Letter to the Editor
Clinical Typology of Chronic Fatigue Syndrome: Classificatory Hypothesis
Tipología clínica del síndrome de fatiga crónica: hipótesis clasificatoria
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It is characterized by intense fatigue in addition to cognitive, autonomic, neuroendocrine, immunoallergic and musculoskeletal symptoms, which are of recent appearance and that cannot be explained by other clinical reasons, lasting for at least 6 months, is non-remitting significantly with rest and which worsens with physical or mental activity, with very slow recovery and a reduction of >50% of activities of daily living previously performed by the patient.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–4</span></a> It is diagnosed according to the 1994 Fukuda criteria,<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> the Canadian consensus document published in 2003<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> or, more recently, the international consensus criteria of 2011; with the name of myalgic encephalomyelitis that offers a review on its physiopathology, symptoms and treatment.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Prevalence is estimated to be between 0.5% and 2.5% of the general population.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–3,5</span></a> In spite of it being recognized as a disease by the WHO since 1989, and classified with the code G93.3 in the ICD-10,<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,6</span></a> and that evidence accumulated from different fields during the past 2 decades, it is possible that pCFS is still largely unknown by most health professionals.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Due to the great heterogeneity in its clinical expression and the lack of standardized instruments to order its different symptoms (according to greater or lesser frequency) and clinical presentation (distinguishing between pCFS, sCFS and Idiopathic CF), we propose a classification into clusters: I, II, IIIa, IIIb and IIIc, subgrouping the main clinical conditions in a consecutive series of 199 patients (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>), seen in a period of time between June 2010 and February 2013 at the Chronic Fatigue Specialized Hospital Unit of the Camp de Tarragona belonging to the Hospital Universitario Joan <span class="elsevierStyleSmallCaps">XXIII</span>. 84% of patients (n=167) were women (5:1). Mean age at symptom onset was 41.5 years (range 9–76). The onset of symptoms was insidious in 72.8% of patients and 71.3% had a progressive evolution of disease. At the moment of interview, 51.7% (n=103) were unemployed (65 lost their job while 38 were disabled). 8% (n=16) were retired. The pCFS criteria are valid for the diagnosis in the clinical daily practice independently of other associated criteria.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6–8</span></a> Having a classification of patients with CFS will allow us to identify more homogeneous groups of patients, candidates both for more individualized diagnostic and therapeutic guidelines and which allow for better expectations. In order to correctly classify a patient with CFS, we recommend a multidisciplinary approach. In first place, the CFS diagnosis must be confirmed (family physician, internal medicine specialist and/or rheumatologist), in order to then evaluate the existence of possible associated systemic diseases or chronic local processes that have a large differential diagnosis and, finally, to perform a precise diagnosis of the disease with a psychopathological background (psychologist and/or psychiatrist). Having a clear diagnosis in each one of these 6 areas, as well as the analysis of the chronology of symptoms or processes allows the inclusion of the patient into each one of the different classification subgroups.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Qanneta R, Fontova R, Poveda MJ, Castro S. Tipología clínica del síndrome de fatiga crónica: hipótesis clasificatoria. Reumatol Clin. 2014;10:132–133.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">COPD: chronic obstructive pulmonary disease; CF: chronic fatigue; JAK2: Janus Kinase 2; OSA: obstructive sleep apnea; CFS: chronic fatigue syndrome (p: primary; s: secondary); CMPS: chronic myeloproliferative syndrome; ET: essential thrombocytosis.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Classification subtypes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Primary disease (n=73/199, 36.75%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Association autoimmune chronic thyroiditis (n=38/199, 19.1%) \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cluster <span class="elsevierStyleSmallCaps">I</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">pCFS, according to the Fukuda criteria \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">None, 90/199 patients (45.2%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19/90 patients (21.1%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cluster <span class="elsevierStyleSmallCaps">II</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Idiopathic CF, without having the Fukuda criteria \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">None, 36/199 patients (18.1%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5/36 patients (13.8%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cluster IIIa \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">sCFS autoimmune disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">17/199 patients (8.5%)• 9 patients with primary Sjögren's syndrome<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7,8</span></a>• 4 patients with polymyalgia rheumatica• 2 patients with systemic lupus erythematosus• 1 patient with Crohn's disease• 1 patient with Guillain–Barré’s syndrome \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7/17 patients (41.1%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cluster IIIb \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">sCFS to other medical entities \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">40/199 patients (20.1%)• 7 postchemotherapy patients• 6 patients due to drugs• 5 patients with severe OSA• 3 patients with a secreting hypophiseal microadenoma• 3 patients with hepatic cirrhosis• 3 patients with morbid obesity• 3 patients with severe iron deficiency• 3 patients with meopause• 2 patients with COPD• 2 patients with type TE JAK2 V617F CMPS• 1 patient with multiple myeloma• 1 patient with neuromuscular lung disease• 1 patient with severe myocardiopathy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6/40 patients (15%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cluster IIIc \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">sCFS to psychopathologic abnormalities \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16/199 patients (8%)• 12 patients with depression• 3 patients with somatization• 1 patient with schizophrenia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1/16 patients (6.2%) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab476176.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Classification Subtypes of Chronic Fatigue Syndrome.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:8 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The chronic fatigue syndrome, comprehensive approach to its definition and study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "K. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 10 | 12 | 22 |
| 2024 October | 43 | 30 | 73 |
| 2024 September | 56 | 19 | 75 |
| 2024 August | 61 | 45 | 106 |
| 2024 July | 50 | 38 | 88 |
| 2024 June | 62 | 40 | 102 |
| 2024 May | 57 | 45 | 102 |
| 2024 April | 52 | 26 | 78 |
| 2024 March | 59 | 31 | 90 |
| 2024 February | 48 | 39 | 87 |
| 2024 January | 37 | 27 | 64 |
| 2023 December | 43 | 26 | 69 |
| 2023 November | 55 | 25 | 80 |
| 2023 October | 47 | 34 | 81 |
| 2023 September | 62 | 39 | 101 |
| 2023 August | 35 | 20 | 55 |
| 2023 July | 39 | 25 | 64 |
| 2023 June | 36 | 17 | 53 |
| 2023 May | 32 | 27 | 59 |
| 2023 April | 26 | 13 | 39 |
| 2023 March | 47 | 24 | 71 |
| 2023 February | 40 | 29 | 69 |
| 2023 January | 32 | 15 | 47 |
| 2022 December | 39 | 39 | 78 |
| 2022 November | 46 | 21 | 67 |
| 2022 October | 40 | 41 | 81 |
| 2022 September | 21 | 36 | 57 |
| 2022 August | 41 | 39 | 80 |
| 2022 July | 32 | 39 | 71 |
| 2022 June | 37 | 32 | 69 |
| 2022 May | 37 | 44 | 81 |
| 2022 April | 53 | 42 | 95 |
| 2022 March | 63 | 39 | 102 |
| 2022 February | 68 | 29 | 97 |
| 2022 January | 55 | 34 | 89 |
| 2021 December | 40 | 40 | 80 |
| 2021 November | 38 | 44 | 82 |
| 2021 October | 46 | 54 | 100 |
| 2021 September | 42 | 46 | 88 |
| 2021 August | 38 | 33 | 71 |
| 2021 July | 34 | 29 | 63 |
| 2021 June | 50 | 54 | 104 |
| 2021 May | 43 | 34 | 77 |
| 2021 April | 144 | 57 | 201 |
| 2021 March | 59 | 23 | 82 |
| 2021 February | 28 | 25 | 53 |
| 2021 January | 33 | 23 | 56 |
| 2020 December | 31 | 13 | 44 |
| 2020 November | 23 | 24 | 47 |
| 2020 October | 24 | 24 | 48 |
| 2020 September | 31 | 16 | 47 |
| 2020 August | 29 | 16 | 45 |
| 2020 July | 16 | 10 | 26 |
| 2020 June | 40 | 23 | 63 |
| 2020 May | 33 | 5 | 38 |
| 2020 April | 20 | 12 | 32 |
| 2020 March | 16 | 17 | 33 |
| 2020 February | 2 | 0 | 2 |
| 2018 May | 7 | 0 | 7 |
| 2018 April | 36 | 5 | 41 |
| 2018 March | 35 | 7 | 42 |
| 2018 February | 30 | 3 | 33 |
| 2018 January | 22 | 5 | 27 |
| 2017 December | 20 | 4 | 24 |
| 2017 November | 32 | 7 | 39 |
| 2017 October | 25 | 3 | 28 |
| 2017 September | 35 | 2 | 37 |
| 2017 August | 43 | 4 | 47 |
| 2017 July | 40 | 4 | 44 |
| 2017 June | 50 | 3 | 53 |
| 2017 May | 30 | 10 | 40 |
| 2017 April | 26 | 3 | 29 |
| 2017 March | 38 | 2 | 40 |
| 2017 February | 15 | 4 | 19 |
| 2017 January | 35 | 5 | 40 |
| 2016 December | 71 | 11 | 82 |
| 2016 November | 49 | 5 | 54 |
| 2016 October | 86 | 12 | 98 |
| 2016 September | 56 | 7 | 63 |
| 2016 August | 54 | 8 | 62 |
| 2016 July | 23 | 8 | 31 |
| 2015 December | 2 | 0 | 2 |
| 2015 September | 2 | 0 | 2 |
| 2015 August | 1 | 0 | 1 |
| 2015 July | 17 | 6 | 23 |
| 2015 June | 25 | 3 | 28 |
| 2015 May | 47 | 19 | 66 |
| 2015 April | 27 | 10 | 37 |
| 2015 March | 20 | 5 | 25 |
| 2015 February | 53 | 3 | 56 |
| 2015 January | 43 | 8 | 51 |
| 2014 December | 36 | 9 | 45 |
| 2014 November | 23 | 6 | 29 |
| 2014 October | 31 | 14 | 45 |
| 2014 September | 23 | 9 | 32 |
| 2014 August | 25 | 15 | 40 |
| 2014 July | 43 | 15 | 58 |
| 2014 June | 47 | 12 | 59 |
| 2014 May | 37 | 17 | 54 |
| 2014 April | 57 | 20 | 77 |
| 2014 March | 42 | 20 | 62 |
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