Sotzny, Franziska, Blanco, Julià, Capelli, Enrica et al. · Autoimmunity reviews · 2018 · DOI
This review examines evidence that ME/CFS may be caused by the immune system attacking the body (autoimmune disease). Researchers found that people with ME/CFS have unusual immune patterns, including abnormal antibodies and changes in immune cells. Importantly, a treatment that removes certain immune cells (rituximab) helped about half of ME/CFS patients in clinical trials, suggesting an autoimmune mechanism in at least some people.
This review consolidates growing evidence that autoimmunity plays a significant role in at least some ME/CFS cases, moving the field beyond purely infectious or behavioral explanations. The clinical response to B-cell depleting therapy provides tangible proof-of-concept that immune-targeted interventions can benefit ME/CFS patients, potentially opening pathways to more effective, mechanism-based treatments.
This review does not establish that autoimmunity causes ME/CFS in all patients—it identifies autoimmune mechanisms in a subset. The review does not prove causation from correlational immunological findings, nor does it explain why only some patients respond to rituximab or identify which patient characteristics predict autoimmune versus other disease mechanisms. Long-term treatment efficacy and optimal patient selection criteria remain unresolved.
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 →
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Primary citation
Sotzny, Franziska, Blanco, Julià, Capelli, Enrica, Castro-Marrero, Jesús, Steiner, Sophie, Murovska, Modra, et al. (2018). Myalgic Encephalomyelitis/Chronic Fatigue Syndrome - Evidence for an autoimmune disease.. Autoimmunity reviews. https://doi.org/10.1016/j.autrev.2018.01.009
BibTeX
@article{mecfsatlas-sotzny-2018-myalgic-encephalomyelitis,
author = {Sotzny, Franziska and Blanco, Julià and Capelli, Enrica and Castro-Marrero, Jesús and Steiner, Sophie and Murovska, Modra and Scheibenbogen, Carmen and European Network on ME/CFS (EUROMENE)},
title = {Myalgic Encephalomyelitis/Chronic Fatigue Syndrome - Evidence for an autoimmune disease.},
journal = {Autoimmunity reviews},
year = {2018},
doi = {10.1016/j.autrev.2018.01.009},
note = {PubMed: 29635081},
url = {https://www.mecfsatlas.com/evidence/sotzny-2018-myalgic-encephalomyelitis},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-26. https://www.mecfsatlas.com/evidence/sotzny-2018-myalgic-encephalomyelitis
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