Escalante A, Fischbach M
Department of Medicine, The University of Texas Health Science Center at San Antonio, 78284, USA.
J Rheumatol. 1998 Nov;25(11):2228-35.
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.
关节及其他部位疼痛一直是经历不明病因疾病的沙漠风暴行动退伍军人常见的主诉。我们对一组被转诊至风湿病诊所的海湾战争退伍军人的风湿表现进行了特征描述。
连续被转诊以评估风湿表现的南德克萨斯海湾战争退伍军人接受了肌肉骨骼症状、疼痛及健康相关生活质量的全面评估。
在一家筛查诊所接受不明症状评估的928名退伍军人中，145人有风湿表现（15.6%）并被转诊至风湿病诊所。最常见的诊断是纤维肌痛，49例（33.8%），其次是各种软组织问题25例（17.2%）、非特异性关节痛14例（9.6%）、临床或影像学骨关节炎16例（11.0%）。39例患者（26.9%）在评估时无症状，仔细的肌肉骨骼检查和实验室检查正常，无法做出诊断。2例患者患有赖特综合征。4例类风湿因子阳性，3例抗核抗体阳性，但这些患者均无类风湿关节炎或系统性红斑狼疮的临床证据。几乎所有患者都有疼痛，且分布广泛，该组患者身体各部位均受累。最常疼痛的部位是膝盖（>65%）、下背部（>60%）、肩部（50%）以及手和手腕（35%）。65.1%的退伍军人有全身广泛性疼痛。SF - 36健康调查所测量的所有8个量表的平均值均低于已公布的全国规范的第25百分位数，疼痛和非关节性风湿症状的数量解释了我们所评估的退伍军人中与健康相关生活质量下降的大部分原因。
转诊至风湿病诊所的患有不明病因疾病的海湾战争退伍军人没有特定的风湿诊断特征。然而，这些患者疼痛常见且广泛，他们与健康相关的生活质量较差。有必要进一步研究以确定海湾战争退伍军人症状的原因。
