The association between fibromyalgia and autoimmune diseases has been widely reported in literature. Coeliac disease is a small intestine immune-mediated disorder triggered by gluten ingestion in genetically predisposed patients.
In recent years, the Internet and the non-medical press have reported a correlation between gluten-related disorders and fibromyalgia-like symptoms.
Researchers at Policlinico S.Orsola-Malpighi, University of Bologna ( Italy ) have verified a possible association between fibromyalgia and coeliac disease, by assessing the prevalence of coeliac disease in a cohort of fibromyalgia syndrome patients and vice versa.
Ninety consecutive subjects from rheumatologic outpatient clinic who had been diagnosed with fibromyalgia were serologically tested for coeliac disease and positive patients underwent esophagogastroduodenoscopy to obtain duodenal biopsies.
A second group of 114 consecutive subjects from coeliac disease outpatient clinic were investigated for the presence of fibromyalgia-like symptoms through a questionnaire. Patients reporting chronic widespread pain were addressed to a rheumatologist for further evaluation.
The overall prevalence of coeliac disease in fibromyalgia patients was identical to that expected in general population ( around 1% ). In coeliac disease group 17 patients ( 14.9% ) reported chronic widespread pain at the questionnaire and 13 ( 11.4% ) satisfied ACR 1990 criteria for fibromyalgia. Their symptoms had not been modified by gluten-free diet.
In conclusion, a serological screening for coeliac disease is not recommended in fibromyalgia patients but rather a case-finding strategy should be performed.
At the same time, proposals of gluten-free diet in fibromyalgia patients, in absence of a well-established diagnosis of coeliac disease, should be rigorously avoided. ( Xagena )
Tovoli F et al, Clin Exp Rheumatol 2013; Published online ahead of print