May - June 1999
Muscle recovery delayed
study in Scotland has demonstrated
that CFIDS patients recover muscle strength more slowly than healthy people do. The study by Dr. Lorna
Paul and colleagues at Glasgow Caledonian University and the University of Glasgow, was published in the
European Journal of Neurology (1999, Vol. 6, No. 1). During a sequence of quadriceps contractions,
CFIDS patients and controls showed similar declines in strength, but during a recovery period and at 24
hours later, CFIDS patients were able to produce markedly less force than their initial efforts, while
controls had recovered their strength. The results indicated that muscle endurance seemed to be normal
in CFIDS patients but recovery from exercise was impaired. The authors wrote that the results could not
be due to deconditioning, as the control subjects were similarly sedentary.
The following two studies were
funded in part by grants from
The CFIDS Association of America.
Orthostatic intolerance a subset
CFIDS who also have orthostatic intolerance (OI) are a clinically identifiable subgroup from those who
have CFIDS without OI. This subgroup would likely benefit from treatments specifically aimed at improving
OI, according to a study by Dr. Ronald Schondorf and colleagues at McGill University in Montreal, Canada.
In the study published in the Feb. 15, 1999, issue of The Journal of the Autonomic Nervous System,
the researchers noted that patients with OI (40% of a group of unselected CFIDS patients) typically were
younger and their onset less sudden than those without OI. Interestingly, the researchers also argued
against deconditioning as a cause of the OI, noting that the degree of OI in these patients correlated
conversely with the duration of illness (in other words, the longer a person had been ill with CFIDS,
the less OI they experienced).
Orthostatic intolerance in CFIDS:
Dr. Ronald Schondorf
of McGill University in Montreal and Dr. Roy Freeman of Beth Israel Deaconess Medical Center in Boston
have taken an extensive look at the overlaps and interrelationship of orthostatic intolerance (OI) and
CFIDS. The article was published in the February 1999 issue of The American Journal of the Medical
Sciences. They examine the definition of both conditions and then explore a variety of questions
about the overlap. They note that the primary symptoms of OI-disabling fatigue, dizziness, difficulty
concentrating-are often seen in CFIDS patients. The article presents a critical review of scores of studies
involving diagnosis, laboratory testing, pathophysiology and treatment of OI in conjunction with CFIDS.
Assessing fluctuating symptoms
procedures that fail to provide information on either the severity of symptoms or the fluctuations in
severity and activity levels over time may prevent health-care professionals from understanding the complexities
of CFS. In the Journal of Clinical Psychology (volume 55, pages 411-424), Leonard Jason, PhD,
and colleagues at DePaul University in Chicago present a pair of CFS case studies "to illustrate the advantages
of using self-reporting rating scales in combination with a device used to measure the frequency and intensity
of activity. The implications of this assessment system, which captures the symptom dynamics and variability
involved in CFS, are discussed in the article, "Chronic Fatigue Syndrome: Assessing Symptoms and Activity
Writing may ease symptoms
CFIDS patients have found
benefits in writing, and a new study suggests those benefits may be more than emotional.
with asthma or rheumatoid arthritis who wrote about the most stressful experiences in their lives experienced
a substantial, clinically observed reduction in physical symptoms, according to a study published in the
April 14, 1999, issue of The Journal of the American Medical Association. The study, by Joshua
M. Smyth, PhD, and colleagues at North Dakota State University in Fargo, involved 112 patients who were
assigned to write about stressful events or emotionally neutral topics. Those who wrote about traumatic
life experiences had significant changes in health after four months, compared to the control group.
gains were beyond those attributable to the standard medical care that all participants were receiving,"
the authors wrote. "It remains unknown whether these health improvements will persist beyond four months
or whether this exercise will prove effective with other diseases."
A growing amount of literature
suggests that addressing patients' psychological needs produces both psychological and physical health
benefits. Expressive writing is one such technique that has been used successfully in several controlled
studies. While the mechanisms underlying these effects have not been established, the authors noted that
participants experienced considerable emotional upset during the writing sessions along with changes in
heart rate and blood pressure. Perhaps, as other studies have suggested, the immune response is affected
by those physiological responses, or memories of past traumas may be altered by the writing process, making
it easier to cope with stress.
In an accompanying editorial, David Spiegel, MD, of Stanford University,
wrote that the study "provided evidence that medical treatment is more effective when standard pharmacological
intervention is combined with the management of emotional distress. Ventilation of negative emotions,
even just to an unknown reader, seems to have helped these patients. It is not simply mind over matter,
but it is clear that mind matters."
Gulf War treatments studied
potential treatments for
Gulf War syndrome are being tested at military and veterans' clinics in studies sponsored by the Defense
Department and the Department of Veterans' Affairs.
An $8 million study of the antibiotic doxycycline
got under way in April at 30 military clinics across the country. As many as 1,000 veterans are expected
to participate. This trial will test the theory developed by Dr. Garth Nicolson, of the Institute for
Molecular Medicine in Huntington Beach, Calif., that tiny organisms called mycoplasmas are responsible
for the illness and that doxycycline is effective against them. An estimated 100,000 of the 700,000 Gulf
War troops report extreme fatigue, joint and muscle pain, concentration and memory problems, rashes, fever,
diarrhea and other symptoms that have become known as Gulf War syndrome. Dr. Nicolson has found mycoplasmas
in CFIDS and fibromyalgia patients, as well as in sick Gulf War veterans, and he believes the organisms
may play a role in a variety of chronic illnesses.
Another $12 million study will test the effectiveness
of exercise and behavior therapy in reducing the symptoms experienced by the Gulf War veterans. This trial
is based in part on the theory that stress plays a key role in causing and perpetuating the symptoms.
Results of the two studies are not expected for more than a year.
Public unaware of Sjgren's syndrome
by Bruskin/Goldring Research shows that three out of four women over 35 years of age experience at least
two symptoms of Sjgren's syndrome, but that fewer than half mention these symptoms to their physicians.
And less than one-fifth of women surveyed have ever heard of Sjgren's syndrome. The autoimmune disorder
mimics a number of other conditions, particularly menopause, Dr. Frederick Vivino of Thomas Jefferson
in Philadelphia said in a release to raise awareness of Sjgren's. Dry mouth and dry eyes are hallmark
symptoms of the illness; the symptoms of chronic fatigue syndrome and rheumatoid arthritis are also frequently
associated with Sjgren's.