Joint Pain in Gulf War Syndrome

Joint Pain in Gulf War Syndrome Appears Not To Be Inflammatory But Rather Neurological: Presented at ACR-ARHP
By Maggie Schwarz

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] November 15, 2006