Joint Pain in Gulf War Syndrome Appears Not To Be
Inflammatory But Rather Neurological: Presented at ACR-ARHP
By Maggie Schwarz
November 15, 2006
http://www.docguide.com/news
WASHINGTON, DC -- November 15, 2006 -- Joint pain in veterans with Gulf War
syndrome appears to be a stress response similar to fibromyalgia or chronic
fatigue syndrome, rather than an inflammatory one, researchers reported here at
the American College of Rheumatology - Association of Rheumatology Health
Professionals Annual Scientific Meeting (ACR-ARHP).
Frank Pessler, MD, PhD, research associate, University of Pennsylvania School of
Medicine, Philadelphia, Pennsylvania, and colleagues performed a histological
examination of synovial biopsies from Gulf War veterans complaining of
rheumatologic symptoms.
Gulf War syndrome is a dramatically symptomatic, incompletely explained illness
described among US and British military personnel who returned from the First
Gulf War (1990-1991). Some of its symptoms may reflect underlying immune
dysfunction. Rheumatologic symptoms, including joint pain and stiffness, are
reported frequently, yet whether synovitis is a cause of the articular
complaints in these individuals has not been determined until now.
Dr. Pessler and colleagues hypothesized that exposure to a large number of
immunizations or toxins might have triggered the joint inflammation associated
with Gulf War syndrome.
The researchers obtained biopsies from 9 veterans with Gulf War syndrome, and
obtained 7 specimens with sufficient tissue quality for analysis. Specimens from
11 patients with rheumatoid arthritis and 14 with osteoarthritis were used as
controls.
Inflammatory changes were quantified using a synovitis score. Cell division and
vascular density were also measured. Differences were also assessed using a
composite inflammation score that consolidates results from immunohistochemical
parameters into one value.
Microscopy revealed normal synovial tissue with changes consistent with healthy
joints. Inflammatory cells (macrophages, T cells, CD20 B lymphocytes CD3, CD38
and CD68) were absent.
Mean synovitis score of 1.39 +/- 0.29 corresponded to absence of synovitis.
Consistent with these results, inflammatory cell densities, cell division index,
vascular density and inflammation score were lowest in Gulf War syndrome,
intermediate in controls with osteoarthritis and highest in controls with
rheumatoid arthritis.
The low numbers of inflammatory cells, which were occasionally seen, were
similar to the background frequency expected in synovial biopsies from
asymptomatic knee joints.
Dr. Pessler concluded that prevailing thinking on Gulf War syndrome that points
to a neurological stress response rather than an inflammatory one appears to be
correct.
[Presentation title: Absence of Inflammation in Synovial Biopsies Form Patients
With "Gulf War Syndrome" and Joint Pain. Abstract 160]