Gulf war and CFS/etc

[Guest guest]

Not that this will be news to anyone on this list, but

from an official source such as MEDLINE which offers

CME's for doctors, it's a bit of progress.

Jim

Gulf War Deployment May Have Increased the Risk of

Fibromyalgia, Chronic Fatigue, Skin Conditions, and

Dyspepsia CME

News Author: Laurie Barclay, MD

CME Author: Vega, MD, FAAFP

Complete author affiliations and disclosures, and

other CME information, are available at the end of

this activity.

Release Date: June 6, 2005; Valid for credit through

June 6, 2006

Credits Available

Physicians - up to 0.25 AMA PRA Category 1 continuing

physician education credits

All other healthcare professionals completing

continuing education credit for this activity will be

issued a certificate of participation.

Participants should claim only the number of hours

actually spent in completing the educational activity.

June 6, 2005 — Gulf War deployment is associated with

an increased risk of fibromyalgia, chronic fatigue,

skin conditions, and dyspepsia, according to the

results of a cross-sectional survey published in the

June issue of the ls of Internal Medicine.

" United States military personnel reported various

symptoms after deployment to the Persian Gulf during

the 1991 Gulf War, " write Seht A. Eisen, MD, from the

Veterans Affairs Medical Center, Washington University

School of Medicine, in St. Louis, Missouri, and

colleagues from the Gulf War Study Participating

Investigators. " However, the symptoms' long-term

prevalence and association with deployment remain

controversial. "

In this cross-sectional prevalence study performed 10

years after the 1991 Gulf War, 1,061 deployed and

1,128 nondeployed veterans were examined at one of 16

Veterans Affairs medical centers. Primary outcomes

were fibromyalgia, chronic fatigue syndrome,

dermatologic conditions, dyspepsia, physical

health–related quality of life (Short Form-36

[sF-36]), hypertension, obstructive lung disease,

arthralgias, and peripheral neuropathy.

Four of 12 conditions were more prevalent among

deployed than nondeployed veterans: fibromyalgia (2.0%

vs 1.2%; odds ratio [OR], 2.32; 95% confidence

interval [CI], 1.02 - 5.27), chronic fatigue syndrome

(1.6% vs 0.1%; OR, 40.6; 95% CI, 10.2 - 161),

dermatologic conditions (34.6% vs 26.8%; OR, 1.38; 95%

CI, 1.06 - 1.80), and dyspepsia (9.1% vs 6.0%; OR,

1.87; 95% CI, 1.16 - 2.99). The mean physical

component summary score of the SF-36 was 49.3 for

deployed veterans and 50.8 for nondeployed veterans.

" Ten years after the Gulf War, the physical health of

deployed and nondeployed veterans is similar, " the

authors write. " However, Gulf War deployment is

associated with an increased risk for fibromyalgia,

the chronic fatigue syndrome, skin conditions,

dyspepsia, and a clinically insignificant decrease in

the SF-36 physical component score. "

Study limitations include relatively low participation

rates, introducing potential participation bias;

failure to detect deployment-related illnesses that

resolved before the research examination; collection

of data focused on the major symptom groups reported

by Gulf War veterans; cross-sectional design; lack of

blinding; observer bias; limited sample size; and

failure to determine differences in death rates and

causes of death among eligible veterans who did not

participate in the study.

" Health care providers should be particularly alert

for these conditions when examining veterans who

served in the Persian Gulf region during either the

1991 Gulf War or the current conflict, " the authors

conclude. " More field studies are needed, perhaps with

prospective monitoring of U.S. personnel deployed in

the Middle East for the development of these

conditions. "

The ative Studies Program of the U.S. Department

of Veterans Affairs Office of Research and Development

supported this study. The authors report no financial

conflict of interest.

In an accompanying editorial, L. Komaroff, MD,

from the Harvard Medical School and Brigham and

Women's Hospital in Boston, Massachusetts, describes

these findings as " robust evidence that armed forces

personnel from several countries who were deployed to

the Gulf War in the early 1990s have been more likely

to report debilitating symptoms than armed forces

personnel deployed elsewhere during the same time. "

However, he does not believe there is convincing

evidence that this symptom constellation constitutes a

unique syndrome.

" A country that sends its young people to war has an

obligation to study all illnesses that occur in the

aftermath of war, not just traumatic injury, " Dr.

Komaroff writes. " All illness like the Gulf War

syndrome has been chronicled after every armed

conflict since the Civil War, yet no systematic

attempts have been made to understand it. Our armed

forces deserve far better. Whatever the cause, the

suffering is real. "

Dr. Komaroff reports no potential conflicts of

interest.

Ann Intern Med. 2005;142:881-890, 938-939

Learning Objectives for This Educational Activity

Upon completion of this activity, participants will be

able to:

* List common health complaints among veterans who

participated in the 1991 U.S. Gulf War.

* Identify clinically defined illnesses more

likely to be prevalent in Gulf War veterans.

Clinical Context

The constellation of symptoms related to the first

U.S. Gulf War has been frequently profiled in the

medical literature as well as the popular media, but

categorization of these symptoms into a specific

syndrome has been difficult. An editorial by Komaroff,

which accompanies the current article, lists the most

common symptoms reported by these veterans as fatigue,

rashes, headache, muscle and joint pain, and memory

impairment. Although these symptoms contributed to

significant rates of disability in Gulf War veterans

in 2001, these veterans had similar risks of

hospitalization and death when compared with military

personnel not serving in the Gulf War.

The authors of the current study sought to confirm the

higher prevalence of subjective symptoms reported by

Gulf War veterans by employing multiple objective

measures of disease.

Study Highlights

* The study cohort was a subset of deployed and

nondeployed military personnel first queried in 1995

regarding self-reported conditions related to the Gulf

War.1,996 deployed and 2,883 nondeployed personnel

were invited to participate in the current study.

* Subjects who joined the study underwent a

thorough history and physical examination at Veterans

Affairs medical centers, along with laboratory tests.

Researchers were specifically looking for evidence of

fibromyalgia, chronic fatigue syndrome, peripheral

neuropathy, self-reported lower quality of life,

dermatologic conditions, dyspepsia, hypertension,

hepatitis, obstructive lung disease, and thyroid

disorders. All of these conditions were diagnosed

during the examination by standard, well-accepted

criteria. Examiners were not blinded to deployment

status, although data analysis was performed by

blinded personnel.

* Neurologic and psychiatric data were also

assessed and will be reported in later articles by the

study authors.

* The percentages of invited personnel who could

not be located for study participation were similar in

the deployed and nondeployed cohorts. More nondeployed

(45.7%) than deployed (34.1%) personnel declined to

participate in the study. Nonparticipants were more

likely to be older, female, white, and in the military

reserves. Study participants reported more symptoms

than did nonparticipants.

* Deployed participants were younger (38.9 vs 40.7

years), had a lower rate of college graduation, had a

lower average annual family income, and were more

likely to be single compared with the nondeployed

group.

* The deployed and nondeployed groups were similar

for most self-reported outcomes measured. Deployed

participants had higher rates of self-report of skin

rash (39.8% vs 27.6%) and chronic fatigue syndrome

(2.3% vs 0.4%).

* On clinical evaluation, deployed study subjects

were found to be significantly more likely to have

skin conditions, fibromyalgia, dyspepsia, and chronic

fatigue syndrome compared with the nondeployed cohort.

* Of 38 deployed study subjects who reported

chronic fatigue syndrome, only 3 had clinical criteria

qualifying for the diagnosis. 8 study subjects in the

nondeployed cohort reported chronic fatigue syndrome,

and only 2 received the diagnosis after clinical

evaluation. Nonetheless, the OR of chronic fatigue

syndrome associated with Gulf War deployment was 40.6.

* The rates of clinically discovered skin

conditions not related to trauma or sun exposure was

34.6% in the deployed cohort and 26.8% in the

nondeployed group. Higher rates of atopic dermatitis

and verruca vulgaris accounted for much of this

difference.

* Rates of fibromyalgia were 2% and 1.2% in the

deployed and nondeployed groups, respectively.

Respective rates of gastritis were 9.1% and 6%.

* There was a small but significant difference in

quality-of-life scores, favoring the nondeployed

group.

* Rates of findings of abnormalities on physical

examination were similar between the deployed and

nondeployed groups. 40 laboratory evaluations were

performed on the study cohort, with no significant

differences suggesting a particular organ or system

dysfunction associated with Gulf War deployment.