Evidence browser

Autoimmunity's enigmatic role: exploring the connection with myalgic encephalomyelitis/chronic fatigue syndrome.

Batham, Jacob, Dwyer, Jessica, Eaton-Fitch, Natalie et al.·BMC immunology·2024

Researchers reviewed 10 studies to understand whether ME/CFS is caused by autoimmunity—a condition where the immune system attacks the body's own cells. While some signs of autoimmune activity were found in ME/CFS patients, the evidence is mixed and not strong enough to confirm that autoimmunity is the main cause. The authors conclude that ME/CFS is more complex than a straightforward autoimmune disease.

Immune System

Immune SystemNeuroinflammation

Microglia and Sleep Disorders.

Picard, Katherine, Dolhan, Kira, Watters, Jyoti J et al.·Advances in neurobiology·2024

This review examines how microglia—immune cells in the brain and spinal cord—affect sleep and sleep disorders. The authors discuss how sleep problems and lack of sleep can harm brain health and potentially lead to diseases like Alzheimer's and Parkinson's. They specifically look at how microglia may be involved in ME/CFS and other sleep disorders, and what happens to these immune cells when people don't get enough sleep.

E0 ConsensusReviewPEM not requiredReview-Narrative

Autoimmune Autonomic Neuropathy: From Pathogenesis to Diagnosis.

Nakane, Shunya, Koike, Haruki, Hayashi, Tomohiro et al.·International journal of molecular sciences·2024

This review describes autoimmune autonomic ganglionopathy (AAG), a rare condition where the immune system attacks nerve cells that control automatic body functions like heart rate and blood pressure. The authors explain how doctors can diagnose AAG and how it differs from other similar conditions, including ME/CFS and long COVID, which can have overlapping symptoms.

Autonomic Nervous SystemDiagnostics

Identifying microRNAs Possibly Implicated in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome and Fibromyalgia: A Review.

Tsamou, Maria, Kremers, Fabiënne A C, Samaritakis, Keano A et al.·International journal of molecular sciences·2024

This review examined tiny molecules called microRNAs that may play a role in ME/CFS and fibromyalgia. Researchers looked at existing studies to identify which microRNAs appear to be abnormal in these conditions and what role they might play in causing symptoms. They found that certain microRNAs may be involved in immune system problems, energy production difficulties, and increased pain sensitivity—processes that could help explain why people with these diseases experience fatigue, pain, and other symptoms.

BiomarkersImmune System

Brain-regional characteristics and neuroinflammation in ME/CFS patients from neuroimaging: A systematic review and meta-analysis.

Lee, Jin-Seok, Sato, Wakiro, Son, Chang-Gue·Autoimmunity reviews·2024

Researchers combined results from 65 brain imaging studies involving over 1,500 ME/CFS patients to look for signs of inflammation in the brain. They used four different types of brain scans and found that specific brain regions—particularly the insular and thalamic regions that help process emotions and manage body functions—showed reduced activity in ME/CFS patients compared to healthy controls. These findings suggest that problems in how these brain regions communicate may help explain why ME/CFS causes fatigue and other characteristic symptoms.

Neuroinflammation

A review of Patient Reported Outcome Measures (PROMs) for characterizing Long COVID (LC)-merits, gaps, and recommendations.

Ejalonibu, Hammed, Amah, Adelaide, Aburub, Alaa et al.·Journal of patient-reported outcomes·2024

This study reviewed existing questionnaires and measurement tools that patients can use to report their Long COVID symptoms and how the illness affects their daily life. The researchers found that a combination of specific, validated questionnaires—particularly the Post-COVID Functional Status Scale paired with tools measuring fatigue, thinking problems, mood, headaches, sleep, and post-exertional malaise—work best for capturing the full range of Long COVID effects.

Post-Exertional Malaise

Long COVID in pediatrics-epidemiology, diagnosis, and management.

Toepfner, Nicole, Brinkmann, Folke, Augustin, Silvia et al.·European journal of pediatrics·2024

This review looked at what we know about Long COVID in children and teenagers after COVID-19 infection. Most young people recover within a few months, but some experience long-lasting symptoms like fatigue, difficulty with exercise, and anxiety that can last over a year and affect daily life. The review found that a small number of these children meet the criteria for ME/CFS, but currently there are no blood tests or scans to confirm Long COVID, making it difficult to diagnose.

Energy MetabolismImmune System

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: the biology of a neglected disease.

Arron, Hayley E, Marsh, Benjamin D, Kell, Douglas B et al.·Frontiers in immunology·2024

This review examines what we know about ME/CFS by looking at how the disease develops from a combination of genetic factors, infections, and immune problems. The researchers found that ME/CFS appears to result from multiple body systems going wrong at the same time—including the immune system, inflammation, digestive health, and energy production. The study argues that doctors and scientists need to stop looking at ME/CFS as a single problem and instead understand it as a complex condition involving many interconnected issues.

E0 ConsensusReviewPEM not requiredSystematic-Review

Ear abnormalities in chronic fatigue syndrome (CFS), fibromyalgia (FM), Coronavirus-19 infectious disease (COVID) and long-COVID syndrome (PCS), sick-building syndrome (SBS), post-orthostatic tachycardia syndrome (PoTS), and autoimmune/inflammatory syndrome induced by adjuvants (ASIA): A systematic review.

Skare, Thelma L, de Carvalho, Jozélio Freire, de Medeiros, Italo Roberto Torres et al.·Autoimmunity reviews·2024

This review examined hearing and balance problems (including hearing loss, tinnitus, dizziness, and vertigo) reported across multiple conditions including ME/CFS, fibromyalgia, and long COVID. Researchers searched medical literature from 1990 to 2024 and found that while hearing problems are common, balance problems are less frequently reported. The study suggests these symptoms may stem from immune system dysfunction affecting the inner ear.

Immune System

E0 ConsensusReviewPEM requiredSystematic-Review

Qigong and Tai Chi for ME/CFS: A Systematic Review of Randomized Controlled Trials.

Markwart, Michaela, Felsenstein, Donna, Mehta, Darshan H et al.·Global advances in integrative medicine and health·2024

This review looked at studies testing whether Qigong (a gentle Chinese exercise practice) might help people with ME/CFS. Researchers found 5 good-quality studies with a total of 481 people. The results suggest Qigong may help reduce symptom severity and improve both physical and emotional well-being, though more research is needed to be sure. Currently, there are no similar high-quality studies on Tai Chi for ME/CFS.

Post-Exertional Malaise

Physical Activity and Fatigue Symptoms: Neurotypical Adults and People with Chronic Multisymptom Illnesses.

Boruch, Alex, Branchaw, Grace, O'Connor, Patrick J et al.·Current topics in behavioral neurosciences·2024

This review examined how physical activity affects fatigue in people with ME/CFS and similar long-term illnesses, compared to healthy people. In healthy adults, exercise usually makes people feel more energized, but in people with ME/CFS and related conditions, exercise often makes fatigue worse. Short-term exercise programs show small improvements in fatigue for healthy people, but little to no improvement for those with these chronic illnesses.

E0 ConsensusReviewPEM not requiredSystematic-Review

Clinical evidence of the link between gut microbiome and myalgic encephalomyelitis/chronic fatigue syndrome: a retrospective review.

Wang, Jing-Hua, Choi, Yujin, Lee, Jin-Seok et al.·European journal of medical research·2024

Researchers reviewed 11 studies comparing gut bacteria in ME/CFS patients to healthy people. They found that people with ME/CFS have fewer types of bacteria and different bacterial communities in their guts compared to healthy controls. Additionally, ME/CFS patients produce lower levels of certain beneficial bacterial byproducts that are normally important for health.

Gut Microbiome

Evaluation of safety and effectiveness of NAD in different clinical conditions: a systematic review.

Gindri, Izabelle de Mello, Ferrari, Gustavo, Pinto, Luiz Paulo S et al.·American journal of physiology. Endocrinology and metabolism·2024

This review examined whether taking NAD+ or NADH supplements (molecules that help cells produce energy) are safe and helpful for people with different health conditions, including chronic fatigue syndrome. Researchers looked at 10 clinical trials involving 489 people and found that these supplements were generally well-tolerated, with some people reporting improvements in fatigue, quality of life, and sleep. The most common side effects were mild and included muscle pain, headaches, and sleep disturbances, but nothing serious.

Sleep

Postacute Sequelae of SARS-CoV-2 in Children.

Rao, Suchitra, Gross, Rachel S, Mohandas, Sindhu et al.·Pediatrics·2024

Some children who have COVID-19 experience symptoms that last for weeks or months after the initial infection—a condition called long COVID. This review summarizes what we currently know about long COVID in children, including how common it is, what symptoms children experience, and what might cause it. The authors also describe major research efforts being funded to better understand long COVID in young people and find effective treatments.

E0 ConsensusReviewPEM unclear

Blood virome research in myalgic encephalomyelitis/chronic fatigue syndrome: challenges and opportunities.

Obraitis, Dominic, Li, Dawei·Current opinion in virology·2024

This review examines whether viruses trigger myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Scientists have found that some ME/CFS cases may start after viral infections, and blood tests can detect viral genetic material in patients. The review highlights that while viruses are a suspected cause, no single virus has been found in all ME/CFS patients, and researchers need better tools to understand these complex viral patterns.

Long COVID Overlap

E0 ConsensusReviewPEM not requiredSystematic-Review

The use and effectiveness of exercise for managing postural orthostatic tachycardia syndrome in young adults with joint hypermobility and related conditions: A scoping review.

Peebles, Karen C, Jacobs, Charl, Makaroff, Logan et al.·Autonomic neuroscience : basic & clinical·2024

This review looked at 10 studies examining whether exercise helps people with POTS (a condition causing dizziness and fast heart rate when standing) who also have joint hypermobility, chronic fatigue, or fibromyalgia. The research found that 3 months of gradually increasing exercise—starting lying down and progressing to standing—reduced POTS symptoms and improved quality of life. However, very few studies have specifically tested exercise in people with the combination of POTS and joint hypermobility problems.