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Published on: September 9, 2022
Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and fibromyalgia: PR3-versus MPO-ANCA-associated
Charmaine van Eeden1,2, Naima Mohazab1,2, Desiree Redmond1,2
1Division of Rheumatology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.
Background:
Persistent fatigue is a common complaint in ANCA-vasculitis (AAV) patients and has a profound impact on patient's quality of life. The symptoms associated with this fatigue mirror those found in patients with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and fibromyalgia. Etiologic and pathophysiologic differences exist between PR3- and MPO-ANCA disease, yet differences in their fatigue manifestations have not been well researched. We compared fatigue and its associations in healthy controls, AAV patients and fibromyalgia controls.
Methods:
The Canadian consensus criteria were used for ME/CFS diagnosis, and American College of Rheumatology criteria for fibromyalgia diagnosis. Factors such as cognitive failure, depression, anxiety, and sleep disturbances were assessed by patient reported questionnaires. Clinical factors such as BVAS, vasculitis damage index, CRP and BMI were also collected.
Findings:
Our AAV cohort comprised 52 patients, with a mean age of 44.7 (20-79), 57% (30/52) of the patients were female. We found 51.9% (27/52) of patients fulfilled the diagnostic criteria for ME/CFS, with 37% (10/27) of those having comorbid fibromyalgia. Rates of fatigue were higher in MPO-ANCA patients, than in PR3-ANCA patients, and their symptoms were more similar to the fibromyalgia controls. Fatigue in PR3-ANCA patients was related to inflammatory markers. These differences may be due to the varied pathophysiology of the PR3- and MPO-ANCA serotypes.
Interpretation:
A large proportion of AAV patients suffer from debilitating fatigue consequential enough to meet the diagnostic criteria for ME/CFS. Fatigue associations were not the same between PR3- and MPO-ANCA patients, suggesting that the underlying mechanisms may be different. Future studies should consider ANCA serotype, as further research may inform different clinical treatment strategies for AAV patients suffering from ME/CFS.
Funding:
This manuscript was funded by the Dutch Kidney Foundation (17PhD01).
Insights
Many patients with ANCA-vasculitis (AAV) experience fatigue meeting criteria for myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Fatigue differs between PR3- and MPO-ANCA types, suggesting distinct mechanisms and potential for tailored treatments.
Area of Science:
- Rheumatology
- Immunology
- Neurology
Background:
- Persistent fatigue significantly impacts the quality of life for patients with ANCA-associated vasculitis (AAV).
- Fatigue symptoms in AAV patients often resemble those seen in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and fibromyalgia.
- Existing research has not fully explored the differences in fatigue manifestations between PR3-ANCA and MPO-ANCA disease subtypes.
Purpose of the Study:
- To compare fatigue and its associated factors in healthy controls, AAV patients, and fibromyalgia controls.
- To investigate potential differences in fatigue between PR3-ANCA and MPO-ANCA patients.
- To explore the relationship between fatigue and clinical factors in AAV.
Main Methods:
- Utilized Canadian consensus criteria for ME/CFS diagnosis and American College of Rheumatology criteria for fibromyalgia diagnosis.
- Assessed patient-reported outcomes including cognitive failure, depression, anxiety, and sleep disturbances.
- Collected clinical data such as Birmingham Vasculitis Activity Score (BVAS), vasculitis damage index, C-reactive protein (CRP), and body mass index (BMI).
Main Results:
- Over half of the 52 AAV patients met diagnostic criteria for ME/CFS, with a significant portion also having comorbid fibromyalgia.
- MPO-ANCA patients reported higher rates of fatigue with symptoms more akin to fibromyalgia controls compared to PR3-ANCA patients.
- Fatigue in PR3-ANCA patients was correlated with inflammatory markers, suggesting different underlying pathophysiologies.
Conclusions:
- A substantial number of AAV patients experience fatigue severe enough to meet ME/CFS criteria.
- The distinct fatigue associations between PR3-ANCA and MPO-ANCA patients indicate potentially different underlying mechanisms.
- Future research should stratify by ANCA serotype to inform personalized treatment strategies for AAV patients with ME/CFS.
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