Mahroum, Naim, Shoenfeld, Yehuda · Pathophysiology : the official journal of the International Society for Pathophysiology · 2022 · DOI
This article suggests that several chronic conditions—including ME/CFS, fibromyalgia, long COVID, and complex regional pain syndrome—may share a common cause: the immune system mistakenly producing antibodies that attack the autonomic nervous system (the part of your body that controls automatic functions like heart rate and blood pressure). The authors propose calling these conditions "autoimmune autonomic dysfunction syndromes" to highlight this shared mechanism and potentially help doctors diagnose and treat them more effectively.
For ME/CFS patients, this framework offers a potentially unifying explanation for why the disease involves both pain and dysautonomia (abnormal autonomic function), and suggests that autoimmune mechanisms may be central to pathophysiology. Recognition of ME/CFS within a broader autoimmune autonomic dysfunction category could accelerate development of targeted immunological treatments and improve diagnostic approaches across related conditions.
This review does not provide new experimental evidence that autoantibodies against autonomic receptors are present in ME/CFS patients or that they directly cause symptoms. It does not establish causation—only proposes a unifying hypothesis. The paper does not validate diagnostic criteria for this proposed new category or demonstrate that treatment approaches effective for one syndrome would work for others.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
The first block is for the primary paper and is the citation you should use in research work. The atlas-snapshot line only applies if you are specifically referring to this atlas’s reading of the paper on the date shown.
Primary citation
Mahroum, Naim & Shoenfeld, Yehuda (2022). Autoimmune Autonomic Dysfunction Syndromes: Potential Involvement and Pathophysiology Related to Complex Regional Pain Syndrome, Fibromyalgia, Chronic Fatigue Syndrome, Silicone Breast Implant-Related Symptoms and Post-COVID Syndrome.. Pathophysiology : the official journal of the International Society for Pathophysiology. https://doi.org/10.3390/pathophysiology29030033
BibTeX
@article{mecfsatlas-mahroum-2022-autoimmune-autonomic,
author = {Mahroum, Naim and Shoenfeld, Yehuda},
title = {Autoimmune Autonomic Dysfunction Syndromes: Potential Involvement and Pathophysiology Related to Complex Regional Pain Syndrome, Fibromyalgia, Chronic Fatigue Syndrome, Silicone Breast Implant-Related Symptoms and Post-COVID Syndrome.},
journal = {Pathophysiology : the official journal of the International Society for Pathophysiology},
year = {2022},
doi = {10.3390/pathophysiology29030033},
note = {PubMed: 35997389},
url = {https://www.mecfsatlas.com/evidence/mahroum-2022-autoimmune-autonomic},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-26. https://www.mecfsatlas.com/evidence/mahroum-2022-autoimmune-autonomic
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