Idiopathic chronic fatigue: Difference between revisions

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===Differential diagnosis ===
===Differential diagnosis ===
====Differences from chronic fatigue ====
====Differences from chronic fatigue ====
ICF differs from chronic fatigue since it is unexplained rather than linked to a medical or psychological illness (for example, diabetes or depression). This means that ICF patients have reduced treatment options: there is no underlying disease or known cause that could be treated in order to reduce the degree of fatigue, which results in a worse prognosis for ICF.<ref name="fukuda1994"/>
ICF differs from chronic fatigue since it is unexplained rather than linked to a medical or psychological illness (for example, diabetes or depression).<ref name="fukuda1994" /> This means that ICF patients have reduced treatment options: there is no underlying disease or known cause that could be treated in order to reduce the degree of fatigue, which results in a poorer prognosis for ICF.<ref name="Valiani2010" />


In ICF, the fatigue lasts for a minimum of six months, but chronic fatigue is ''usually'' (but not always) considered to last for a minimum of six months to be considered chronic, and if lasting between one and six months it is considered prolonged fatigue.
In ICF, the fatigue lasts for a minimum of six months, but chronic fatigue is ''usually'' (but not always) considered to last for a minimum of six months to be considered chronic, and if lasting between one and six months it is considered prolonged fatigue.
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* ICF is categorized within general signs and symptoms by the [[World Health Organization]],<ref name="ICD-11"/> while CFS is categorized as a neurological disease<ref name="ICD11-CFS">[https://icd.who.int/browse11/l-m/en#/http://id.who.int/icd/entity/569175314 8EF9 - Postviral syndrome,Chronic fatigue syndrome, Myalgic Encephalomyelitis] ICD-11. WHO. 2023-01.</ref>
* ICF is categorized within general signs and symptoms by the [[World Health Organization]],<ref name="ICD-11"/> while CFS is categorized as a neurological disease<ref name="ICD11-CFS">[https://icd.who.int/browse11/l-m/en#/http://id.who.int/icd/entity/569175314 8EF9 - Postviral syndrome,Chronic fatigue syndrome, Myalgic Encephalomyelitis] ICD-11. WHO. 2023-01.</ref>


Ability to tolerate exertion including exercise has been shown to be greater in ICF patients compared to CFS patients, particularly on consecutive days, and this applies to both men and women.<ref name="Vermeulen2014">https://translational-medicine.biomedcentral.com/articles/10.1186/1479-5876-12-20</ref><ref name="VanC-females2021">https://www.mdpi.com/2227-9032/9/6/682</ref><ref name="VanC-males2021">https://www.mdpi.com/2227-9032/9/6/683</ref>
Ability to tolerate exertion including exercise has been shown to be greater in ICF patients compared to CFS patients, particularly on consecutive days, and this applies to both men and women.<ref name="Vermeulen2014">{{Cite journal |last=Vermeulen |first=Ruud CW |last2=van Vermeulen Eck |first2=Ineke WG |date=2014-01-23 |title=Decreased oxygen extraction during cardiopulmonary exercise test in patients with chronic fatigue syndrome |url=https://doi.org/10.1186/1479-5876-12-20 |journal=Journal of Translational Medicine |volume=12 |issue=1 |pages=20 |doi=10.1186/1479-5876-12-20 |issn=1479-5876 |pmc=PMC3903040 |pmid=24456560}}</ref><ref name="VanC-females2021">{{Cite journal |last=van Campen |first=C. (Linda) M. C. |last2=Visser |first2=Frans C. |date=June 2021 |title=Female Patients with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome or Idiopathic Chronic Fatigue: Comparison of Responses to a Two-Day Cardiopulmonary Exercise Testing Protocol |url=https://www.mdpi.com/2227-9032/9/6/682 |journal=Healthcare |language=en |volume=9 |issue=6 |pages=682 |doi=10.3390/healthcare9060682 |issn=2227-9032}}</ref><ref name="VanC-males2021">{{Cite journal |last=van Campen |first=C. (Linda) M. C. |last2=Visser |first2=Frans C. |date=June 2021 |title=Comparing Idiopathic Chronic Fatigue and Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) in Males: Response to Two-Day Cardiopulmonary Exercise Testing Protocol |url=https://www.mdpi.com/2227-9032/9/6/683 |journal=Healthcare |language=en |volume=9 |issue=6 |pages=683 |doi=10.3390/healthcare9060683 |issn=2227-9032}}</ref>


Severity of illness in ICF is typically less than in CFS, with some relatively small studies finding no severe ICF patients, the same studies found [[fibromyalgia]] was significantly less common in ICF.<ref name="VanC-females2021"/><ref name="VanC-males2021"/>
Severity of illness in ICF is typically less than in CFS, with some relatively small studies finding no severe ICF patients, the same studies found [[fibromyalgia]] was significantly less common in ICF.<ref name="VanC-females2021"/><ref name="VanC-males2021"/>

Revision as of 20:35, 25 April 2023

This page does not refer to fatigue caused by any discrete medical condition (for example, chronic fatigue syndrome)
Idiopathic Chronic Fatigue
Other namesChronic Idiopathic Fatigue (CIF), unexplained chronic fatigue
SpecialtyFamily medicine, Internal medicine, Musculoskeletal
SymptomsChronic fatigue
Usual onsetAcquired (not lifelong)[1]
DurationAt least six consecutive months
CausesUnknown
Diagnostic methodBased on symptoms. Diagnosis of exclusion requiring laboratory evaluation, physical and biopsychosocial assessment.[1]
Differential diagnosisOccupational burnout; chronic fatigue due to a known medical condition such as chronic fatigue syndrome, overtraining
TreatmentSymptomatic
Frequency6.2 to 64.2 per 1000[2]

Idiopathic chronic fatigue (ICF), is characterized by unexplained fatigue that lasts at least six consecutive months.[1] which does not meet the criteria for chronic fatigue syndrome. It is widely understood to have a profound effect on the lives of patients who experience it.[1][3]

ICF is a common illness of unknown origin,[4] and remains poorly understood.

Classification

Idiopathic chronic fatigue is classified as a physical medical condition of unknown origin by the World Health Organization.[4][5]

Diagnosis

ICF is fatigue of unknown origin, persisting or relapsing for a minimum of six consecutive months, and failing to meet the criteria for chronic fatigue syndrome.[6] There are no agreed upon international criteria for idiopathic chronic fatigue, however the CDC's 1994 Idiopathic Chronic Fatigue criteria, known as the Fukuda ICF criteria, are commonly used.[1][3]

Differential diagnosis

Differences from chronic fatigue

ICF differs from chronic fatigue since it is unexplained rather than linked to a medical or psychological illness (for example, diabetes or depression).[6] This means that ICF patients have reduced treatment options: there is no underlying disease or known cause that could be treated in order to reduce the degree of fatigue, which results in a poorer prognosis for ICF.[7]

In ICF, the fatigue lasts for a minimum of six months, but chronic fatigue is usually (but not always) considered to last for a minimum of six months to be considered chronic, and if lasting between one and six months it is considered prolonged fatigue.

Chronic fatigue is the term used when medical tests and a mental and physical assessment has not yet been carried out. ICF can only be diagnosed after these are done and the results show no underlying untreated cause.[6]

Differences from neurasthenia

  • ICF has no known cause, and psychological factors such as stress have been ruled out, but neurasthenia was believed to be caused by the stresses of the modern age and psychological or psychosocial factors were seen as important[8]
  • Neurasthenia is very rarely reported since the 21st century, and was deprecated in the World Health Organization's most recent International Classification of Diseases, known as the ICD-11.[5] Neurasthenia had previously been categorized as a psychological illness, but ICF is mot.[9]
  • ICF consists of the single symptom of fatigue, which may be either mental or physical or both, and may be described in many different ways including as "exhaustion".

Differential diagnosis from chronic fatigue syndrome

  • Chronic fatigue syndrome (CFS) requires the additional symptoms of:
  1. post-exertional malaise (significantly worsening symptoms with activity which results in a significant reduction in daily activities, which may ME delayed by up to 3 days
  2. sleep dysfunction
  3. either:
A range of other symptoms commonly result from CFS including headaches, muscle and joint pain and low-grade fever[10]
  • ICF requires:
  1. only one symptom: chronic fatigue
  2. does not need a significant reduction in activities: some people are able to push through the fatigue to continue activities
  3. is only diagnosed if CFS symptoms are not met[6]
  • Prevalence of ICF is between 3-15%, which is two to ten times higher than CFS[7]
  • Older age at onset is more common in ICF, particularly from age 50,[7] while in CFS age at onset is typically 16-35 years old[10]
  • The recovery rate within a year is significantly higher for ICF patients, 30-50% compared to under 10% in CFS[7][10]
  • ICF is categorized within general signs and symptoms by the World Health Organization,[5] while CFS is categorized as a neurological disease[11]

Ability to tolerate exertion including exercise has been shown to be greater in ICF patients compared to CFS patients, particularly on consecutive days, and this applies to both men and women.[12][13][14]

Severity of illness in ICF is typically less than in CFS, with some relatively small studies finding no severe ICF patients, the same studies found fibromyalgia was significantly less common in ICF.[13][14]

Signs and symptoms

  • Clinically evaluated fatigue
  • New or definite onset (not lifelong)
  • Fatigue persists or is relapsing for six consecutive months or longer
  • Fails to meet the criteria for chronic fatigue syndrome
  • The cause is unknown (not resulting from another medical condition)[1][6][3]

Exclusions

Common medical causes of fatigue

These must be ruled out before a diagnosis of ICF can be made.

  • Infectious diseases including viruses and TB
  • chronic fatigue syndrome
  • Vascular diseases (affecting heart and circulation)
  • Toxins and drug effects including poisons and substance use (addiction)
  • Diseases affecting the lungs, including chronic obstructive pulmonary disease (COPD)
  • Endocrine and metabolic problems, e.g., thyroid diseases and diabetes
  • Diseases involving benign or cancerous tumours, including cancer fatigue
  • Anaemia, Lupus and certain autoimmune or neurological diseases
  • dementia (any form)
  • severe obesity (a body mass index greater than 45)[1]

Management

Idiopathic chronic fatigue is typically managed in general medicine rather than by referral to a specialist. There is no cure, no approved drug, and treatment options are limited.[15] Management may involve a form of counseling, or antidepressant medication, although some patients may prefer herbal or alternative remedies.[1]

Counseling

A form of counseling known as cognitive behavioral therapy may help some people manage or cope with idiopathic chronic fatigue.[1]

Medication

There are no approved drugs for ICF.[15]

Anti-depressants

Antidepressants drugs such as tricyclic antidepressants (TCAs) or selective serotonin reuptake inhibitors (SSRIs) may be appropriate.[1]

Alternative and complementary treatments

Only limited trials had been conducted for alternative and complementary treatments; there is no clear evidence of these treatments being effective for ICF due to a lack of randomized controlled trials.[15]

Prognosis

Between 30% and just under 50% of patients recover within one year.[1][16]

Epidemiology

Fatigue is common in the general population and often caused by overwork, too much activity or a specific illness or disease. Around 20% of patients who visit their clinician report fatigue.[1] Prolonged fatigue is fatigue that persists for more than a month, and chronic fatigue is fatigue that lasts at least six consecutive months, which may be caused by a physical or psychological illness, or may be idiopathic (no known cause).[1] Chronic fatigue with a known cause is twice as common as idiopathic chronic fatigue.[6]

Idiopathic chronic fatigue affects between 2.4% and 6.42% of patients,[17] with females more likely to be affected than men.[1] Age at onset is typically over 50 years of age.[7] A significant number of patients present with idiopathic chronic fatigue as part of a mix of medically unexplained symptoms, while others present with a primary problem of fatigue alone.[1]

See also

References

  1. ^ a b c d e f g h i j k l m n o p Saultz, J (2002-09-23). "Care of the Patient with Fatigue". In Taylor, Robert (ed.). Family Medicine: Principles and Practice. Springer Science & Business Media. pp. 465–469. ISBN 978-0-387-95400-4.
  2. ^ Kim, Tae-Hun; Kim, Do-Hoon; Kang, Jung Won (2020-04-01). "Medicinal herbs for managing fatigue symptoms in patients with idiopathic chronic fatigue: A PRISMA compliant updated systematic review and meta-analysis of randomized controlled trials based on the GRADE approach". European Journal of Integrative Medicine. 35: 101069. doi:10.1016/j.eujim.2020.101069. ISSN 1876-3820. S2CID 214256657.
  3. ^ a b c d Son, Chang-Gue (2019-06-01). "Differential diagnosis between "chronic fatigue" and "chronic fatigue syndrome"". Integrative Medicine Research. 8 (2): 89–91. doi:10.1016/j.imr.2019.04.005. ISSN 2213-4220. PMC 6522773. PMID 31193269.
  4. ^ a b "ICD-10 Version:2016 | R53". World Health Organization. Retrieved 2020-05-29.
  5. ^ a b c "ICD-11 - Mortality and Morbidity Statistics | MG22 Fatigue". World Health Organization. 2019. Retrieved 2020-05-31.
  6. ^ a b c d e f g h Fukuda, K.; Straus, S. E.; Hickie, I.; Sharpe, M. C.; Dobbins, J. G.; Komaroff, A. (1994-12-15). "The chronic fatigue syndrome: a comprehensive approach to its definition and study. International Chronic Fatigue Syndrome Study Group". Annals of Internal Medicine. 121 (12). American College of Physicians: 954–957. doi:10.7326/0003-4819-121-12-199412150-00009. ISSN 0003-4819. PMID 7978722. S2CID 510735.
  7. ^ a b c d e Valiani, Vincenzo; Corbett, Duane B.; Knaggs, Jeffrey D.; Manini, Todd M. (November 2016). "Metabolic Rate and Perceived Exertion of Walking in Older Adults With Idiopathic Chronic Fatigue". The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences. 71 (11): 1444–1450. doi:10.1093/gerona/glw108. ISSN 1758-535X. PMC 5975719. PMID 27271253.
  8. ^ Cite error: The named reference Connor2022 was invoked but never defined (see the help page).
  9. ^ Cite error: The named reference icd-10 was invoked but never defined (see the help page).
  10. ^ a b c "What is ME/CFS? | Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)". Centers for Disease Control and Prevention. 12 July 2018. Archived from the original on 17 August 2020. Retrieved 21 May 2020.
  11. ^ 8EF9 - Postviral syndrome,Chronic fatigue syndrome, Myalgic Encephalomyelitis ICD-11. WHO. 2023-01.
  12. ^ Vermeulen, Ruud CW; van Vermeulen Eck, Ineke WG (2014-01-23). "Decreased oxygen extraction during cardiopulmonary exercise test in patients with chronic fatigue syndrome". Journal of Translational Medicine. 12 (1): 20. doi:10.1186/1479-5876-12-20. ISSN 1479-5876. PMC 3903040. PMID 24456560.{{cite journal}}: CS1 maint: PMC format (link) CS1 maint: unflagged free DOI (link)
  13. ^ a b van Campen, C. (Linda) M. C.; Visser, Frans C. (June 2021). "Female Patients with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome or Idiopathic Chronic Fatigue: Comparison of Responses to a Two-Day Cardiopulmonary Exercise Testing Protocol". Healthcare. 9 (6): 682. doi:10.3390/healthcare9060682. ISSN 2227-9032.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  14. ^ a b van Campen, C. (Linda) M. C.; Visser, Frans C. (June 2021). "Comparing Idiopathic Chronic Fatigue and Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) in Males: Response to Two-Day Cardiopulmonary Exercise Testing Protocol". Healthcare. 9 (6): 683. doi:10.3390/healthcare9060683. ISSN 2227-9032.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  15. ^ a b c Adams, Denise; Wu, Taixiang; Yang, Xunzhe; Tai, Shusheng; Vohra, Sunita (2009). "Traditional Chinese medicinal herbs for the treatment of idiopathic chronic fatigue and chronic fatigue syndrome". Cochrane Database of Systematic Reviews (4): CD006348. doi:10.1002/14651858.CD006348.pub2. ISSN 1465-1858. PMID 19821361.
  16. ^ Joyce J, Hotopf M, Wessely S. The prognosis of chronic fatigue and chronic fatigue syndrome: a systematic review. Quarterly Journal of Medicine 1997;90:223‐233.
  17. ^ https://doi.org/10.2105%2Fajph.87.9.1449
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