Blog | Thursday, March 13, 2014

QD: News Every Day--2 definitions may help treat Gulf War veterans with multisymptom illnesses

The medical community still struggles to define the illnesses of Gulf War soldiers, nearly 25 years later. Two existing definitions of chronic multisymptom illness (CMI) should be used to guide research and treatment, the Institute of Medicine said.

Definitions from the CDC and from a study of Kansas Gulf War veterans should be used to guide research and treatment of Gulf War veterans, says a new report from the Institute of Medicine (IOM). (The report can be downloaded for free via a guest registration.)

Determining which definition to use in different circumstances should be based on specific needs, and the term “Gulf War illness” should replace “CMI” to reflect the population in which the illness manifests and the patient’s distinctive experiences, said the report. This will enable health care providers to prescribe standard treatments and enroll patients into research and drug trials, the IOM stated. Physicians may want a broader consensus case definition to determine appropriate evaluation and treatment, while researchers might want a narrower one to create a relevant cohort.

Since the conflict in the Persian Gulf from 1990 to 1991, Gulf War veterans have experienced various unexplained symptoms that many associate with their service. But a wide variation in symptoms, overlap with symptoms from other diseases and conditions, and a lack of clinically validated tests or measures for diagnosing CMI left the IOM unable to develop a new consensus definition.

The committee recommended that the VA use the CDC and Kansas definitions because they capture the most common symptoms and will provide a framework for further treatment and research. The CDC case definition, which has been widely used by researchers, identifies 29% to 60% of U.S. Gulf War-deployed veterans as CMI cases, depending on the population studied. The Kansas definition identifies 34% as CMI cases in the Kansas Gulf War veterans studied.

The committee also recommended that the VA use the term Gulf War illness rather than CMI to reflect the geographic area where people served and the unique experience of this group of veterans, the committee said.