Rowe, P C, Barron, D F, Calkins, H et al. · The Journal of pediatrics · 1999 · DOI
This study looked at 12 teenagers who had both ME/CFS and a connective tissue condition called Ehlers-Danlos syndrome (EDS). All of them also experienced problems with blood pressure and heart rate when standing up (orthostatic intolerance). The researchers found that abnormal connective tissue in blood vessels may cause blood to pool in the legs when standing, which could explain why these conditions often occur together.
This study is important because it identifies a potential subgroup of ME/CFS patients who also have EDS and suggests a specific physiological mechanism—abnormal blood vessel function—that could explain symptoms in these individuals. It recommends that doctors evaluating ME/CFS patients routinely screen for connective tissue disorders and orthostatic intolerance, which could lead to better diagnosis and targeted treatment strategies.
This small case series cannot establish how common the combination of ME/CFS, EDS, and orthostatic intolerance actually is in the broader ME/CFS population. It does not prove that EDS causes ME/CFS or orthostatic intolerance, only that these conditions may co-occur in some patients. The study cannot determine whether the proposed mechanism (venous pooling from connective tissue abnormalities) is the actual cause of symptoms.
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
Rowe, P C, Barron, D F, Calkins, H, Maumenee, I H, Tong, P Y, & Geraghty, M T (1999). Orthostatic intolerance and chronic fatigue syndrome associated with Ehlers-Danlos syndrome.. The Journal of pediatrics. https://doi.org/10.1016/s0022-3476(99)70173-3
BibTeX
@article{mecfsatlas-rowe-1999-orthostatic-intolerance,
author = {Rowe, P C and Barron, D F and Calkins, H and Maumenee, I H and Tong, P Y and Geraghty, M T},
title = {Orthostatic intolerance and chronic fatigue syndrome associated with Ehlers-Danlos syndrome.},
journal = {The Journal of pediatrics},
year = {1999},
doi = {10.1016/s0022-3476(99)70173-3},
note = {PubMed: 10518084},
url = {https://www.mecfsatlas.com/evidence/rowe-1999-orthostatic-intolerance},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-30. https://www.mecfsatlas.com/evidence/rowe-1999-orthostatic-intolerance
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