In this post I link to and excerpt from the 17-page PDF TESTING RECOMMENDATIONS FOR SUSPECTED ME/CFS, US ME/CFS Clinician Coalition, version 1, February 20, 2021.
All that follows is from the above resource.
Overview
People with ME/CFS may present with a range of symptoms that include a decreased level of functioning, debilitating fatigue, cognitive impairment, orthostatic intolerance, flu-like symptoms, a worsening of their symptoms following exertion, pain, and other symptoms. Patients often report symptoms started with a viral infection. Recently, some COVID-19 patients are reporting extended illness with symptoms similar to ME/CFS.
To help improve the speed and accuracy of diagnosis, the National Academy of Medicine established new diagnostic criteria for ME/CFS in 2015 that focus on the hallmark symptoms of the illness. While there are no specific diagnostic tests for ME/CFS, the clinician can rely on medical history, physical exam, laboratory testing results (used primarily to identify alternative diagnoses and comorbidities), and recognition of the hallmark symptoms to diagnose ME/CFS.
This document includes tests recommended to identify alternative and comorbid diagnoses and further characterize ME/CFS. These recommendations include a limited set of tests
recommended for all people with suspected ME/CFS and additional tests to be ordered based on the patient’s particular presentation. These recommendations are intended as general
guidance for a diagnostic process that may extend over several office visits and involve referrals to specialists. The clinician will need to apply their own clinical judgment in deciding which tests to order and whether to refer to a specialist.In addition to tests to support the diagnostic process, this document also includes recommendations for tests that can be used to help support disability claims and guide treatment decisions. The testing recommendations are broken into three tiers as follows:
Tier 1 (Page 2)
More common
diagnoses● Tests recommended in all suspected patients and tests for specific
presentation to identify more common alternative and comorbid diagnoses or fatal or easily treatable diagnoses. Many of these
tests are normal in ME/CFS patients.Tier 2 (Page 7)
Followup● Follow-up and/or more advanced tests for given presentation to
identify less common alternative diagnoses and comorbiditiesTier 3 (Page 11)
ME/CFS specific● Tests to help characterize ME/CFS and to help document disability and guide treatment. These may require access to specialized labs Each tier is further broken down by the system, describes the presentation that might indicate a given test, and suggests the next steps that might be taken if abnormalities are detected.
For more information on ME/CFS diagnosis and management and on terms of use for these recommendations, see the ME/CFS Clinician Coalition website and handout.
- Website: https://mecfscliniciancoalition.org/
- Handout: https://drive.google.com/file/d/1SG7hlJTCSDrDHqvioPMq-cX-rgRKXjfk/view
- This handout summarizes the alternative diagnoses and comorbidities to be evaluated depending on presentation during the differential diagnosis.
