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The Eosinophilia-Myalgia Syndrome: Status of 205 Patients and Results of Treatment 2 Years after Onset

Phillip A. Hertzman, MD; Daniel J. Clauw, MD; Lee D. Kaufman, MD; John Varga, MD; Richard M. Silver, MD; Holly L. Thacker, MD; Phillip Mease, MD; Luis R. Espinoza, MD; and Theodore Pincus, MD
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From Los Alamos Medical Center, Los Alamos, New Mexico. Georgetown University Medical Center, Washington, D.C. State University of New York at Stony Brook, Stony Brook, New York. Thomas Jefferson University, Philadelphia, Pennsylvania. Medical University of South Carolina, Charleston, South Carolina. Cleveland Clinic Foundation, Cleveland, Ohio. Minor and James Medical Center, Seattle, Washington. Louisiana State University Medical Center, New Orleans, Louisiana. Vanderbilt University School of Medicine, Nashville, Tennessee. Requests for Reprints: Theodore Pincus, MD, Division of Rheumatology and Immunology, Department of Medicine, Vanderbilt University School of Medicine, T-3219 Medical Center North, Nashville, TN 37232. Acknowledgments: The authors thank Drs. Ken Bulpitt, Elliot Chartash, Bruce Freundlich, Scott Glickstein, Edward Lally, David Mathison, and Barbara Mittleman for contributing patients to the registry and Wendy Smith and Annette Oeser for assistance with the database and statistical analyses. Grant Support: In part by the Jack C. Massey Foundation, National Institutes of Health grant AR 21393, the Arthritis, Rheumatism, and Aging Medical Information System (ARAMIS), and the Showa Denko Corp.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1995;122(11):851-855. doi:10.7326/0003-4819-122-11-199506010-00008
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Objective: To describe the course of the eosinophilia-myalgia syndrome during a 2-year period.

Design: 15 physicians completed a structured review form to describe symptoms, physical findings, laboratory data, and responses to treatments in 205 patients with the eosinophilia-myalgia syndrome at the onset of illness and after 18 to 24 months of follow-up.

Setting: 15 university and private clinical practice settings.

Patients: 205 patients for whom follow-up data were available and who met four criteria at diagnosis: eosinophil count of 1000 cells/mm3 or greater; presence of fasciitis, peripheral neuropathy, polyradiculopathy, interstitial pulmonary disease, pulmonary hypertension, or myocardial involvement; history of L-tryptophan consumption; and absence of other conditions that could account for these findings.

Intervention: Empirical interventions by the physicians.

Measurements: Symptoms, physical findings, laboratory test results, biopsy findings, radiographic reports, therapeutic interventions, and responses to these interventions.

Results: After 18 to 24 months, all symptoms except cognitive changes were reported to have improved in most patients. Nearly all physical findings were also reported to have improved or resolved in most patients; only peripheral neuropathy was unchanged. No evidence of ongoing inflammatory disease was reported. Prednisone was reported to be helpful in 79% of patients who received it during the acute phase of the syndrome. No other treatment was reported to be consistently beneficial.

Conclusions: 18 to 24 months after the onset of illness, most symptoms and physical findings in most patients with the eosinophilia-myalgia syndrome resolved or improved. Cognitive changes were reported to be worse in 32% of patients. Prednisone was helpful in the acute phase of illness. No treatment was clearly valuable in management of the later phase of the syndrome.





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