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NICE ME/CFS diagnostic criteria 2021
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==Investigations and tests == *medical assessment (including symptoms and history, comorbidities, overall physical and mental health) *a physical examination *an assessment of the impact of symptoms on psychological and social wellbeing *investigations to exclude other diagnoses, e.g. urine and blood tests<ref name="ng206" /> {{collapse top | title = suggested tests}}<div style="column-count:2;"> * urinalysis for protein, blood and glucose * full blood count * urea and [[electrolyte]]s * liver function * [[thyroid]] function * [[erythrocyte sedimentation rate]] or plasma viscosity * [[C-reactive protein]] * [[calcium]] and phosphate * [[HbA1c]] * serum [[iron|ferritin]] (blood iron levels) * [[celiac disease|celiac]] screening * [[creatine kinase]]<ref name="ng206" /></div> {{collapse bottom}} ===Confirmed ME/CFS=== *Investigations and tests must have '''excluded other possible causes''' of the symptoms *Symptoms of [[#Suspected_ME/CFS|suspected ME/CFS]] in the box below must have been present for at least '''three months''' (in adults, children and young people)<br /> {| class="wikitable" style="background-color: #fefeef; color: #000; text-align: left; margin:1em; padding:0.5em; border: 5px solid black;" > |- !'''All''' the following symptoms are required for a diagnosis of ME/CFS: |- |Debilitating [[marked, rapid physical and/or cognitive fatigability in response to exertion|fatigue that is worsened by activity]], is not caused by excessive cognitive, physical, [[mental health|emotional]] or social exertion, and is not significantly relieved by rest. |- |[[Post-exertional malaise]] after activity in which the worsening of symptoms: *is often delayed in onset by hours or days *is disproportionate to the activity *has a prolonged recovery time that may last hours, days, weeks or longer. |- |[[Unrefreshing sleep]] or [[sleep dysfunction|sleep disturbance]] (or both), which may include: *feeling exhausted, feeling [[flu-like symptoms|flu-like]] and [[stiff on waking]] *[[sleep dysfunction|broken or shallow sleep]], altered sleep pattern or [[hypersomnia]] |- |[[cognitive dysfunction|Cognitive difficulties]] (sometimes described as 'brain fog'), which may include [[word-finding problems|problems finding words or numbers]], difficulty in speaking, slowed responsiveness, short-term [[memory problems]], and [[concentration problems|difficulty concentrating]] or multitasking. |- |The symptoms persistent for at least '''three months'''.<ref name="ng206" /> |} *Adults should be referred to a ME/CFS specialist team to confirm diagnosis *Children and young people should be referred to a pediatrician for diagnosis<ref name="ng206-criteria">{{Cite web|url=https://www.nice.org.uk/guidance/ng206/chapter/Recommendations#diagnosis | title = Myalgic Encephalomyelitis (or Encephalopathy)/Chronic Fatigue Syndrome:diagnosis and management. NICE guideline [NG206] {{{|}}} Diagnosis | last = | first = | authorlink = |publisher=[[National Institute for Health and Care Excellence]] | date = 2021-10-29}}</ref>
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