MUSCULOSKELETAL MANIFESTATIONS, PAIN, AND QUALITY-OF-LIFE IN PERSIAN-GULF-WAR VETERANS REFERRED FOR RHEUMATOLOGIC EVALUATION

Objective. Pain in the joints and other areas has been a frequent comp laint among veterans of Operation Desert Storm who are experiencing un explained illness. We characterized the rheumatic manifestations of a group of veterans of the Persian Gulf War who were referred to a rheum atology clinic. Methods. Consecutive South Texas veterans of the Persi an Gulf War who were referred for evaluation of rheumatic manifestatio ns underwent a comprehensive evaluation of their musculoskeletal sympt oms, pain, and health related quality of life. Results. Of 928 veteran s evaluated in a screening clinic for unexplained symptoms, 145 had rh eumatic manifestations (15.6%) and were referred to a rheumatology cli nic. The most common diagnosis was fibromyalgia, present in 49 patient s (33.8%), followed by various soft tissue problems in 25 (17.2%), non specific arthralgias in 14 (9.6%), and clinical or radiographic osteoa rthritis in 16 (11.0%). In 39 patients (26.9%), no symptoms were prese nt at the time of the evaluation, a careful musculoskeletal examinatio n 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 evid ence of rheumatoid arthritis or systemic lupus erythematosus. Pain was present in nearly all patients and was widely distributed, with no bo dy area spared in this group of patients. The most frequent painful ar eas 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 presen t 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 n ational norms, with pain and the number of nonarticular rheumatic symp toms explaining most of the decreased health related quality of life i n the veterans we evaluated. Conclusion. No specific rheumatic diagnos is is characteristic of Gulf War veterans with unexplained illness ref erred 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 o f veterans of the Gulf War.