Abstract
Post-exertional malaise (PEM), the key feature of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), is characterized by baseline symptom exacerbation after exposure to a stressor, and some patients can experience new or non-typical symptoms. We hypothesized that new or non-typical symptoms occurring long enough before onset of baseline symptom exacerbation could be warning signals predicting PEM. Adult ME/CFS patients who attended the internal medicine department of Angers University Hospital (France) between October 2011 and December 2019 were included in a retrospective medical records review. Patients who experienced one or more new or non-typical symptoms before baseline symptom exacerbation were compared with the rest of the study population for PEM features, epidemiological characteristics, fatigue features, and comorbidities. New or non-typical symptoms preceded baseline symptom exacerbation in 27/197 (13.7%) patients, and the most frequent ones were mood disorders (37%). When compared to the rest of the study population, only PEM intensity was significantly lower in these patients (p = 0.004), even after adjustment for sex and age at disease onset (p = 0.007). New or non-typical symptoms preceding baseline symptom exacerbation in some ME/CFS patients could be warning signals for PEM. Their identification could help preventing PEM occurrences or reducing their intensity leading to improving disease prognosis.
Highlights
Post-exertional malaise (PEM) is the key feature of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and recent criteria require its presence to establish the diagnosis [1,2]
The results of the current study showed that PEM intensity was significantly lower in patients who experienced new or non-typical symptoms before onset of baseline symptom exacerbation compared with the rest of the study population
Taking warning symptoms into consideration could alert patients to the fact that they are going beyond their energy reserves and have to reduce or stop their activity level in order to avert PEM occurrence
Summary
Post-exertional malaise (PEM) is the key feature of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and recent criteria require its presence to establish the diagnosis [1,2]. ME/CFS is a long-term and debilitating multisystem condition of unknown etiology affecting several millions of individuals worldwide [3]. It represents a significant public health issue due to the high levels of health care resource use by ME/CFS patients, and the loss of productivity in relation to the illness [4]. Besides worsening of baseline symptoms, new or non-typical symptoms could emerge in some ME/CFS patients [2,5]. These symptoms differ from of those habitually experienced by patients after exposure to PEM stressors
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