CPRU: NR McGregor, RH Dunstan, S Niblet, K King, HL Butt, T Harrison, W Taylor, TK Roberts, IJ Klineberg.
RNS Hospital: P Clifton-Bligh, G Fulcher, J Dunsmore, L Hoskins.
Anti-Nuclear Antibodies and CFS
Ninety-eight CFS patients and 81 age- and sex-matched controls were assessed for the changes in symptoms (clinically determined and questionnaire), SCL-90-R psychological responses, blood cell parameters, blood biochemistry and the urinary excretion of organic and amino acids in relationship to their anti-nuclear antibody (ANA) status. CFS patients were divided into ANA positive and ANA negative groups for comparison.
The fatigue responses in the ANA +ve group were more severe than those observed in the remaining CFS -ve patients. The fatigue responses were associated with alterations in red blood cell parameters, which were consistent with an increased compensated haemolysis reaction. Increasing ANA titres were associated with alterations in haemoglobin and red cell volume as well as increases in iron levels and reductions in sodium levels. No change in any immune cell parameter was found. These responses were quite different from those noted in the CFS -ve patients. The ANA patients had an increase in depression scores, which were found to be associated with alterations in red blood cell parameters and increased levels of bilirubin and the bilirubin:albumin ratio. This indicates a potential chemical neurotoxicity and not a psychological depressive state.
These data were consistent with an auto-immune-associated alteration in red cell haemolysis, which has been previously associated with the presentation of fatigue in mild hepatobillary disorders or porphyrin disorders. These types of fatigue/pain illnesses need to be diagnosed and excluded under the current CFS definition.
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