{"id":3791,"date":"2022-05-03T11:47:20","date_gmt":"2022-05-03T10:47:20","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/chronicfatiguesyndromeme\/"},"modified":"2025-06-11T10:57:25","modified_gmt":"2025-06-11T09:57:25","slug":"chronicfatiguesyndromeme","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/rehabilitation\/chronicfatiguesyndromeme\/","title":{"rendered":"Chronic Fatigue Syndrome: ME-CFS"},"content":{"rendered":"\n<p><strong><mark style=\"background-color:#eed202\" class=\"has-inline-color has-alert-red-color\">The Scottish Government has withdrawn the <a href=\"https:\/\/www.gov.scot\/publications\/scottish-good-practice-statement-myalgic-encephalomyelitis-chronic-fatigue-syndrome-cfs\/\" data-type=\"link\" data-id=\"https:\/\/www.gov.scot\/publications\/scottish-good-practice-statement-myalgic-encephalomyelitis-chronic-fatigue-syndrome-cfs\/\" target=\"_blank\" rel=\"noreferrer noopener\">Scottish Good Practice Statement on ME \u2013 CFS<\/a><a href=\"https:\/\/www.gov.scot\/publications\/scottish-good-practice-statement-myalgic-encephalomyelitis-chronic-fatigue-syndrome-cfs\/\" data-type=\"link\" data-id=\"https:\/\/www.gov.scot\/publications\/scottish-good-practice-statement-myalgic-encephalomyelitis-chronic-fatigue-syndrome-cfs\/\"> <\/a>from May 2025 and RefHelp will be updated shortly. However, the diagnostic and management approaches remain broadly relevant and were approved by the Lothian GP Sub-Committee.<\/mark><\/strong><\/p>\n\n\n\n<p>NHS Lothian does not offer a specific diagnostic service for Myalgic Encephalomyelitis &#8211; Chronic Fatigue Syndrome (ME-CFS). However, once a diagnosis is made the patient can be referred to multidisciplinary non-medical rehabilitation services where fatigue is the dominant symptom. Patients with pain symptoms predominating may benefit from the <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/chronicpain\/\" target=\"_blank\" rel=\"noreferrer noopener\">chronic pain service<\/a>.<\/p>\n\n\n\n<p><em><mark style=\"background-color:#ffffff\" class=\"has-inline-color has-alert-red-color\"><strong>If the primary care clinician feels unable to secure a diagnosis, and particularly if there are concerns about alternative diagnoses, specialist referral should be considered.<\/strong><\/mark><\/em><a id=\"_msocom_1\"><\/a><\/p>\n\n\n\n<p>The <a href=\"https:\/\/www.gov.scot\/publications\/scottish-good-practice-statement-myalgic-encephalomyelitis-chronic-fatigue-syndrome-cfs\/\" target=\"_blank\" rel=\"noreferrer noopener\">Scottish Good Practice Statement on ME-CFS<\/a> refers to the <a href=\"https:\/\/www.nice.org.uk\/guidance\/NG206\" target=\"_blank\" rel=\"noreferrer noopener\">NICE guidance<\/a> but adapts its recommendations.&nbsp; It is a \u2018living\u2019 document, with ongoing updates and provides guidance to support the diagnosis and management of ME-CFS in primary care. <em>All the guidance on these pages relates to the Scottish guidance and to adults only.<\/em><\/p>\n\n\n\n<p><strong>Background<\/strong><\/p>\n\n\n\n<p>ME-CFS is a condition characterised by persistent and fluctuating symptoms of fatigue, pain and loss of endurance to normal activities associated with conspicuous deterioration after exercise. It is commoner in women, and in the age group 35-55.&nbsp;<\/p>\n\n\n\n<p>The WHO categorises ME-CFS as a neurological disease: there are no internationally-recognised standard diagnostic criteria but the Scottish guidance favours pragmatic use of the <a href=\"https:\/\/www.gov.scot\/publications\/scottish-good-practice-statement-myalgic-encephalomyelitis-chronic-fatigue-syndrome-cfs\/pages\/11\/\" target=\"_blank\" rel=\"noreferrer noopener\">Canadian Consensus definition<\/a>. The prognosis is extremely variable, with symptoms lasting months to decades, and some have a relapsing \/ remitting course. The onset may be sudden or gradual and can be precipitated by a viral illness. Approaches to care should be holistic, involve shared decision making and explicit discussion of the diagnosis, with realistic information about what to expect and links to other support. The Scottish Good Practice Statement outlines other approaches to management including of specific symptoms, rehabilitation, welfare benefits and carer support. Please see Primary Care Management for further detail, including the RefHelp summary of the Scottish Good Practice Statement on <a href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/ME-CFS-Post-Diagnosis-Management-Summary-May-2024.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">management of ME-CFS following diagnosis<\/a><\/p>\n\n\n\n<p><strong>Diagnosis:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>is key to further management, including acceptance, adaptation and lifestyle change;<\/li>\n\n\n\n<li>is clinical, as with many neurological conditions, relying on symptom recognition rather than specific diagnostic tests;<\/li>\n\n\n\n<li>made early and accurately is beneficial, aiming for a provisional diagnosis within 3-4 months of illness wherever possible, and ME-CFS considered as a differential diagnosis 6 weeks from onset of abnormal fatigue;<\/li>\n\n\n\n<li>can not be formally confirmed until the patient has had 6 months of symptoms&nbsp;<\/li>\n\n\n\n<li>should not delay approaches to symptom alleviation, which can take place alongside.<\/li>\n<\/ul>\n\n\n\n<p>Most patients can have a diagnosis made without referral to a specialist service, according to the principles and guidance outlined in the Primary Care Management section.<\/p>\n\n\n\n<p class=\"has-alert-red-color has-text-color has-link-color wp-elements-4e852608077b1a99e80b6dceda9916b4\" style=\"text-decoration:underline\"><strong>Where there are specific symptoms that require further specialist investigation, the following may be useful, and are considered \u2018red flags\u2019 in the diagnostic process:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Joint swelling, particularly with unusual rashes \u2013 Rheumatology<\/li>\n\n\n\n<li>Possible sleep apnoea \u2013 Respiratory<\/li>\n\n\n\n<li>\u2018Hard\u2019 neurological signs \u2013 Neurology<\/li>\n\n\n\n<li>Severe postural hypotension:<ul><li>Cardiology (please also see <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/cardiology\/postural-tachycardia-syndrome-pots\/\" target=\"_blank\" rel=\"noreferrer noopener\">PoTS<\/a>)<\/li><\/ul>\n<ul class=\"wp-block-list\">\n<li>Endocrinology, if adrenal insufficiency is suspected<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Weight loss &#8211; <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/paediatric-radiology\/gpaccesstoctforsuspectedcancernoclinicallyobviousprimary\/\" target=\"_blank\" rel=\"noreferrer noopener\">Suspected malignancy with no obvious primary<\/a><\/li>\n\n\n\n<li>Where there are clear indicators of an infective aetiology (eg&nbsp;fever of unknown origin or suggestive ongoing symptoms such as night sweats, weight loss and lymphadenopathy) \u2013 Infectious Diseases. &nbsp;<em>Please also see exclusions below in \u2018who not to refer\u2019.<\/em><\/li>\n<\/ul>\n\n\n\n<p>The <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/generalmedicine\/\" target=\"_blank\" rel=\"noreferrer noopener\">RefHelp General Medicine<\/a> page gives an outline of referral pathways for a range of non-specific symptoms.<\/p>\n\n\n\n<p class=\"has-alert-red-color has-text-color has-link-color wp-elements-b1730193e327a309c32fb0ee4017037f\"><strong><em>Again if the primary care clinician feels unable to secure a diagnosis, and particularly if there are concerns about alternative diagnoses, specialist referral should be considered.<\/em><\/strong><\/p>\n\n\n\n<p><strong>This page has been updated without specialty input by C.M, Referrals Advisor April 2024<\/strong><\/p>\n\n\n\n<div class=\"wp-block-getwid-tabs\" data-active-tab=\"0\"><ul class=\"wp-block-getwid-tabs__nav-links\"><\/ul>\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Referral Guidelines<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h4 class=\"wp-block-heading\">Who to refer:<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Patients with a clear diagnosis of ME-CFS confirmed, where a rehabilitative approach to fatigue is appropriate \u2013 please see <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/me-cfs-chronic-fatigue-rehabilitation-service\/\" target=\"_blank\" rel=\"noreferrer noopener\">ME-CFS Rehabilitation Service.<\/a><\/li>\n\n\n\n<li>Referral to other specialties where there are other concerns (see above).<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\"><strong>Who not to refer:<\/strong><\/h4>\n\n\n\n<p>Patients should not be referred:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>To discuss possible causations e.g. candida, rare and fastidious bacteria, environmental toxins etc.&nbsp;<\/li>\n\n\n\n<li>To discuss the results of unconventional tests carried out in the private sector.<\/li>\n\n\n\n<li>To request unconventional treatments not recommended within the NHS.<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\"><strong>How to refer:<\/strong><\/h4>\n\n\n\n<p>For rehabilitation approaches to fatigue, please see <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/me-cfs-chronic-fatigue-rehabilitation-service\/\" target=\"_blank\" rel=\"noreferrer noopener\">ME-CFS Rehabilitation Service<\/a>.<\/p>\n\n\n\n<p>Referral to other specialties is via the usual SCI Gateway pathways.<\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Primary Care Management<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p>This guidance is based on the <a href=\"https:\/\/www.gov.scot\/publications\/scottish-good-practice-statement-myalgic-encephalomyelitis-chronic-fatigue-syndrome-cfs\/\" target=\"_blank\" rel=\"noreferrer noopener\">Scottish Good Practice Statement on ME-CFS<\/a> but the recommended list of investigations has been adapted for Lothian following discussion with PLIG clinicians.<\/p>\n\n\n\n<p>The investigating clinician should undertake the following:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>A full history and a physical examination to exclude alternative diagnoses and to elicit characteristic features of ME-CFS. This needs to include a neurological and mental health assessment, and looking for signs of abnormal pigmentation, rashes or arthritis suggestive of systemic inflammatory disease, underlying cardiac or respiratory disease, lymphadenopathy, organomegaly or weight loss. The possibility of cancer should always be considered.<\/li>\n\n\n\n<li>Patients may have multiple symptoms (itself sometimes suggestive of the diagnosis) so useful to make a list of these, which also helps guide management.<\/li>\n\n\n\n<li>Examination should include erect and supine blood pressure and pulse rate (to exclude significant postural hypotension which can resemble some of the symptoms of ME\u2010CFS or be suggestive of hypoadrenalism).&nbsp; An increase in heart rate of over 30 bpm on standing may suggest <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/cardiology\/postural-tachycardia-syndrome-pots\/\" target=\"_blank\" rel=\"noreferrer noopener\">Postural Tachycardia Syndrome<\/a> (PoTS), a recognised co-morbid condition of ME-CFS. There may be other autonomic manifestations<\/li>\n<\/ul>\n\n\n\n<p><strong>As a minimum, all patients should have the following investigations to exclude alternative diagnoses:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>FBC, U&amp;Es and creatinine, LFTs (including albumin), TFTs, glucose (random),<br>ESR, C reactive protein, calcium, creatinine kinase, ferritin, HIV, HCV,HBV serology, urinalysis.<\/li>\n<\/ul>\n\n\n\n<p><strong>In addition to the above, Lothian guidance is to also consider:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><ul><li>Coeliac screen<\/li><\/ul>\n<ul class=\"wp-block-list\">\n<li>HIV, HCV and HBV serology<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Please also see the full Lothian guidance on <a href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Investigations-for-ME-CFS-Aug-2023-1.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">investigations for ME-CFS<\/a>.<\/li>\n\n\n\n<li>A differential diagnosis of <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/rheumatology\/fibromyalgia\/\" target=\"_blank\" rel=\"noreferrer noopener\">fibromyalgia<\/a> may also need to be considered, and some consider this an \u2018overlap\u2019 syndrome.<\/li>\n\n\n\n<li>FBC, U&amp;Es and creatinine, LFTs (including albumin), TFTs, glucose (random),<br>ESR, C reactive protein, calcium, creatinine kinase, ferritin, HIV, HCV,HBV serology, urinalysis.<\/li>\n<\/ul>\n\n\n\n<p class=\"has-alert-red-color has-text-color has-link-color wp-elements-dd80ede4f9300997a8e631ba671e6871\"><strong><em>If the primary care clinician feels unable to secure a diagnosis, and particularly if there are concerns about alternative diagnoses, specialist referral should be considered.<\/em><\/strong><\/p>\n\n\n\n<p><strong>Other investigations<\/strong><\/p>\n\n\n\n<p>These may be indicated depending on specific patient or clinical circumstances. When indicated by history or examination the following blood tests should also be considered:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Abnormal LFTs: AMA, CMV IgG and IgM. EBV serology, HIV, Hepatitis B+C (and see <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/gastrointestinal\/liverandbiliary\/\" target=\"_blank\" rel=\"noreferrer noopener\">Liver and Biliary<\/a> for more detail)<\/li>\n\n\n\n<li>Weight loss or GI upset: coeliac serology, HIV serology<\/li>\n\n\n\n<li>Cardiological symptoms: ECG<\/li>\n\n\n\n<li>Lymphadenopathy: HIV, EBV, CMV, toxoplasmosis, syphilis (and see <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/haematology\/lymphadenopathy\/\" target=\"_blank\" rel=\"noreferrer noopener\">lymphadenopathy<\/a>)<\/li>\n\n\n\n<li>Lyme serology where there are specific indications.<\/li>\n<\/ul>\n\n\n\n<p><strong>The following investigations are <em>not <\/em>currently indicated:<\/strong><\/p>\n\n\n\n<p><strong>Laboratory tests:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Vitamin B12 &amp; folate (where normal FBC)<\/li>\n\n\n\n<li>Candida albicans<\/li>\n\n\n\n<li>Fibrinogen<\/li>\n\n\n\n<li>Lactate dehydrogenase<\/li>\n\n\n\n<li>Mitochondrial testing<\/li>\n\n\n\n<li>Platelet activation<\/li>\n\n\n\n<li>Protein electrophoresis<\/li>\n\n\n\n<li>Prothrombin fragment 1&amp;2<\/li>\n\n\n\n<li>Soluble fibre monomer<\/li>\n\n\n\n<li>Thrombin-antithrombin complexes<\/li>\n\n\n\n<li>Xenotropic murine leukaemia virus-related virus (XMRV) serology<\/li>\n<\/ul>\n\n\n\n<p>Other:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>MRI brain scan (in the absence of objective neurological signs)<\/li>\n\n\n\n<li>PET imaging<\/li>\n\n\n\n<li>SPECT imaging<\/li>\n\n\n\n<li>Tilt-table testing (in the absence of unexplained syncope or other clinical indications)<\/li>\n\n\n\n<li>Auditory brainstem responses<\/li>\n\n\n\n<li>Electroencephalography (EEG)<\/li>\n\n\n\n<li>electrodermal activity<\/li>\n<\/ul>\n\n\n\n<p><strong><u>Management Principles.<\/u><\/strong><\/p>\n\n\n\n<p>Please see the RefHelp summary of the Scottish Good Practice Statement on <a href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/ME-CFS-Post-Diagnosis-Management-Summary-May-2024.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">management of ME-CFS following diagnosis<\/a>.<\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Resources and Links<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p><a href=\"https:\/\/www.nice.org.uk\/guidance\/NG206\" target=\"_blank\" rel=\"noreferrer noopener\">ME-CFS Guideline NICE<\/a><\/p>\n\n\n\n<p><a href=\"https:\/\/www.gov.scot\/publications\/scottish-good-practice-statement-myalgic-encephalomyelitis-chronic-fatigue-syndrome-cfs\/\" target=\"_blank\" rel=\"noreferrer noopener\">Scottish Good Practice Statement on ME-CFS<\/a><\/p>\n\n\n\n<p><a href=\"https:\/\/www.actionforme.org.uk\/\" target=\"_blank\" rel=\"noreferrer noopener\">Action for M.E<\/a><\/p>\n\n\n\n<p><a href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Investigations-for-ME-CFS-Aug-2023-1.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Investigations-for-ME-CFS-Aug-2023.pdf<\/a><\/p>\n\n\n\n<p><a href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/ME-CFS-Post-Diagnosis-Management-Summary-May-2024.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/apps.nhslothian.scot\/files\/sites\/2\/ME-CFS-Post-Diagnosis-Management-Summary-May-2024.pdf<\/a><\/p>\n\n\n\n<p>For patients with fatigue following a viral illness (including Covid-19):<\/p>\n\n\n\n<p><a href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Guidance-on-managing-post-viral-fatigue-V1-0.pdf\" data-type=\"URL\" data-id=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Guidance-on-managing-post-viral-fatigue-V1-0.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Guidance on managing post viral fatigue V1 0.pdf<\/a><\/p>\n\n\n\n<p><a rel=\"noreferrer noopener\" href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Initial-Management-of-Fatigue-V-1-0-1.pdf\" data-type=\"URL\" data-id=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Initial-Management-of-Fatigue-V-1-0-1.pdf\" target=\"_blank\">Initial Management of post viral fatigue V1 0.pdf<\/a><\/p>\n\n\n\n<p><\/p>\n<\/div><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>The Scottish Government has withdrawn the Scottish Good Practice Statement on ME &ndash; CFS from May 2025 and RefHelp will be updated shortly. However, the diagnostic and management approaches remain broadly relevant and were approved by the Lothian GP Sub-Committee. NHS Lothian does not offer a specific diagnostic service for Myalgic Encephalomyelitis &ndash; Chronic Fatigue<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":4364,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"categories":[287],"class_list":["post-3791","page","type-page","status-publish","hentry","category-me-cfs"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"NHS Lothian","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/nhs-lothian\/"},"rttpg_comment":0,"rttpg_category":" <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/infectiousdiseases\/me-cfs\/\" rel=\"tag\">Chronic Fatigue Syndrome: ME-CFS<\/a>","rttpg_excerpt":"The Scottish Government has withdrawn the Scottish Good Practice Statement on ME &ndash; CFS from May 2025 and RefHelp will be updated shortly. However, the diagnostic and management approaches remain broadly relevant and were approved by the Lothian GP Sub-Committee. NHS Lothian does not offer a specific diagnostic service for Myalgic Encephalomyelitis &ndash; Chronic Fatigue","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3791","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=3791"}],"version-history":[{"count":38,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3791\/revisions"}],"predecessor-version":[{"id":24279,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3791\/revisions\/24279"}],"up":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4364"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=3791"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=3791"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}