Preprint Changing patterns of multimorbidity among patients with ambiguous diagnoses: case of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome, 2024, Bragée

https://www.researchsquare.com/article/rs-4000390/v1

Research Article

Changing patterns of multimorbidity among patients with ambiguous diagnoses: The case of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome

Björn Bragée1

Lennart Carlsson2

Per Sjögren2

Bo C Bertilson2

1 Karolinska Institutets folkhälsoakademi: Karolinska Institutet,

2 Karolinska Institutet

https://doi.org/10.21203/rs.3.rs-4000390/v1

This work is licensed under a CC BY 4.0 License

Introduction:
Increased attention has been given to multimorbidity. This phenomenon often has been explored through associations between diseases based on the frequency of combinations of diagnoses. A more patient-focused strategy, together with a trajectory of the multimorbidity situation, has recently attracted increased interest. Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a state that per se includes multimorbidity and is preceded by numerous ambiguous diagnoses. A history of infectious disease is considered the most common denominator and pathophysiological base of ME/CFS, even though no biomarker of such infection has been found. Exploring changing patterns of multimorbidity might contribute to the knowledge about the unknown pathophysiology of this disease.

Methods and materials:
This was a retrospective register-based cohort study of 549 patients from 2015–2020 in Region Stockholm, Sweden. We processed the number and type of diagnoses during each year according to the Adjusted Clinical Groups© case-mix system from Johns Hopkins University. The images were visualized with Excel and “Gapminder” software.

Results
Fifty percent of all patients had more than eight diagnoses—up to 32 diagnoses per year—during the last twelve months of the study period. The most frequent diagnosis clusters were “General Signs and Symptoms”, “Musculoskeletal”, “Psychosocial” and “Neurologic”. The cluster “Infections” was found as number fifteen in order. The number of patients with psychiatric or psychosomatic disorders was lower after the registration of ME/CFS diagnoses.

Discussion and conclusion:
This study illustrates the complexity of the pattern of multimorbidity over time, depicting overlapping diagnoses. Analyses of trajectories of different patterns of multimorbidity might pave the way for a broader understanding of triggers for more complex health conditions, as seen in the case of ME/CFS. The traditional view that ME/CFS is the result of an infectious disease was not confirmed in our cohort. The drive toward patient-oriented analyses may lead to findings of subcategories of patients with similar patterns of multimorbidity over time.

Multimorbidity

Myalgic encephalomyelitis

Chronic fatigue syndrome

Patient-Centered Care

Adjusted Clinical Groups©

Data visualization

Postviral fatigue syndrome

Chronic pain

 

It's not a traditional view, it's

The lack of coding in health records actually reflects the fact that it's not the traditional view, in fact this most commonly reported inflection point is widely disputed, hence the invention of the generic "chronic fatigue syndrome", detached from any etiology or cause, and the general misapplication of psychosomatic ideology.

Weird thing to say given that there is no valid basis to say it.

 

It has been my experience and also general knowledge that family doctors are typically not interested in so called benign viral infections. We know that EBV and some sort of flu-like illness are associated with ME onset. Mine is actually documented by lab but still, nothing to be done.

 

They write: "The ICD-10 diagnosis code for ME/CFS (G93.3) belongs to the 'General Signs and Symptoms' cluster".

Hard to make sene of this paper if you don't how they made those clusters of diagnoses. Info about the system they used, The Adjusted Clinical Groups© case-mix system from Johns HopkinsUniversity (ACG©), does not seem to be publicly available.

That's quite a lot. I suspect that these are just different ways to describe the same constellation of symptoms rather than comorbidities.

 

As far as I can see, "The ICD-10 diagnosis code for ME/CFS (G93.3) belongs to the 'General Signs and Symptoms' cluster", isn't right.

G93.3 is the code for "Postviral fatigue syndrome: Myalgic encephalomyelitis", https://icd.who.int/browse10/2019/en#/G93.3, which belongs to "G90-G99 Other disorders of the nervous system".

Codes for "General symptoms and signs", assuming that is what they meant, are R50-R69, https://icd.who.int/browse10/2019/en#/R50-R69