction, autoantibody lab testing, and self-reporting of symptoms. Of those 364 records, 61 were identified for further research. Additional autoantibody testing was conducted, including antimuscarinic      cholinergic receptor 4, anti-beta-2 adrenergic, antimuscarinic cholinergic 3, and anti-beta-1 adrenergic. A study recently conducted in Sweden identified these autoantibodies as being linked to ME/CFS.

Researchers point toward IVIG as a potential treatment in these patients. Additional data showed that a patient who exhibited symptoms of ME/CFS and also had neuropathic symptoms was treated with two IVIG infusions, given approximately six months apart. After these infusions, the patient had a drastic decrease in all four of the autoantibodies that were previously discussed, as well as a reduction in reported symptoms. This case has given researchers and providers further reason to consider IVIG as a potential treatment for patients with ME/CFS, who previously had no viable treatment options.

Another recent, albeit smaller, study showed a drastic reduction in the same autoantibody levels with the administration of immunoadsorption, giving clinicians another possible avenue for treatment for ME/CFS patients.

Regardless, researchers and clinicians are pleased with these results. These study results show that there is in fact some sort of biomarker that is abnormal in at least some patients with ME/CFS. While they don’t have the entire answer now, this helps them to hopefully be able to understand the pathophysiology of the disease and could possibly be used in the future to help target therapies and further help those affected by ME/CFS.


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