AHMF: 98 Conference: McGregor

Aphthous Ulceration and Symptoms In Polysymptomatic Patients

N.R.McGregor, H.L.Butt [1], R.H.Dunstan, T.K.Roberts, I.J.Klineberg.

Collaborative Pain Research Unit:
Department of Biological Sciences
The University of Newcastle
Callaghan
NSW 2308, Australia.
Neurobiology Research Unit
Centre for Oral Health Research
University of Sydney
Westmead Hospital
Westmead
NSW 2084, Australia.
1 Division of Microbiology and Infectious Diseases
Hunter Area Pathology Service
John Hunter Hospital
Newcastle
NSW 2305, Australia.

The reporting of a sore throat in patients complying with the CFS definition is often associated with oral and throat recurrent aphthous ulceration (RAU). Current evidence suggests that RAU represents reactivation of viruses such as CMV, Varicella zoster, enterovirus or HSV-6, but not HSV-1.

To evaluate the incidence of RAU in chronic fatigue and chronic pain patients, 319 polysymptomatic patients consisting of 115 non-CFS and 204 CFS patients and 102 control subjects were assessed for presence of aphthous ulceration. A total of 86 out of 319 polysymptomatic patients (26.9%) had recurrent oral ulceration consistent with RAU compared with 25 out of 102 of control subjects (24.6%). These data indicate that the incidence of RAU is the same in the control subjects and the polysymptomatic patients.

A more extensive evaluation was made with the polysymptomatic patient cohort in comparison with a smaller control group (n=32) which had a more extensive array of symptom evaluations and pathology investigations. At the time of examination active RAU was noted in 2 of 32 control subjects (5.9%) compared with 17 of 115 (14.7%) non-CFS polysymptomatic patients and 69 of 204 (33.8%) CFS patients (both P &LT; 0.005 compared with controls).

RAU was associated with very similar symptoms in both CFS and non-CFS patients. There were increases in the prevalence of history of spinal disk prolapse problems and appendectomy, and increases in the prevalence and/or severity of low back pain, cervical Iymphodynia, palpitations, muscle cramps, problems with concentration, loss of libido as well as reduced gastric motility. Reductions in urinary frequency and the symptoms of irritable bowel were noted with alterations in both ulcer prevalence and severity.

Two potential disease models exist: 1) that CFS patients with RAU have a severe form of an RAU asscociated disease, such as Behcet's Syndrome; or 2) that viral reactivation is a secondary phenomenon. The RAU/symptom associations however suggest that whilst CFS patients had an equal prevalence of history of RAU they had an increased prevalence of active RAU. This suggests that increased reactivation of existing viral infections occurs in CFS patients and that the symptoms associated with these reactivated viruses not only increase the patient's symptom prevalence and severity but may confound the potential diagnosis of the underlying aetiology.