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Natural History of the Eosinophilia-Myalgia Syndrome

Randall C. Culpepper, MD, MPH; Ronald G. Williams, MD, MPH; Philip J. Mease, MD; Thomas D. Koepsell, MD, MPH; and John M. Kobayashi, MD, MPH
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Requests for Reprints: Randall C. Culpepper, MD, MPH, Great Lakes Naval Hospital, OHPMD Code 037, Great Lakes, IL 60088.

Current Author Addresses: Dr. Culpepper: Great Lakes Naval Hospital, OHPMD Code 037, Great Lakes, IL 60088.

Dr. Williams: Commander, U. S. Army Medical Research Institute of Infectious Diseases, Fort Detrick, Maryland 21702-5011.

Dr. Mease: Minor and James Medical Clinic, 515 Minor Avenue, Seattle, WA 98104.

Dr. Koepsell: School of Public Health and Community Medicine, University of Washington, SC-37, Seattle, WA 98195.

Dr. Kobayashi: Washington State Department of Health, Communicable Disease Epidemiology, 1610 N. E. 150th Street, Seattle, WA 98155-7224.

Ann Intern Med. 1991;115(6):437-442. doi:10.7326/0003-4819-115-6-437
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Objective: To describe the natural history and disease progression of the eosinophilia-myalgia syndrome and to assess the therapeutic effects of orally administered steroids on the disorder as of October 1990.

Design: Case-series analysis. A cohort of 45 patients with the eosinophilia-myalgia syndrome was followed prospectively by periodic telephone interviews and medical examinations for an average of 14 months after onset of illness.

Setting: Washington state.

Patients: The cases of 47 patients were reported to the Washington State Department of Health from 1 July to 12 December 1989. Two patients were unavailable for follow-up, and the remaining 45 completed the study.

Main Results: Patients were predominantly non-Hispanic white women (87%) with an average age of 49 years. Symptoms typically progressed from early onset of myalgia and fatigue to later development of neurologic and scleroderma-like skin changes. Six (13%) patients recovered completely within 2 to 5 months of symptom onset. After 14 months of illness, over half of the patients who initially presented with myalgia, fatigue, or scleroderma-like skin changes remained symptomatic. The average severity of each major symptom was measured using interviews and patient self-reports and has improved subjectively by at least 40%. Statistical analyses showed no significant difference in long-term symptom duration or severity between patients treated and those not treated with prednisone.

Conclusions: The eosinophilia-myalgia syndrome is a long-term illness characterized by progressive improvement during the first 25 weeks after symptom onset, followed by a protracted phase of symptom resolution. We could not show a clear-cut benefit of prednisone in reducing the long-term severity or duration of the disease.





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