Fatigue in ANCA-associated vasculitis (AAV) and systemic sclerosis (SSc): similarities with Myalgic encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS). A critical review of the literature.
van Eeden, Charmaine, Osman, Mohammed S, Cohen Tervaert, Jan Willem · Expert review of clinical immunology · 2022 · DOI
Quick Summary
This review examined severe, long-lasting fatigue in patients with certain autoimmune diseases and compared it to ME/CFS. The researchers found that fatigue in these autoimmune diseases shares similarities with ME/CFS, including common immune and metabolic problems. Importantly, this fatigue often persists even after the main disease is brought under control, suggesting it may need different treatment approaches than the underlying condition.
Why It Matters
This review is significant because it formally recognizes that ME/CFS-like fatigue occurs in other autoimmune conditions and shares biological mechanisms, validating ME/CFS as a distinct clinical entity worthy of specialized investigation. For ME/CFS patients, it suggests that successful disease remission should not be the only treatment goal—fatigue itself requires targeted intervention. It also establishes that physicians should screen SARD patients for ME/CFS features, potentially improving outcomes for many overlooked patients.
Observed Findings
- Persistent fatigue is prominent in systemic autoimmune rheumatic diseases and often persists despite disease remission.
- Fatigue in these autoimmune conditions shares immune and metabolic abnormalities with ME/CFS.
- Fatigue in SARDs is frequently not associated with traditional markers of disease activity or progression.
- Fatigue is often overlooked clinically despite significantly impacting quality of life in SARD patients.
Inferred Conclusions
- Common pathophysiological pathways may underlie fatigue across ME/CFS, SSc, and primary systemic vasculitides, suggesting these may represent related disease mechanisms.
- Current treatment approaches targeting disease remission are insufficient for managing ME/CFS-like fatigue in SARD patients.
- Physicians should identify patients with ME/CFS features in SARD populations and consider alternative therapeutic strategies specifically addressing fatigue.
Remaining Questions
- What are the specific immune and metabolic mechanisms that link ME/CFS to fatigue in systemic autoimmune diseases?
- Which therapeutic approaches effectively reduce ME/CFS-like fatigue in SARD patients?
- How should clinicians operationalize screening for ME/CFS features in autoimmune disease populations?
- Are there biomarkers that can distinguish ME/CFS-like fatigue from fatigue secondary to active disease in SARDs?
What This Study Does Not Prove
This review does not prove that ME/CFS is caused by autoimmune diseases or vice versa; it identifies similar pathways without establishing causality. It does not define the exact mechanisms causing fatigue or provide evidence that specific treatments proven for one condition will work for others. The review synthesizes existing literature, so its conclusions depend on the quality and comprehensiveness of the underlying studies reviewed.
Topics
Tags
Metadata
- DOI
- 10.1080/1744666X.2022.2116002
- PMID
- 36045606
- Review status
- Machine draft
- Evidence level
- Established evidence from major reviews, guidelines, or evidence maps
- Last updated
- 7 April 2026