adjusted risk ratio for hospitalization for musculoskeletal system diseases was 0.99 (95% CI 0.96-1.02). Exposure was based on the 2000 Khamisiyah gaseous hazard area modeling done by the DoD.
A similar assessment of DoD hospitalizations between August 1991 through July 1991 for 405,142 active-duty Gulf War veterans who had been exposed to smoke from the Kuwaiti oil-well fires compared with nonexposed veterans was conducted by Smith et al. (2002). Exposure to particulate matter from the fires was estimated based on meteorological data, diffusion modeling, and troop location data; seven exposure levels were developed ranging from no exposure to an average daily exposure of > 260 μg/m3 for more than 50 days. No increased risk of hospitalization for musculoskeletal system diseases was seen for any of the exposure groups (risk ratios all less than 1.0).
The committee identified one secondary study that reported on musculoskeletal diseases in Gulf War veterans. Bourdette et al. (2001) conducted physical examinations of 443 Gulf War deployed veterans residing in the northeast United States, 244 of whom met the authors’ definition of unexplained illness and 113 of whom did not meet the case definition served as controls. The prevalence of osteoarthritis was similar between cases and controls, and there were no reports of autoimmune or inflammatory rheumatic diseases. The authors noted that four veterans were diagnosed with spondyloarthropathy, but they did not indicate whether these veterans were cases or controls.
Among those examined, there was no significant difference in arthralgias, a surrogate for arthritis, but data on self-reports indicate that arthritis was more common among those deployed to the gulf. The data, however, suffer from the problem of self-reporting of a common condition that can be easily confused with other symptoms without a thorough diagnosis by a physician. There appears to be no significant increase in the prevalence of arthralgias among veterans who underwent a medical examination.
The hospitalization studies reviewed by the committee also showed no increased risk of hospitalization for musculoskeletal system diseases among Gulf War deployed veterans compared with their nondeployed counterparts. Possible exposure to oil-well fire smoke and nerve agents from the Khamisiyah demolition also failed to result in increased hospitalizations. The committee notes, however, that many musculoskeletal diseases, such as arthritis, do not typically require hospitalization and are more likely to be treated on an outpatient basis.
Therefore, the committee concludes that there is insufficient/inadequate evidence of an association between deployment to the Gulf War and musculoskeletal system diseases.