Comorbidities of Myalgic Encephalomyelitis

Patients with myalgic encephalomyelitis frequently meet the criteria for one or more other conditions including: postural orthostatic tachychardia syndrome and other forms of orthostatic intolerance; mast cell activation syndrome; Ehlers-Danlos syndrome; fibromyalgia; endometriosis; and a variety of autoimmune diseases. It is not yet known whether these are true co-morbidities that share underlying genetic or environment risk factors, or if they are artifacts of diagnosis and disease definition.

Canadian Consensus Criteria
The Canadian Consensus Criteria recognizes the following list of comorbidities for ME/CFS: Fibromyalgia, Myofascial pain syndrome (MPS), Temporomandibular joint syndrome (TMJ), Irritable bowel syndrome (IBS), Interstitial cystitis, Irritable bladder syndrome, Raynaud’s phenomenon, Prolapsed mitral valve, Depression, Migraine, allergies, Multiple chemical sensitivities (MCS), Hashimoto's thyroiditis, Sicca syndrome.

Preceding conditions
Conditions that begin many years before ME/CFS that but then become associated with it include irritable bowel syndrome, migraines and depression - these are regarded as more loosely associated by the Canadian Consensus Criteria. ME/CFS and Fibromyalgia are regarded as often closely connected "overlap syndromes.

Theories
RCCX Theory

Clinical perspectives

 * In “The Nightingale Research Foundation Definition of Myalgic Encephalomyelitis (M.E.)” ME physician Byron Hyde has describes the relationship between ME, POTS/dyaustonomia, and EDS in terms of disease severity:
 * “Patients with dysautonomia and/or POTS dysfunctions invariably demonstrated hypoperfusion in the operculum area overlying the insular cortex as in the above patient, suggesting an insular cortex injury in our dysautonomia patients.”
 * “Patients with pre-existing or newly-discovered (a) Ehlers-Danlos Hypermobility Syndrome, (b) Collagen diseases... are among the most disabled patients we have seen.”
 * At a two-day physician summit in Salt Lake City, Utah March 2018, physicians discussed the relationship between “Chronic Fatigue Syndrome” and mast cell activation syndrome.
 * David Kaufman: "ME/CFS is a descriptive diagnosis of a bunch of symptoms, but it says nothing about what's causing the symptoms, which is probably part of the reason it's so hard for it to get recognition. So, the question becomes, What other pathology is driving this illness and making the person feel so ill? I think mast cell activation is one of those drivers, whether cause, effect, or perpetuator, I don't know."
 * Charles Lapp: "I see a lot of this. I think it's one of the many overlap syndromes that we've been missing for years."
 * Susan Levine: "I suspect 50% to 60% of ME/CFS patients have it. It's a very new concept."...In Levine's experience, MCAS often manifests in patients being unable to tolerate certain foods or medications. "If we can reduce the mast cell problem, we can facilitate taking other drugs to treat ME/CFS," she said. However, she also cautioned, "It's going to be a subset, not all ME/CFS patients."

Studies and collaborations

 * A lab at the Stanford Genome Technology Center is currently studying the genetic relationship between EDS and ME/CFS. Early data show a possible relationship.

Research findings
Recent research has focused on the possible relationships between EDS, POTS, and MCAS. In particular, these disorders were associated in a sample of 25 families.