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We discuss how ME/CFS emerges from an intricate web of genetic vulnerabilities and environmental triggers, notably viral infections, leading to a complex series of pathological responses including immune dysregulation, chronic inflammation, gut dysbiosis, and metabolic disturbances

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If the x-rays are normal, your care provider might consider checking an HLA-B27 and, if tested positive, do advanced imaging with an MRI scan or a CT scan of the sacroiliac joints looking for evidence of sacroiliac inflammation or damage (see figures)

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