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Featured articleMyalgic encephalomyelitis/chronic fatigue syndrome is a featured article; it (or a previous version of it) has been identified as one of the best articles produced by the Wikipedia community. Even so, if you can update or improve it, please do so.
Main Page trophyThis article appeared on Wikipedia's Main Page as Today's featured article on November 25, 2024.
Did You Know Article milestones
DateProcessResult
March 9, 2024Good article nomineeListed
July 25, 2024Peer reviewReviewed
August 25, 2024Featured article candidatePromoted
Did You Know A fact from this article appeared on Wikipedia's Main Page in the "Did you know?" column on April 12, 2024.
The text of the entry was: Did you know ... that some people with severe myalgic encephalomyelitis/chronic fatigue syndrome can lose the ability to speak?
Current status: Featured article

Did you know nomination

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The following is an archived discussion of the DYK nomination of the article below. Please do not modify this page. Subsequent comments should be made on the appropriate discussion page (such as this nomination's talk page, the article's talk page or Wikipedia talk:Did you know), unless there is consensus to re-open the discussion at this page. No further edits should be made to this page.

The result was: promoted by PrimalMustelid talk 16:51, 8 April 2024 (UTC)[reply]

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Improved to Good Article status by Femke (talk), Ward20 (talk), and The Quirky Kitty (talk). Nominated by Femke (talk) at 08:49, 10 March 2024 (UTC). Post-promotion hook changes for this nom will be logged at Template talk:Did you know nominations/Myalgic encephalomyelitis/chronic fatigue syndrome; consider watching this nomination, if it is successful, until the hook appears on the Main Page.[reply]

General: Article is new enough and long enough
Policy: Article is sourced, neutral, and free of copyright problems
Hook: Hook has been verified by provided inline citation
QPQ: Done.

Overall: Overall a good read. NW1223<Howl at me•My hunts> 19:10, 15 March 2024 (UTC)[reply]

Either hook is good. NW1223<Howl at me•My hunts> 19:18, 15 March 2024 (UTC)[reply]

We are in WP:QPQ backlog mode. Double reviews are required.-TonyTheTiger (T / C / WP:FOUR / WP:CHICAGO / WP:WAWARD) 07:03, 17 March 2024 (UTC)[reply]

TonyTheTiger, according to https://qpqtool.toolforge.org/qpq/Femke, Femke has made nine DYK nominations, so she does not need an extra QPQ. TSventon (talk) 14:11, 17 March 2024 (UTC)[reply]
Double QPQ is not required. This nomination is good to go. NW1223<Howl at me•My hunts> 18:12, 17 March 2024 (UTC)[reply]
Yes, the QPQ check tool to the right counts only 9. I don't really trust the QPQ tool that much because it barely counts 40% of my own nominations. But If the nominator feels that they have done less than 20 noms this can go forward or they can do the double. This case is on the honor system.-TonyTheTiger (T / C / WP:FOUR / WP:CHICAGO / WP:WAWARD) 18:48, 17 March 2024 (UTC)[reply]
I don't see an obvious one missing on the list, but will help with the backlog when I've got some time to spare. —Femke 🐦 (talk) 19:03, 17 March 2024 (UTC)[reply]
The tool gives a complete list of the nominations made by Femke since she started editing in 2014. It does not pick up nominations made before 2011, but that is not relevant here. TSventon (talk) 20:11, 17 March 2024 (UTC)[reply]

Restored section on bacterial infections

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Hello. Femke reverted my recent addition of a section on bacterial infections as a possible cause or contributor to some cases of chronic fatigue syndrome. The reason given was: Most of these sources do not meet WP:MEDRS as they are primary or too old.

However, three of the sources are peer-reviewed MEDLINE-indexed secondary-source literature reviews. And two are merely supplementary primary sources that I included after those reviews for convenience. Hence, the sources aren't mostly primary. Moreover, the reviews are dated 2007, 2022, and 2010. 2022 is within last five years. WP:MEDDATE of WP:MEDRS does not say that sources older than 5 years cannot be used, it merely states that newer sources are preferred (and should replace older sources where possible). Indeed, reviews older than 5 years are widely cited here on Wikipedia, we just prefer use of newer reviews since they are more up-to-date. Thus, I would argue that the sources are also not too old. In my opinion, per the preceding, they are WP:MEDRS-compliant.

As such, I have restored the section. Bacterial infections being involved in a subset of cases of chronic fatigue syndrome is a valid area of inquiry and there are some promising supporting data that are covered in the reviews and other sources. There are cases of patients diagnosed with chronic fatigue syndrome who were found to have longstanding low-grade bacterial infections and who rapidly remitted with short-term antibiotic therapy. There are solid sources covering this topic and I think that it deserves at least brief mention here on Wikipedia.

Thank you. – 76.174.0.57 (talk) 03:08, 5 November 2024 (UTC)[reply]

The issue with older sources, such as the ones you have included, is that newer reviews often are more reliable as new evidence has been brought forward. Per WP:MEDDATE If recent reviews do not mention an older primary source, the older source is dubious which is I think the main issue here. Newer reviews don't make mention of this theory. IntentionallyDense (talk) 03:19, 5 November 2024 (UTC)[reply]
At minimum I think the primary sources need to be trimmed and probably the whole needs to be shortened and placed under a general “infection” header, rather than having its own section, if kept at all. I personally am interested in this idea but the quality of evidence just isn’t currently on par with the viral evidence, and the current framing gives them close to equal weight. Innisfree987 (talk) 03:26, 5 November 2024 (UTC)[reply]
Hello IP editor. Would you be okay proposing a single sentence on the topic. What is key with these types of articles is whether something is WP:DUE weight. Do sources talk about it a lot, we add a lot of text. Do recent sources talk about it less, we mention it in a sentence, or as we currently do, sentence fragment. —Femke 🐦 (talk) 20:15, 5 November 2024 (UTC)[reply]

Tapanui flu?

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Is this the disease known as Tapanui Flu?

If so, I'm surprised to not see it mentioned in the article. Newzild (talk) 04:39, 25 November 2024 (UTC)[reply]

I thought that was a purely historical term in a smaller country. Is it still used? It's mentioned in history of ME/CFS, in the past tense. —Femke 🐦 (talk) 08:37, 25 November 2024 (UTC)[reply]
Tapanui#Tapanui flu says that's the case. There have been a lot of names over the decades, and I'm not sure that Myalgic encephalomyelitis/chronic fatigue syndrome#Classification and terminology should include them all. WhatamIdoing (talk) 08:38, 25 November 2024 (UTC)[reply]
It's the same disease but a complete list of alternate names would be quite long. If the terminology section isn't inclusive enough, we can always include a "see also" link to History of ME/CFS#Historical naming. Lewisguile (talk) 11:22, 25 November 2024 (UTC)[reply]

"Disabling" in the lede

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I find the term "disabling" to be too vague and subjective to be in the lede so I removed it. Should the term "disabling" be included in the lede? ThatIPEditor They / Them 09:57, 25 November 2024 (UTC)[reply]

All of the common definitions of ME/CFS say that there must be functional impairment (diagnostic criteria). Modern definitions often say that there must at least a 50% reduction in functional ability. Does that not fit the word disabling? To me, the sentence becomes overly vague if we omit it instead. —Femke 🐦 (talk) 10:06, 25 November 2024 (UTC)[reply]
I do think it adds significant, verifiable information, I’m inclined to keep it. Innisfree987 (talk) 11:06, 25 November 2024 (UTC)[reply]
Interesting. I concur. However, basically every condition requires clinical significance to be, well, clinical significant. ThatIPEditor They / Them 11:29, 25 November 2024 (UTC)[reply]
"Disabling" should be included, as it's a key part is the diagnosis. It's not just that fatigue is a symptom (as fatigue is fairly common), but that fatigue is substantial enough to cause disability/"functional impairment". It's used in several of the major criteria, including the more recent ones, and is also clearer language for the lay person than "functional impairment". Lewisguile (talk) 11:19, 25 November 2024 (UTC)[reply]

PEM should be named in opening section

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Please could you insert the term ‘Post Exertion Malaise (PEM)’ between hallmark symptom and the explanation of it (worsening of symptoms…). The term is used later in the page, but is sufficiently important, as the hallmark symptom of ME, that it should be correctly named in the opening too.

Thank you 90.247.95.149 (talk) 10:03, 25 November 2024 (UTC)[reply]

Semi-protected edit request on 25 November 2024

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Please change the fourth sentence of this article:

‘The hallmark symptom is a worsening of the illness which starts hours to days after minor physical or mental activity. ’

To

‘The hallmark symptom is ** PEM (Post Exertional Malaise), ** a worsening of the illness which starts hours to days after minor physical or mental activity’

by adding the piece bewteen the **.

Thank you! 2A02:A463:4D52:0:282B:11FE:B159:8975 (talk) 10:14, 25 November 2024 (UTC)[reply]

 Not done: The page's protection level has changed since this request was placed. You should now be able to edit the page yourself. If you still seem to be unable to, please reopen the request with further details. The AP (talk) 09:54, 26 November 2024 (UTC)[reply]

Diagnosis

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Regarding diagnosis of exclusion, or not, the CDC Grand Rounds source says, "The new case definition is shorter, easier to apply consistently, and emphasizes that ME/CFS is a diagnosis to be actively made, not simply a diagnosis of exclusion." So it seems to me that claim should at least be removed from the lead; if sources conflict, perhaps it could be discussed in the body. Innisfree987 (talk) 10:28, 25 November 2024 (UTC)[reply]

I agree. There is a related diagnosis of exclusion: idiopathic chronic fatigue, which is sometimes diagnosed for chronic fatigue after ME/CFS is first excluded. It was added very recently, so the status quo ante is to omit it from the article. —Femke 🐦 (talk) 10:32, 25 November 2024 (UTC)[reply]
Interesting. I agree with the removal of diagnosis by exclusion from this article as the CDC article talks about the diagnosis of ME/CFS is a lot more explicitly than the other two refs present before your edit. ThatIPEditor They / Them 11:33, 25 November 2024 (UTC)[reply]
So, as with all things ME/CFS, it's complicated. ME/CFS is a positive diagnosis, not an exclusionary diagnosis, but exclusionary testing (for differential diagnoses) is part of the diagnostic process. Your revised wording covers that fine, I think.
In terms of additional supporting evidence, evidence review D: identifying and diagnosing ME/CFS of the new NICE guideline, goes into differential diagnoses from p. 56. On p. 57, the report says 8/9 diagnostic criteria in their meta analysis included exclusion of differential diagnoses as a part of the diagnostic process. Lewisguile (talk) 11:39, 25 November 2024 (UTC)[reply]

Sex-based frequency of occurrence

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The article states that this condition "is more common in women than men", and does so more than once. However, it never states how much more common, and should do so. Two percent more common is very different from twice as common, even if both are statistically significant. Minturn (talk) 17:05, 25 November 2024 (UTC)[reply]

It does say so: In epidemiology, it says: Women are diagnosed about 1.5 to four times more often with ME/CFS than men. —Femke 🐦 (talk) 17:20, 25 November 2024 (UTC)[reply]

Lead edit [1]

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There are still differing definitions of the illness and I believe the previous wording was better in that it described major symptoms without favoring some definition symptoms over others. By adding "characterised" to a number of symptoms, it makes those symptoms directly compete in importance with the "Hallmark" symptom, which is generally more important in the various definitions. So I'm going to do a manual partial revert. Please discuss. Ward20 (talk) 23:06, 28 November 2024 (UTC)[reply]

Mainly I think the higher readability of two shorter sentences is reason not to combine them by adding "characterised by". But on that topic, would anyone object if after “…fatigue that does not go away with rest”, I inserted "as well as" before "sleep issues, and problems with memory or concentration"? I know it’s added verbiage but my brain keeps expecting to see a list of things that don’t relieve the fatigue, as opposed to a list of other symptoms. Thoughts? Innisfree987 (talk) 06:17, 29 November 2024 (UTC)[reply]
I understand what you're indicating and believe the new wording would be an improvement. Ward20 (talk) 07:46, 29 November 2024 (UTC)[reply]
Oh great—I went ahead and made the change here so folks can more easily see what I had in mind, but I’m very open to further ideas if people have them. Innisfree987 (talk) 08:40, 29 November 2024 (UTC)[reply]

Greeting on having the article featured

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Greeting on having the article featured. I am happy that I also contributed to improving the articles by sharing my suggestions during and after the GA review process ;-)

Thank you very much for your work on making this topic (ME/CFS) very well presented! Maxim Masiutin (talk) 12:31, 10 December 2024 (UTC)[reply]

Besides viruses, other reported triggers include stress

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There is a sentence starting with "Besides viruses, other reported triggers include stress", but viruses were not mentioned before. It should have been better to have a sentence before such as "The most common cause of ME/CFS onset are viruses...." or if we won't use the introductory sentence, we could write "The reported triggers include viruses, stress," Maxim Masiutin (talk) 12:34, 10 December 2024 (UTC)[reply]

They are mentioned in the preceding paragraph. —Femke 🐦 (talk) 20:53, 10 December 2024 (UTC)[reply]

Suggestions for improvements

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I am copying over some comments made by someone on the S4ME forum:

The page is very good. Some comments on the first section of the entry for consideration:

"Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a disabling chronic illness. People with ME/CFS experience profound fatigue that does not go away with rest, sleep issues, and problems with memory or concentration. Further common symptoms include dizziness, nausea and pain. The hallmark symptom is a worsening of the illness which starts hours to days after minor physical or mental activity. This "crash" can last from hours or days to several months."

  • The 'Further common symptoms' sentence would be better moved to the end of that paragraph. [Done]
  • I don't think that dizziness and nausea are key symptoms. I think people may have been trying to describe orthostatic intolerance. I think it would be better to use the words 'difficulty being upright (orthostatic intolerance)'. From memory, the IOM criteria referred to orthostatic intolerance. I think many people would not recognise their illness in a description that suggests that dizziness and nausea are common symptoms.
  • I think the hallmark symptom should be named here i.e. post-exertional malaise [Done]

"The cause of the disease is unknown. ME/CFS often starts after an infection, such as mononucleosis. It can run in families, but no genes that contribute to ME/CFS have been confirmed. ME/CFS is associated with changes in the nervous and immune systems, as well as in energy production. Diagnosis is based on symptoms and a differential diagnosis because no diagnostic test is available."

  • "ME/CFS is associated with changes in the nervous and immune systems, as well as energy production" would be better as "Preliminary research has suggested that ME/CFS is associated with changes in the nervous and immune systems, as well as energy production." That change both strengthens the assertion, because the association is based on research rather than complete speculation, while also indicating that the association has not been proven.

"The illness can improve or worsen over time, but full recovery is uncommon.No therapies or medications are approved to treat the condition, and management is aimed at relieving symptoms.: 29  Pacing of activities can help avoid worsening symptoms, and counselling may help in coping with the illness. Before the COVID-19 pandemic, ME/CFS affected two to nine out of every 1000 people, depending on the definition. However, many people fit ME/CFS diagnostic criteria after contracting long COVID. ME/CFS occurs more often in women than in men. It most commonly affects adults between ages 40 and 60 but can occur at other ages, including childhood."

  • "full recovery is uncommon". I think it's important that we get more nuance here. Otherwise Garner and people wanting to sell junk treatments will claim that they are special and have special knowledge because they recovered, albeit within a year of onset. I've suggested words and references elsewhere, something like 'recovery within two years after onset is common (ref Dubbo study, Jason's mononucleosis prospective study), but full recovery after this time is not".
  • "ME/CFS occurs more often in women than in men". While this is probably true, I don't think we know for sure. It would be better to say "ME/CFS is diagnosed more often in women than in men."
  • "It commonly affects adults between ages 40 to 60." This is misleading on two counts. It makes it sound as though ME/CFS is common in this age group, when the vast majority of people aged between 40 to 60 don't have ME/CFS. Also, it also suggests that the disease is predominantly one of this age group. In fact, if a lot of people never recover, it is probably most common in people aged over 60, it's just that it isn't diagnosed in this age group. I personally think it is better to avoid giving age ranges at all, and just stick with 'ME/CFS affects people of all ages, including children'.
  • Related to that, the box says of onset ages:"Peaks at 10–19 and 30–39 years old". The evidence supporting this idea is very thin and questionable, I've discussed it elsewhere. I don't think we should be offering such precision. It doesn't help; in fact might result in people in their 20s who develop ME/CFS symptoms thinking 'oh, I can't have that'.

Dimpizzy (talk) 22:42, 18 December 2024 (UTC)[reply]

@Dimpizzy, if possible it would be better to have that person comment here, for two reasons. The first is that copying this much text from another source strains the limits of Wikipedia’s WP:Copyright policy. Second, almost all of the topics in question reflect, per Wikipedia policy, the way that available reliable sources discuss those subjects; it’s not enough to have a different opinion of the illness, the person would need to show the sources that characterize things as s/he sees them. Innisfree987 (talk) 23:21, 18 December 2024 (UTC)[reply]
Thanks, yes I know it would be better if they could comment, and I hope they do so. But I wanted to make sure editors could see these points if they don't end up doing so. While I didn't provide sources, I hoped some editors are familiar enough with the subject to see that some or all of these make sense.
In terms of straining Wikipedia resources, I don't follow. The post above only includes specific suggestions for changes. And it's not like a book length text. And again I thought the text above on its own could provide some value even without sources. Dimpizzy (talk) 23:28, 18 December 2024 (UTC)[reply]
Oh, I missed you said copyright policy. I thought you were talking about server resources.
The person who wrote it gave me permission to post here. Dimpizzy (talk) 23:30, 18 December 2024 (UTC)[reply]
Most of these look fine and accurate to me, and are borne out by the refs already in the relevant text or are logically consistent issues of formatting/presentation (e.g., women are diagnosed more than men, PEM should description should come before further symptoms, etc). Anything needing sourcing should be sourced, of course. Lewisguile (talk) 08:10, 19 December 2024 (UTC)[reply]
I don’t quite see it that way. A few are matters of presentation but most are not; for example, I don’t think it’s appropriate to insert the speculation that women are only diagnosed more unless sources typically say that. Innisfree987 (talk) 08:37, 19 December 2024 (UTC)[reply]
Thanks for these comments! I've got a busy Christmas period waiting, so it might be a while before I can respond in detail. Some of these are useful and actionable, but some aren't yet. For instance, around recovery, we can only use secondary sourcing (reviews) published in the last 5 years typically. Furthermore, if you compare with long COVID, the period where people commonly recover spontaneously is shorter than two years (except for children), so I'm somewhat skeptical there. Few people are diagnosed within two years, so it's perhaps not that relevant to the lead. —Femke 🐦 (talk) 08:56, 19 December 2024 (UTC)[reply]
Personally, I wouldn't want to imply recovery is common in the first two years anyway. It's more likely, but it's not exactly to be expected. I also take @Innisfree987's point about "diagnosed more in women" (since it could imply men are particularly more likely to be underdiagnosed than women, which isn't evidenced).
Though, "commonly affects adults between ages 40 to 60" is misleading for similar reasons; I'd reword as "most people are diagnosed at ages a–b, and x–y" (sources sometimes differ on what these exact peaks are; I'd be inclined to go with those mentioned in NICE 2021 as the most robust) or similar, since there are two age peaks.
Diagnosis also typically happens a couple of years after onset, so we should be careful not to imply that onset occurs at the point of diagnosis, if possible. And that we aren't saying people are only/usually affected for a 20-year span, as "commonly affects adults between ages 40 to 60" implies. Lewisguile (talk) 10:46, 19 December 2024 (UTC)[reply]
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