Journal: Arch Dis Child. 2009 Oct 19. [Epub ahead of print]
Authors: May M, Emond A, Crawley E.
Affiliation: Bristol University, United Kingdom.
NLM Citation: PMID: 19843509
OBJECTIVE: To investigate the heterogeneity of chronic fatigue
syndrome (CFS/ME) in children and young people.
SETTING: Regional specialist CFS/ME service.
Patients: Children and young people aged < 19 years old.
METHODS: Exploratory factor analysis was performed on symptoms
present at assessment in 333 children and young people with CFS/ME.
Linear and logistic regression analysis of data from self completed
assessment forms was used to explore the associations between the
retained factors and sex, age, length of illness, depression, anxiety
and markers of severity (fatigue, physical function, pain and school
attendance).
RESULTS: Three phenotypes were identified using factor analysis:
Musculoskeletal (Factor 1) had loadings on muscle and joint pain and
hypersensitivity to touch, and was associated with worse fatigue
(regression coefficient 0.47, 95% CI 0.25, 0.68, p <0.001), physical
function (regression coefficient -0.52, 95% CI -0.83, -0.22, p=
0.001) and pain. . Factor 2 (Migraine) loaded on noise and light
hypersensitivity, headaches, nausea, abdominal pain and dizziness and
was most strongly associated with physical function and pain. Sore
throat phenotype, (Factor 3) had loadings on sore throat and tender
lymph nodes and was not associated with fatigue or pain. There was no
evidence that phenotypes were associated with age, length of illness
or symptoms of depression (regression coefficient for association of
depression with Musculoskeletal pain -0.02, 95% CI -0.27, 0.23, p=
0.87). The Migraine phenotype was associated with anxiety (0.40, 95%
CI 0.06, 0.74, p=0.02).
Implications: CFS/ME is heterogeneous in children with 3 phenotypes
at presentation that are differentially associated with severity and
are unlikely to be due to age or length of illness.
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