Benefits and Harms of Doxycycline Treatment for Gulf War Veterans' Illnesses

Donta, Sam T.; Engel, Charles C.; Collins, Joseph F.; Baseman, Joel B.; Dever, Lisa L.; Taylor, Thomas N.; Boardman, Kathy D.; Kazis, Lewis E.; Martin, Suzanne E.; Horney, Rebecca A.; Wiseman, Annette L.; Kernodle, Douglas S.; Smith, Raymond P.; Baltch, Aldona L.; Handanos, Christine; Catto, Brian A.; Montalvo, Luis; Everson, Michael P.; Blackburn, Warren D.; Thakore, Manisha; Brown, Sheldon T.; Lutwick, Larry I.; Norwood, Dorothy; Bernstein, J.; Bacheller, Catherine; Ribner, Bruce S.; Church, L. W. Preston; Wilson, Kenneth H.; Guduru, Prabhakar; Cooper, Robert B.; Lentino, Joseph R.; Hamill, Richard J.; Gorin, Arnold B.; Gordan, Victor; Wagner, David R.; Robinson, Clifford G.; Dejace, Pierre; Greenfield, Ronald A.; Beck, Lisa A.; Bittner, Marvin J.; Schumacher, H. Ralph; Silverblatt, Fredric J.; Schmitt, James M.; Wong, Edward S.; Ryan, Margaret A. K.; Figueroa, Javier; Nice, Christopher; Feussner, John R.

doi:10.7326/0003-4819-141-2-200407200-00006

Cited by 48 publications

(21 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The patients were deployed US veterans of the first Gulf War and originated from the referral area to the Philadelphia VA Medical Center. They were initially seen at this institution in a screening clinic for individuals with suspected GWVI and met entry criteria for a study of treatment for GWVI with doxycycline (7). All patients in that study had been deployed to the Persian Gulf area between August 1990 and August 1991, developed manifestations of GWVI after deployment, and had symptoms for at least 6 months (7).…”

Section: Methodsmentioning

confidence: 99%

Absence of histologic evidence of synovitis in patients with Gulf War veterans' illness with joint pain

Díaz-Torné

Schumacher

Xiang

et al. 2007

Arthritis & Rheumatism

View full text Add to dashboard Cite

Objective. An unexplained multisymptom illness, Gulf War veterans' illness (GWVI), has been described among allied force veterans of the first Gulf War (1990War ( -1991. It has been proposed that some of its symptoms reflect an immune dysfunction, and rheumatologic symptoms including joint pain and stiffness are reported frequently. However, it is unknown whether synovial inflammation causes the articular symptoms. We examined synovial tissue from individuals with GWVI and joint pain for evidence of inflammation. Methods. We compared synovial biopsy samples from 6 individuals with GWVI and joint pain with samples from 9 clinically asymptomatic controls (hematoxylin and eosin [H&E] stains only) and biopsy samples or surgically obtained specimens from 10 patients with rheumatoid arthritis (RA) and 12 with osteoarthritis (OA). Inflammatory changes were quantified in H&E stained sections with a modified synovitis score by immunostaining for CD3, CD20, CD38, CD68, Ki-67, and von Willebrand factor, and with a composite inflammation score based on these markers. Results. Normal histology was seen in the GWVI specimens, except for mild focal lining hyperplasia and rare low-grade perivascular infiltrates in 1 specimen each. Mean ؎ SEM synovitis scores were lowest and nearly identical in control (1.38 ؎ 0.30) and GWVI specimens (1.41 ؎ 0.29), intermediate in OA specimens (2.64 ؎ 0.39), and highest in RA specimens (6.0 ؎ 0.19). Likewise, inflammatory cells, cell division, vascular density, and composite inflammation score were lowest in the GWVI specimens. Conclusion. Despite significant joint pain, the GWVI synovia did not differ from normal controls. These results agree with other studies that have failed to document inflammatory or immunologic etiologies in GWVI.

show abstract

Section: Methodsmentioning

confidence: 99%

Absence of histologic evidence of synovitis in patients with Gulf War veterans' illness with joint pain

Díaz-Torné

Schumacher

Xiang

et al. 2007

Arthritis & Rheumatism

View full text Add to dashboard Cite

show abstract

“…Most important from a practical viewpoint is the utility of antibiotic treatment aimed against Mycoplasma in this clinical spectrum. This issue was addressed in a rigorous, placebo-controlled double-blind study conducted on patients suffering from Gulf War syndrome, an entity which shares many overlapping characteristics with fibromyalgia and CFS, including pain, fatigue and cognitive symptoms [29]. The study focused on 491 patients with detectible blood Mycoplasma DNA.…”

Section: Mycoplasma Fibromyalgia and Chronic Fatiguementioning

confidence: 99%

Fibromyalgia, infection and vaccination: Two more parts in the etiological puzzle

Ablin

Shoenfeld

Buskila

2006

Journal of Autoimmunity

View full text Add to dashboard Cite

“…4 Gulf War veterans participating in a 6-month doxycycline prophylaxis study also exhibited problems with side effects and poor medication adherence. 44 Adherence to protracted antibiotic regimens for individuals who feel healthy might be expected to be less than for short-term acute antibiotic treatment of infectious illness [45][46][47] and more similar to long-term medication for chronic diseases such as tuberculosis, hypertension, or diabetes. 48,49 Providers of extended prophylaxis following bioterrorism or other mass exposures may thus anticipate the discontinuation of antibiotics and other antidotes with treatment courses of 2 months or longer, potentially leading to negative medical outcomes.…”

Section: Discussionmentioning

confidence: 99%

Exposure to Bioterrorism and Mental Health Response among Staff on Capitol Hill

North

Pfefferbaum

Vythilingam

et al. 2009

Biosecurity and Bioterrorism: Biodefense Strategy, Practice, an

View full text Add to dashboard Cite

The October 2001 anthrax attacks heralded a new era of bioterrorism threat in the U.S. At the time, little systematic data on mental health effects were available to guide authorities' response. For this study, which was conducted 7 months after the anthrax attacks, structured diagnostic interviews were conducted with 137 Capitol Hill staff workers, including 56 who had been directly exposed to areas independently determined to have been contaminated. Postdisaster psychopathology was associated with exposure; of those with positive nasal swab tests, PTSD was diagnosed in 27% and any postanthrax psychiatric disorder in 55%. Fewer than half of those who were prescribed antibiotics completed the entire course, and only one-fourth had flawless antibiotic adherence. Thirty percent of those not exposed believed they had been exposed; 18% of all study participants had symptoms they suspected were symptoms of anthrax infection, and most of them sought medical care. Extrapolation of raw numbers to large future disasters from proportions with incorrect belief in exposure in this limited study indicates a potential for important public health consequences, to the degree that people alter their healthcare behavior based on incorrect exposure beliefs. Incorrect belief in exposure was associated with being very upset, losing trust in health authorities, having concerns about mortality, taking antibiotics, and being male. Those who incorrectly believe they were exposed may warrant concern and potential interventions as well as those exposed.Treatment adherence and maintenance of trust for public health authorities may be areas of special concern, warranting further study to inform authorities in future disasters involving biological, chemical, and radiological agents.Carol S.

show abstract

Benefits and Harms of Doxycycline Treatment for Gulf War Veterans' Illnesses

Abstract: Long-term treatment with doxycycline did not improve outcomes of GWVIs at 1 year.

Cited by 48 publications

References 27 publications

Absence of histologic evidence of synovitis in patients with Gulf War veterans' illness with joint pain

Absence of histologic evidence of synovitis in patients with Gulf War veterans' illness with joint pain

Fibromyalgia, infection and vaccination: Two more parts in the etiological puzzle

Exposure to Bioterrorism and Mental Health Response among Staff on Capitol Hill

Contact Info

Product

Resources

About