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Andre Barkhuizen, Stephen M. Campbell,
Robert M. Bennett, Daniel Storzbach, Michael R. Lasarev, Linda A. McCauley,
Sandra Joos, Michael L. Wynn, S. Wendy Johnston, Ronald Grewenow, Diane
S. Rohlman, W. Kent Anger, Laurence M. Binder, Keith A. Campbell, Peter
S. Spencer, Dennis N. Bourdette
Portland Environmental Hazards Research Center
(PEHRC)
We describe the rheumatologic and neuropsychologic features
of 349 deployed Persian Gulf War (PGW) veterans (32.8+8yrs; 83%M) from
a population-based case-control study. Data are presented on 229 cases
(unexplained musculoskeletal, MSS, cognitive/psychologic, fatigue, gastrointestinal
and/or dermatologic symptoms) and 120 controls. Unexplained MSS pain was
present in 84 cases (37%). Fibromyalgia was present in 50 and fatigue
in 47 of the MSS cases. Cases were more likely than controls to have musculoskeletal
complaints (86% vs 27%; p<0.001). Some regional syndromes were more
common amongst cases: mechanical backache (39% vs 18%; p<0.001), myofascial
pain syndrome (24% vs 11%; p=0.006), and patellofemoral syndrome (12%
vs 2%; p=0.002). There was no difference for tendinitis (16% vs 8%), osteoarthritis
(8% vs 4%), overuse syndrome (4% vs 2%), or hypermobility (6% vs 6%).
Inflammatory conditions were infrequent (spondyloarthropathy, 4; and systemic
lupus erythematosis and rheumatoid arthritis, 1 each). Elevated creatinine
kinase levels were present in 15% of cases and controls; and antinuclear
antibody >1:40 in 2% of cases and 3% of controls. MSS cases were significantly
more likely to complain of muscle weakness or cramps, post-exertional
pain, restless legs, headaches, chest pain, abdominal cramps, cold intolerance,
tender skin, dry eyes; and sleep complaints of unrefreshed sleep or bruxism.
MSS cases scored significantly higher on the Fibromyalgia Impact Questionnaire;
Beck Anxiety and Depression Inventory; SF 36 (pain, energy/fatigue, physical
and physical role function, health change, emotional role function, health
perception and social function); and "somatization" sub-scales
of the MMPI and SCL-90. MSS cases reported significantly more combat exposure
and higher post traumatic stress scores (MISS, PENN, PCL C), with greater
negative control and negative impact on the Life Events Scale. Finally,
MSS cases and, in particular, those with fibromyalgia, displayed neurobehavioral
abnormalities of attention and memory (digit span backward, reaction time
and Oregon Digit Recognition).
In conclusion, a wide range of musculoskeletal conditions
is found amongst veterans who were deployed to S.W. Asia during the Persian
Gulf War. Thirty seven percent of cases fulfill criteria for fibromyalgia
or have unexplained MSS symptoms. There are significant differences between
MSS cases and controls in neuropsychological and neurobehavioral tests.
"Keywords:" Musculoskeletal Neuropsychological
Case/Control Study
This work was supported by a grant from the Department of
Veterans Affairs to the PEHRC, a joint project of the Portland Veterans
Affairs Medical Center and the Center for Research on Occupational and
Environmental Toxicology, Oregon Health Sciences University.
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