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Case control study of circulating cytokines in chronic fatigue syndrome
Abstracts / Journal of Psychosomatic Research 78 (2015) 588–634
Conclusion: Renal function in patients with severe affective disorders may be lower than in the general population. But, the difference is small and probably without clinical significance in most cases. This would speak against relevant other factors inherently linked to severe affective disorders apart from long-term lithium exposure. We will explore this further in forthcoming analyses. doi:10.1016/j.jpsychores.2015.03.138
Case control study of circulating cytokines in chronic fatigue syndrome P.D. White, L. Clark, J.M. Thomas, M. Murphy, M. Buckland Queen Mary University of London, Academic Psychological Medicine, London, UK Background: A hypothesis suggests that chronic fatigue syndrome is associated with elevated circulating concentrations of cytokines, supported by the role of infections triggering the illness and the similarity with acute sickness behaviour, which is associated with elevated circulating cytokines. A preliminary study supported the roles of transforming growth factor beta and tumour necrosis factor alpha. Method: We measured serum protein levels and mRNA of 11 cytokines at baseline, after commuting across London, and before and after exercise. After exercise, samples were taken immediately, 3 h and 2 days later. We studied 24 patients with CFS and 21 age- and sex-matched healthy but sedentary controls, following a preliminary study. Results: There were significant differences between patients and controls in TGFβ protein levels both at baseline and all other measurement points. No other cytokine was abnormally distributed. Neither commuting nor exercise had a significant effect on TGFβ or any other cytokine concentrations. There were no significant differences in mRNA between groups at any time point. Conclusion: This study replicates the results in both our preliminary study and a systematic review that circulating TGFβ was at a higher concentration at all times in patients with CFS compared to controls. In this study, mRNA for TGFβ was no different between patients and controls. This finding cannot be related to post-exertional exacerbation of symptoms, but needs further exploration. Studying cytokines in other body tissues, such as cerebrospinal fluid may provide different results.
doi:10.1016/j.jpsychores.2015.03.139
Systematic review of circulating cytokines in chronic fatigue syndrome P.D. White, L. Blundell, K. Ray, M. Buckland Queen Mary University of London, Psychiatry, London, UK Background: The close link between chronic fatigue syndrome (CFS) and infection and the association of certain cytokines with acute sickness behaviour have led to the belief that there may be a link to cytokines in the pathophysiology of the condition. There has been no systematic review of this literature. Method: We systematically reviewed the English language literature for the last 30 years, using a standard method with two independent reviewers and exploring the appropriate databases. We searched for case control studies reporting primary data results of cytokine concentrations in blood samples with cases of CFS or ME, compared to healthy controls, both at baseline and after various stimulation tests such as exercise. We used the Newcastle–Ottawa quality assessment scale of case control studies.
631
Results: The quality of the studies varied. On the whole there were no significant differences between cases and controls in most cytokines measured, although insufficient studies were available for a number of cytokines. The most consistently found difference was of elevated concentrations of Transforming Growth Factor beta (TGF-β) in 5/7 studies, which usually did not change significantly after stimulation. Stimulation studies were generally unhelpful. Conclusion: The evidence for cytokines being associated with CFS was either absent or generally weak, but more studies of TGF-β may be justified. Stimulation studies do not add much to our understanding. Studies of cytokines in other tissues may be worthwhile. doi:10.1016/j.jpsychores.2015.03.140
Measuring distress in musculoskeletal physiotherapy: An example of integrated care in action N. Wilsona, J. Huttona, F. Matchamb a King's College NHS Foundation Trust, London, UK, b Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK Introduction: Musculoskeletal disorders (MSDs) are a major cause of pain and disability, constituting a significant societal burden. Psychological constructs are important predictors and mediators for developing and maintaining long term pain-related disability and a biopsychosocial approach to assessment and treatment of MSDs is recommended. Physiotherapists are a key professional group assessing and treating people with MSDs but screening by them for psychosocial risk factors is inconsistent. Embedding routine collection of patient-reported psychological factors such as depression, pain self-efficacy and avoidance behaviours, may improve quality of patient care and outcomes. Method: The primary aim of this project was to implement screening for psychological risk factors in people attending a NHS physiotherapy musculoskeletal service and characterise the prevalence of distress. To achieve this, self-report questionnaires were embedded within informatics associated with the Integrating Mental and Physical Health Research and Training (IMPARTS) programme to assess: depression, anxiety, risk of persistent disability secondary to back pain, fear avoidance beliefs, pain catastrophizing and pain selfefficacy. A secondary aim was to develop associated care pathways to guide physiotherapist decision making. These include group physical exercise, psychologically informed physiotherapy, Improving Access to Psychological Therapies (IAPT), Accident & Emergency (A&E) or letter to the General Practitioner (GP). Results: 23% of people attending were screened during the first 3 months; of 406 screened, 14% were identified as having probable major depression and 18% as having probable anxiety disorder. Of the 121 patients using the developed care pathway, 68% (N = 82) were allocated to group exercise or IAPT for symptoms of depression or anxiety, and 32% (N = 39) had severe levels of depression and or suicidal ideation and required a letter to the GP or A&E. Just over one third of those screened reported back pain as the primary reason for attendance. Of those, 40% scored at high risk of persistent pain-related disability. Conclusion: Physiotherapy musculoskeletal service redesign to incorporate a systematic approach to identifying psychosocial risk factors in people with MSDs has highlighted the prevalence of comorbid distress. The need for physiotherapists to expand their approach and integrate psychologically-informed practices into consultations is paramount. doi:10.1016/j.jpsychores.2015.03.141
Conclusion: Renal function in patients with severe affective disorders may be lower than in the general population. But, the difference is small and probably without clinical significance in most cases. This would speak against relevant other factors inherently linked to severe affective disorders apart from long-term lithium exposure. We will explore this further in forthcoming analyses. doi:10.1016/j.jpsychores.2015.03.138
Case control study of circulating cytokines in chronic fatigue syndrome P.D. White, L. Clark, J.M. Thomas, M. Murphy, M. Buckland Queen Mary University of London, Academic Psychological Medicine, London, UK Background: A hypothesis suggests that chronic fatigue syndrome is associated with elevated circulating concentrations of cytokines, supported by the role of infections triggering the illness and the similarity with acute sickness behaviour, which is associated with elevated circulating cytokines. A preliminary study supported the roles of transforming growth factor beta and tumour necrosis factor alpha. Method: We measured serum protein levels and mRNA of 11 cytokines at baseline, after commuting across London, and before and after exercise. After exercise, samples were taken immediately, 3 h and 2 days later. We studied 24 patients with CFS and 21 age- and sex-matched healthy but sedentary controls, following a preliminary study. Results: There were significant differences between patients and controls in TGFβ protein levels both at baseline and all other measurement points. No other cytokine was abnormally distributed. Neither commuting nor exercise had a significant effect on TGFβ or any other cytokine concentrations. There were no significant differences in mRNA between groups at any time point. Conclusion: This study replicates the results in both our preliminary study and a systematic review that circulating TGFβ was at a higher concentration at all times in patients with CFS compared to controls. In this study, mRNA for TGFβ was no different between patients and controls. This finding cannot be related to post-exertional exacerbation of symptoms, but needs further exploration. Studying cytokines in other body tissues, such as cerebrospinal fluid may provide different results.
doi:10.1016/j.jpsychores.2015.03.139
Systematic review of circulating cytokines in chronic fatigue syndrome P.D. White, L. Blundell, K. Ray, M. Buckland Queen Mary University of London, Psychiatry, London, UK Background: The close link between chronic fatigue syndrome (CFS) and infection and the association of certain cytokines with acute sickness behaviour have led to the belief that there may be a link to cytokines in the pathophysiology of the condition. There has been no systematic review of this literature. Method: We systematically reviewed the English language literature for the last 30 years, using a standard method with two independent reviewers and exploring the appropriate databases. We searched for case control studies reporting primary data results of cytokine concentrations in blood samples with cases of CFS or ME, compared to healthy controls, both at baseline and after various stimulation tests such as exercise. We used the Newcastle–Ottawa quality assessment scale of case control studies.
631
Results: The quality of the studies varied. On the whole there were no significant differences between cases and controls in most cytokines measured, although insufficient studies were available for a number of cytokines. The most consistently found difference was of elevated concentrations of Transforming Growth Factor beta (TGF-β) in 5/7 studies, which usually did not change significantly after stimulation. Stimulation studies were generally unhelpful. Conclusion: The evidence for cytokines being associated with CFS was either absent or generally weak, but more studies of TGF-β may be justified. Stimulation studies do not add much to our understanding. Studies of cytokines in other tissues may be worthwhile. doi:10.1016/j.jpsychores.2015.03.140
Measuring distress in musculoskeletal physiotherapy: An example of integrated care in action N. Wilsona, J. Huttona, F. Matchamb a King's College NHS Foundation Trust, London, UK, b Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK Introduction: Musculoskeletal disorders (MSDs) are a major cause of pain and disability, constituting a significant societal burden. Psychological constructs are important predictors and mediators for developing and maintaining long term pain-related disability and a biopsychosocial approach to assessment and treatment of MSDs is recommended. Physiotherapists are a key professional group assessing and treating people with MSDs but screening by them for psychosocial risk factors is inconsistent. Embedding routine collection of patient-reported psychological factors such as depression, pain self-efficacy and avoidance behaviours, may improve quality of patient care and outcomes. Method: The primary aim of this project was to implement screening for psychological risk factors in people attending a NHS physiotherapy musculoskeletal service and characterise the prevalence of distress. To achieve this, self-report questionnaires were embedded within informatics associated with the Integrating Mental and Physical Health Research and Training (IMPARTS) programme to assess: depression, anxiety, risk of persistent disability secondary to back pain, fear avoidance beliefs, pain catastrophizing and pain selfefficacy. A secondary aim was to develop associated care pathways to guide physiotherapist decision making. These include group physical exercise, psychologically informed physiotherapy, Improving Access to Psychological Therapies (IAPT), Accident & Emergency (A&E) or letter to the General Practitioner (GP). Results: 23% of people attending were screened during the first 3 months; of 406 screened, 14% were identified as having probable major depression and 18% as having probable anxiety disorder. Of the 121 patients using the developed care pathway, 68% (N = 82) were allocated to group exercise or IAPT for symptoms of depression or anxiety, and 32% (N = 39) had severe levels of depression and or suicidal ideation and required a letter to the GP or A&E. Just over one third of those screened reported back pain as the primary reason for attendance. Of those, 40% scored at high risk of persistent pain-related disability. Conclusion: Physiotherapy musculoskeletal service redesign to incorporate a systematic approach to identifying psychosocial risk factors in people with MSDs has highlighted the prevalence of comorbid distress. The need for physiotherapists to expand their approach and integrate psychologically-informed practices into consultations is paramount. doi:10.1016/j.jpsychores.2015.03.141