A sizeable portion of individuals with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) experience fatigue severe enough to meet the diagnostic criteria for myalgic encephalomyelitis/chronic fatigue syndrome, according to a study published in The Lancet Regional Health — Americas.

The authors of this study sought to assess fatigue in patients with AAV to see if it fit the diagnostic criteria for those conditions. They also sought to compare the differences in fatigue experienced by patients with proteinase 3 (PR3)-AAV vs patients with myeloperoxidase (MPO)-AAV. 

The research team recruited 52 participants from the rheumatology department of the University of Alberta Hospital in Edmonton, Canada, between January 2019 and April 2022. Participants had to be PR3/MPO-ANCA positive and have a diagnosis of AAV. Patients with active disease, cancer, diabetes, or thyroid problems were excluded. 

To diagnose myalgic encephalomyelitis/chronic fatigue syndrome, the researchers used the DePaul symptom questionnaire, which is based on the Canadian consensus criteria. Patients who met at least 5 of the 6 criteria in the questionnaire were considered to have those conditions. 

Read more about AAV diagnosis

The authors reported that half of the participants met the diagnostic criteria for myalgic encephalomyelitis/chronic fatigue syndrome and that these conditions were more common among patients with MPO-AAV than those with PR3-AAV. 

“We emphasize that physicians should be aware of this when assessing treatment and management strategies for improving quality of life in AAV patients,” they concluded.

Fatigue is a common symptom in many autoimmune diseases, and many patients deem their fatigue to be “persistent” and “debilitating.” However, the management of fatigue lacks consistency across the medical world because the source of it often goes unidentified.

The mismanagement of fatigue is a considerable source of distress among patients, who may feel dismissed by their doctor, the study authors wrote. In diseases such as AAV, immunosuppressive drugs may improve some symptoms of fatigue, but in many patients, they do not go far enough. Mismanaged fatigue can give rise to a host of psychological issues, such as depression, anxiety, and burnout. 


van Eeden C, Mohazab N, Redmond D, et al. Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and fibromyalgia: PR3-versus MPO-ANCA-associated vasculitis, an exploratory cross-sectional studyLancet Reg Health Am. Published online February 27, 2023. doi:10.1016/j.lana.2023.100460