Treatment of the eosinophilia-myalgia syndrome

Píndaro Martínez-Osuna, Paul M Wallach, Mitchel J. Seleznick, Robert W. Levin, Luis H. Silveira, Luis J. Jara, Luis R. Espinoza

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

The eosinophilia-myalgia syndrome (EMS) is a unique entity associated with products that contain l-tryptophan (L-trp). Studies of the underlying etiopathogenic processes are underway. EMS is a distinct syndrome, but shares features with eosinophilic fasciitis and other variants of systemic sclerosis. A wide spectrum of clinical manifestations has been described, but there is no consensus regarding treatment. We report the clinical and laboratory features of 12 patients. All were treated with nonsteroidal antiinflammatory drugs (NSAIDs) and analgesics with transient or minimal effect. Two received d-penicillamine (DP) and colchicine, with minimal improvement; one had no response to azathioprine (AZA). Eleven received corticosteroids and had improvement of general symptoms, arthralgias, arthritis, myalgias, skin changes, eosinophilia, and leukocytosis. Nevertheless, all but the latter two findings recurred when corticosteroids were tapered. Seven patients who were unresponsive to the former treatments received low-dose pulse oral methotrexate. Six exhibited continued improvement after a mean follow-up of 4.5 months, with good drug tolerance. Corticosteroids were tapered and, in some instances, discontinued without relapse or complications. One patient improved but later died of aspiration pneumonia. We conclude that methotrexate (MTX) is a therapeutic alternative for patients with severe or refractory EMS.

Original languageEnglish (US)
Pages (from-to)110-121
Number of pages12
JournalSeminars in Arthritis and Rheumatism
Volume21
Issue number2
DOIs
StatePublished - Jan 1 1991

Fingerprint

Eosinophilia-Myalgia Syndrome
Adrenal Cortex Hormones
Methotrexate
Drug Tolerance
Aspiration Pneumonia
Penicillamine
Systemic Scleroderma
Myalgia
Leukocytosis
Azathioprine
Colchicine
Arthralgia
Eosinophilia
Therapeutics
Tryptophan
Arthritis
Analgesics
Consensus
Anti-Inflammatory Agents
Recurrence

Keywords

  • Eosinophilia-myalgia
  • l-tryptophan
  • methotrexate

ASJC Scopus subject areas

  • Rheumatology
  • Anesthesiology and Pain Medicine

Cite this

Martínez-Osuna, P., Wallach, P. M., Seleznick, M. J., Levin, R. W., Silveira, L. H., Jara, L. J., & Espinoza, L. R. (1991). Treatment of the eosinophilia-myalgia syndrome. Seminars in Arthritis and Rheumatism, 21(2), 110-121. https://doi.org/10.1016/0049-0172(91)90044-Z

Treatment of the eosinophilia-myalgia syndrome. / Martínez-Osuna, Píndaro; Wallach, Paul M; Seleznick, Mitchel J.; Levin, Robert W.; Silveira, Luis H.; Jara, Luis J.; Espinoza, Luis R.

In: Seminars in Arthritis and Rheumatism, Vol. 21, No. 2, 01.01.1991, p. 110-121.

Research output: Contribution to journalArticle

Martínez-Osuna, P, Wallach, PM, Seleznick, MJ, Levin, RW, Silveira, LH, Jara, LJ & Espinoza, LR 1991, 'Treatment of the eosinophilia-myalgia syndrome', Seminars in Arthritis and Rheumatism, vol. 21, no. 2, pp. 110-121. https://doi.org/10.1016/0049-0172(91)90044-Z
Martínez-Osuna P, Wallach PM, Seleznick MJ, Levin RW, Silveira LH, Jara LJ et al. Treatment of the eosinophilia-myalgia syndrome. Seminars in Arthritis and Rheumatism. 1991 Jan 1;21(2):110-121. https://doi.org/10.1016/0049-0172(91)90044-Z
Martínez-Osuna, Píndaro ; Wallach, Paul M ; Seleznick, Mitchel J. ; Levin, Robert W. ; Silveira, Luis H. ; Jara, Luis J. ; Espinoza, Luis R. / Treatment of the eosinophilia-myalgia syndrome. In: Seminars in Arthritis and Rheumatism. 1991 ; Vol. 21, No. 2. pp. 110-121.
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