Pain in the joints and other areas has been a
frequent complaint among veterans of Operation Desert Storm
who are experiencing unexplained illness. We characterized the
rheumatic manifestations of a group of veterans of the Persian
Gulf War who were referred to a rheumatology clinic.
Consecutive South Texas veterans of the Persian Gulf War who
were referred for evaluation of rheumatic manifestations
underwent a comprehensive evaluation of their musculoskeletal
symptoms, pain, and health related quality of life.
Of 928 veterans evaluated in a screening clinic for
unexplained symptoms, 145 had rheumatic manifestations (15.6%)
and were referred to a rheumatology clinic. The most common
diagnosis was fibromyalgia, present in 49 patients (33.8%),
followed by various soft tissue problems in 25 (17.2%),
nonspecific arthralgias in 14 (9.6%), and clinical or
radiographic osteoarthritis in 16 (11.0%). In 39 patients
(26.9%), no symptoms were present at the time of the
evaluation, a careful musculoskeletal examination and
laboratory tests were normal, and no diagnosis was possible.
Two patients had Reiter's syndrome. Four had a positive
rheumatoid factor and 3 had antinuclear antibodies, but none
of these had clinical evidence of rheumatoid arthritis or
systemic lupus erythematosus. Pain was present in nearly all
patients and was widely distributed, with no body area spared
in this group of patients. The most frequent painful areas
were the knees in > 65%, the lower back in > 60%, the
shoulders in 50%, and the hands and wrists in 35%. Widespread
body pain was present in 65.1% of the veterans. Average values
of all 8 scales measured by the SF-36 health survey were below
the 25th percentile of published national norms, with pain and
the number of nonarticular rheumatic symptoms explaining most
of the decreased health related quality of life in the
veterans we evaluated.
No specific rheumatic diagnosis is characteristic of Gulf War veterans
with unexplained illness referred to a rheumatology clinic.
However, pain is common and widespread in these patients, and
their health related quality of life is poor. Further research
is necessary to determine the cause of the symptoms of
veterans of the Gulf War.