title: Fibromyalgia and non-celiac gluten sensitivity: a description with remission of fibromyalgia.
abstract: Fibromyalgia (FM) syndrome is a disabling clinical condition of unknown cause, and only symptomatic treatment with limited benefit is available. Gluten sensitivity that does not fulfill the diagnostic criteria for celiac disease (CD) is increasingly recognized as a frequent and treatable condition with a wide spectrum of manifestations that overlap with the manifestations of FM, including chronic musculoskeletal pain, asthenia, and irritable bowel syndrome. The aim of this report was to describe 20 selected patients with FM without CD who improved when placed on a gluten-free diet. An anti-transglutaminase assay, duodenal biopsy, and HLA typing were performed in all cases. CD was ruled out by negative anti-transglutaminase assay results and absence of villous atrophy in the duodenal biopsy. All patients had intraepithelial lymphocytosis without villous atrophy. Clinical response was defined as achieving at least one of the following scenarios: remission of FM pain criteria, return to work, return to normal life, or the discontinuation of opioids. The mean follow-up period was 16 months (range 5-31). This observation supports the hypothesis that non-celiac gluten sensitivity may be an underlying cause of FM syndrome.
authors.affiliation: Department of Rheumatology, Hospital Puerta de Hierro, Majadahonda, Madrid, Spain, carlos.isasi@gmail.com.
authors.forename: Carlos
authors.initials: C
authors.lastname: Isasi
authors.forename: Isabel
authors.initials: I
authors.lastname: Colmenero
authors.forename: Fernando
authors.initials: F
authors.lastname: Casco
authors.forename: Eva
authors.initials: E
authors.lastname: Tejerina
authors.forename: Natalia
authors.initials: N
authors.lastname: Fernandez
authors.forename: José I
authors.initials: JI
authors.lastname: Serrano-Vela
authors.forename: Maria J
authors.initials: MJ
authors.lastname: Castro
authors.forename: Luis F
authors.initials: LF
authors.lastname: Villa
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D055050:Diet, Gluten-Free; D004386:Duodenum / Q000473:pathology; D005260:Female; D005356:Fibromyalgia / Q000175:diagnosis / Q000178:diet therapy* / Q000209:etiology; D005512:Food Hypersensitivity / Q000175:diagnosis / Q000178:diet therapy* / Q000209:etiology; D005983:Glutens / Q000009:adverse effects*; D006801:Humans; D008218:Lymphocytosis / Q000175:diagnosis / Q000178:diet therapy / Q000209:etiology; D008875:Middle Aged; D011237:Predictive Value of Tests; D012074:Remission Induction; D012189:Retrospective Studies; D012307:Risk Factors; D013030:Spain; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D005983:Glutens
references.citation: Gut. 2006 Dec;55(12):1739-45
references.pmid: 16709658
references.citation: J Clin Pathol. 2002 Jun;55(6):424-8
references.pmid: 12037023
references.citation: Dig Liver Dis. 2010 Jan;42(1):28-32
references.pmid: 19473894
references.citation: Arch Pathol Lab Med. 2010 Jun;134(6):826-36
references.pmid: 20524861
references.citation: Am J Gastroenterol. 2007 Nov;102(11):2520-8
references.pmid: 17680846
references.citation: Ann Intern Med. 2005 Feb 15;142(4):289-98
references.pmid: 15710962
references.citation: N Engl J Med. 2007 Oct 25;357(17):1731-43
references.pmid: 17960014
references.citation: Semin Arthritis Rheum. 2011 Dec;41(3):335-45.e6
references.pmid: 21868065
references.citation: BMC Med. 2012 Feb 07;10:13
references.pmid: 22313950
references.citation: Aliment Pharmacol Ther. 2010 Dec;32(11-12):1392-7
references.pmid: 21050242
references.citation: Gut. 2013 Jan;62(1):43-52
references.pmid: 22345659
references.citation: World J Gastroenterol. 2009 Mar 21;15(11):1331-8
references.pmid: 19294762
references.citation: Arch Pathol Lab Med. 2006 Jul;130(7):1020-5
references.pmid: 16831028
references.citation: Curr Opin Rheumatol. 2006 Jan;18(1):101-7
references.pmid: 16344626
references.citation: J Intern Med. 2011 Jun;269(6):582-90
references.pmid: 21481018
references.citation: Dig Dis Sci. 2003 Apr;48(4):761-4
references.pmid: 12741468
references.citation: Histopathology. 2011 Aug;59(2):166-79
references.pmid: 21054494
references.citation: Br Med J. 1972 Aug 12;3(5823):371-4
references.pmid: 5070159