Long-term rheumatologic complications of sulfur mustard in victims of Sardasht, Iran

Abstract

Sulfur mustard (SM) is an alkylating agent used several times by Iraqi forces as a chemical warfare agent in the Iraq-Iran war (1980–1988). Eyes, skin and respiratory system are the most sensitive organs to SM exposure. This agent has a suppressor effect on the immune system. As we did not find any study on the late rheumatologic complications of SM in the exposed victims in literature, in this study we investigated these complications in Sardasht (Iran) civilians 20 years after exposure. In a cohort study, 370 victims of Sardasht (that divided into two groups: hospitalized, n = 167, and non hospitalized, 203) in comparison to 128 control subjects from Rabat (Iran). The chief rheumatologic complaints, the physical examinations, the most probable clinical diagnosis and the rheumatic laboratory tests were compared between the study groups. The chief complaint was lower extremity pain; the most frequent physical finding was widespread tenderness and the most frequent clinical diagnosis was psychogenic pain. Among laboratory tests, only anti nuclear antibody (ANA) had significantly higher titer in the hospitalized victims than in the control subjects (P = 0.02). The most frequent rheumatologic complications were degenerative diseases of joints and spine. There was no significant difference in inflammatory disease between the two groups, but there were more rheumatoid arthritis patients among the victims. Higher ANA titers may indicate some autoimmune disorders as late rheumatic complications of SM.

Keywords::

• Sulfur mustard
• chemical victims
• rheumatology
• arthritis
• autoimmunity
• Sardasht Iran Cohort Study

Acknowledgments

This study was performed by Immunoregulation Research Center of Shahed University, and Janbazan Medical and Engineering Research Center (JMERC) and supported by the Iranian Foundation of Martyr and Veterans Affairs and Ministry of Health and Medical Education. We would like to thank all the participants who took part in this study very kindly. We also kindly thank Dr. Mohsin Reza Heidary for his critical reading of this manuscript and helpful comments.

Declaration of interest: The authors report no conflicts of interest.