Brain–Immune Interactions as the Basis of Gulf War Illness: Clinical Assessment and Deployment Profile of (...), 2021, Steele, Klimas et al

Abstract

The Boston University-based Gulf War Illness Consortium (GWIC) is a multidisciplinary initiative developed to provide detailed understanding of brain and immune alterations that underlie Gulf War illness (GWI), the persistent multisymptom disorder associated with military service in the 1990–1991 Gulf War.

The core GWIC case-control clinical study conducted in-depth brain and immune evaluation of 269 Gulf War veterans (223 GWI cases, 46 controls) at three U.S. sites that included clinical assessments, brain imaging, neuropsychological testing, and analyses of a broad range of immune and immunogenetic parameters. GWI cases were similar to controls on most demographic, military, and deployment characteristics although on average were two years younger, with a higher proportion of enlisted personnel vs. officers.

Results of physical evaluation and routine clinical lab tests were largely normal, with few differences between GWI cases and healthy controls. However, veterans with GWI scored significantly worse than controls on standardized assessments of general health, pain, fatigue, and sleep quality and had higher rates of diagnosed conditions that included hypertension, respiratory and sinus conditions, gastrointestinal conditions, and current or lifetime depression and post-traumatic stress disorder.

Among multiple deployment experiences/exposures reported by veterans, multivariable logistic regression identified just two significant GWI risk factors: extended use of skin pesticides in theater (adjusted OR = 3.25, p = 0.005) and experiencing mild traumatic brain injury during deployment (OR = 7.39, p = 0.009). Gulf War experiences associated with intense stress or trauma (e.g., participation in ground combat) were not associated with GWI. Data and samples from the GWIC project are now stored in a repository for use by GWI researchers.

Future reports will present detailed findings on brain structure and function, immune function, and association of neuroimmune measures with characteristics of GWI and Gulf War service.

Open access: https://www.mdpi.com/2076-3425/11/9/1132

 

I think the comparison of enlisted vs officer is an artefact of control group selection and should not be considered significant experimentally but is indicative of methodological bias.

The control group also seems a little small to me at 17% of subjects.

 

Tender points as diagnostic aids are not present in the most current (2016) guide to diagnosing fibromyalgia, rather the number of areas of pain throughout the body is emphasized.

 

After reading the comments in the NICE document I have become very aware of what researchers and doctors consider CFS or ME/CFS to be.

The only thing in the table that could be specific to ME is feeling unwell after exercise but while that could be PEM it could also be a way of describing heart disease or lung disease or even MS or RA.

Basically, they are describing a situation where fatigue is constant and debilitating and I now believe that this is exactly what doctors consider ME to be and why they think CFS is the better name with CFS/ME thrown in to appease the patients.

We are still in a situation where we suspect it could be ME but no one is asking the right questions to be certain. It is not far from diagnosing chronic fatigue by asking how often people use the lifts instead of climbing the stairs. We are forced to read between the lines of everything and it is just not right we should have to do it. The fact that many of us are so good at it has actually pushed the field forward and I admire the people who can do that.

This is another point where the research and diagnosis is confused. If they are just looking at how many areas of pain there are, how is it possible to differentiate between fibromyalgia and the widespread pain of Myalgic (the clue is in the name) Encephalomyelitis. A doctor told me that at the Royal Free patients hit the roof when they were touched and I have been in pain in some part of my body constantly for over fifty years.

The association with fibro came when CFS was invented and now we have things like POTS added on, even "experts" in the UK claiming that PEM is another disease, instead of seeing widespread pain, dysautonomia and an abnormal reaction to exercise as intrinsic parts of the disease.

I am sick of this guessing game. On forums and within the charities (up to a point!) we know what ME does to you but it is time researchers and doctors had enough respect for us to accept we know more about what the disease is than they do.

 

I agree with you, Hutan but it is the "feeling unwell after physical exertion" that gets to me especially. Surely they could have done better than that. Asking if there are times when there is a delay after exertion before feeling unwell would be very informative. It could hardly add to the cost of the trial to add another question and it makes me wonder if they know this often happens in ME.