title: Is chronic fatigue syndrome a connective tissue disorder? A cross-sectional study in adolescents.
abstract: OBJECTIVE
  To investigate whether constitutional laxity of the connective tissues is more frequently present in adolescents with chronic fatigue syndrome (CFS) than in healthy controls. Increased joint hypermobility in patients with CFS has been previously described, as has lower blood pressure in fatigued individuals, which raises the question of whether constitutional laxity is a possible biological predisposing factor for CFS.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  Thirty-two adolescents with CFS (according to the criteria of the Centers for Disease Control and Prevention) referred to a tertiary hospital and 167 healthy controls.
  
  
  METHODS
  The 32 adolescents with CFS were examined extensively regarding collagen-related parameters: joint mobility, blood pressure, arterial stiffness and arterial wall thickness, skin extensibility, and degradation products of collagen metabolism. Possible confounding factors (age, gender, height, weight, physical activity, muscle strength, diet, alcohol consumption, and cigarette smoking) were also measured. The results were compared with findings in 167 healthy adolescents who underwent the same examinations.
  
  
  RESULTS
  Joint mobility, Beighton score, and collagen biochemistry, all indicators of connective tissue abnormality, were equal for both groups. Systolic blood pressure, however, was remarkably lower in patients with CFS (117.3 vs. 129.7 mm Hg; adjusted difference: -13.5 mm Hg; 95% confidence interval [CI]: -19.1, -7.0). Skin extensibility was higher in adolescents with CFS (mean z score: 0.5 vs. 0.1 SD; adjusted difference: 0.3 SD; 95% CI: 0.1, 0.5). Arterial stiffness, expressed as common carotid distension, was lower in adolescents with CFS, indicating stiffer arteries (670 vs 820 mum; adjusted difference: -110 mum; 95% CI: -220, -10). All analyses were adjusted for age, gender, body mass index, and physical activity. Additionally, arterial stiffness was adjusted for lumen diameter and pulse pressure.
  
  
  CONCLUSIONS
  These findings do not consistently point in the same direction of an abnormality in connective tissue. Patients with CFS did have lower blood pressure and more extensible skin but lacked the most important parameter indicating constitutional laxity, ie, joint hypermobility. Moreover, the collagen metabolism measured by crosslinks and hydroxyproline in urine, mainly reflecting bone resorption, was not different. The unexpected finding of stiffer arteries in patients with CFS warrants additional investigation.
authors.affiliation: Department of Pediatric, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands. e.vandeputte@wkz.azu.nl
authors.forename: E M
authors.initials: EM
authors.lastname: van de Putte
authors.forename: C S P M
authors.initials: CS
authors.lastname: Uiterwaal
authors.forename: M L
authors.initials: ML
authors.lastname: Bots
authors.forename: W
authors.initials: W
authors.lastname: Kuis
authors.forename: J L L
authors.initials: JL
authors.lastname: Kimpen
authors.forename: R H H
authors.initials: RH
authors.lastname: Engelbert
mesh_terms: D000293:Adolescent; D001794:Blood Pressure; D017536:Carotid Artery, Common / Q000000981:diagnostic imaging / Q000502:physiology; D016022:Case-Control Studies; D002648:Child; D003240:Connective Tissue Diseases / Q000150:complications*; D003430:Cross-Sectional Studies; D004548:Elasticity; D015673:Fatigue Syndrome, Chronic / Q000209:etiology*; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000150:complications; D016014:Linear Models; D008297:Male; D012016:Reference Values; D012307:Risk Factors; D012879:Skin Physiological Phenomena; D014463:Ultrasonography