Musculoskeletal complaints in persian Gulf War Veterans

Musculoskeletal complaints are common in patients who are being evaluated for the "Gulf War Syndrome." The objective of this study was to describe these musculoskeletal complaints, laboratory findings, and diagnoses in patients referred for the standardized Department of Defense Comprehensive Clinical Evaluation Program. This study was conducted prospectively and completed at a military medical center. Any military health care beneficiary who served in the Persian Gulf was eligible for evaluation. One thousand one hundred fifty patients were evaluated, and of these, 18% were referred to a rheumatologist for evaluation of musculoskeletal complaints. Most patients complained of polyarthalgias, knee pain, and/or back pain. The most common diagnoses were patellofemoral pain syndrome, bursitis, tendonitis, and nonspecific low back pain. Thirtyseven patients (18%) had fibromyalgia, and 8 patients had an inflammatory arthritis. Extensive laboratory testing was not specific for any diagnosis. Fourteen percent of the cohort had a normal evaluation and were not given a diagnosis to explain their symptoms. In our cohort, musculoskeletal complaints were common, with the majority being non-inflammatory. We recommend that these patients be evaluated with a thorough history and physical examination, placing emphasis on occupational or daily activities that may lead to overuse syndromes or soft tissue rheumatism. Laboratory and radiologic procedures should focus on items identified in the history and physical examination and be used to answer specific clinical questions.