Treatment of the eosinophilia-myalgia syndrome

• Published in: Seminars in arthritis and rheumatism Vol. 21; no. 2; pp. 110 - 121
• Main Authors: Martínez-Osuna, Píndaro, Wallach, Paul M., Seleznick, Mitchel J., Levin, Robert W., Silveira, Luis H., Jara, Luis J., Espinoza, Luis R.
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA Elsevier Inc 01.10.1991; Elsevier
• Subjects: Adrenal Cortex Hormones - adverse effects; Adrenal Cortex Hormones - therapeutic use; Adult; Aged; Biological and medical sciences; Drug toxicity and drugs side effects treatment; Eosinophilia-Myalgia Syndrome - blood; Eosinophilia-Myalgia Syndrome - drug therapy; Eosinophilia-Myalgia Syndrome - pathology; Female; Humans; Medical sciences; Methotrexate - therapeutic use; Middle Aged; Miscellaneous (drug allergy, mutagens, teratogens...); Pharmacology. Drug treatments; Recurrence; methotrexate; l-tryptophan; Eosinophilia-myalgia; Human; Immunomodulator; Treatment; Toxicity; Diseases of the osteoarticular system; Tryptophan; L form; Myalgia; Striated muscle; Eosinophilia
• ISSN: 0049-0172; 1532-866X
• DOI: 10.1016/0049-0172(91)90044-Z

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.