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Fibromyalgia and non-celiac gluten sensitivity: a description with remission of fibromyalgia.

Isasi C, Colmenero I, Casco F, Tejerina E, Fernandez N, Serrano-Vela JI, Castro MJ, Villa LF - Rheumatol. Int. (2014)

Bottom Line: CD was ruled out by negative anti-transglutaminase assay results and absence of villous atrophy in the duodenal biopsy.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).

View Article: PubMed Central - PubMed

Affiliation: Department of Rheumatology, Hospital Puerta de Hierro, Majadahonda, Madrid, Spain, carlos.isasi@gmail.com.

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.

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Related in: MedlinePlus

a CD3 staining of intraepithelial lymphocytes in the duodenal villi of patient #8. b CD3 staining of intraepithelial lymphocytes in the tips of the duodenal villi of patient #1
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Fig1: a CD3 staining of intraepithelial lymphocytes in the duodenal villi of patient #8. b CD3 staining of intraepithelial lymphocytes in the tips of the duodenal villi of patient #1

Mentions: In non-celiac gluten sensitivity, specific autoantibodies are not present, and duodenal biopsy only reveals intraepithelial lymphocytosis or no pathologic changes. Only approximately half of patients with GS carry the HLA DQ2 or DQ8 heterodimers, in contrast to CD in which almost all patients carry the HLA DQ2 or DQ8. The symptoms of non-celiac gluten sensitivity include behavioral changes, bone or joint pain, muscle cramps, leg numbness, weight loss, chronic fatigue, and a foggy mind. Oral aphthae and psoriasis can also be due to non-celiac gluten sensitivity [7]. Intraepithelial lymphocytosis has been the hallmark of gluten intestinal lesions since the first descriptions of the intestinal pathology of CD [17]. In the current classification criteria, a Marsh 1-type lesion is defined as the presence of more than 25 intraepithelial lymphocytes per one hundred enterocytes in a duodenal biopsy. Intraepithelial lymphocytosis can be overlooked or not considered relevant in a pathology report focused on villous atrophy or can be missed if anti-CD3 staining is not performed [13, 14]. Although intraepithelial lymphocytosis is associated with several other conditions, such as Helicobacter pylori disease, NSAID intake, Crohn’s disease, or parasitic infestation, gluten enteropathy must always be considered [18–20]. For our patients, intraepithelial lymphocytosis was found by experienced pathologists after a specific search. Two examples of intraepithelial lymphocytosis are shown in Fig. 1, which presents images of CD3-stained preparations. The high frequency of HLA alleles related to susceptibility to CD in our patients is similar to that described in non-celiac gluten sensitivity.Fig. 1


Fibromyalgia and non-celiac gluten sensitivity: a description with remission of fibromyalgia.

Isasi C, Colmenero I, Casco F, Tejerina E, Fernandez N, Serrano-Vela JI, Castro MJ, Villa LF - Rheumatol. Int. (2014)

a CD3 staining of intraepithelial lymphocytes in the duodenal villi of patient #8. b CD3 staining of intraepithelial lymphocytes in the tips of the duodenal villi of patient #1
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4209093&req=5

Fig1: a CD3 staining of intraepithelial lymphocytes in the duodenal villi of patient #8. b CD3 staining of intraepithelial lymphocytes in the tips of the duodenal villi of patient #1
Mentions: In non-celiac gluten sensitivity, specific autoantibodies are not present, and duodenal biopsy only reveals intraepithelial lymphocytosis or no pathologic changes. Only approximately half of patients with GS carry the HLA DQ2 or DQ8 heterodimers, in contrast to CD in which almost all patients carry the HLA DQ2 or DQ8. The symptoms of non-celiac gluten sensitivity include behavioral changes, bone or joint pain, muscle cramps, leg numbness, weight loss, chronic fatigue, and a foggy mind. Oral aphthae and psoriasis can also be due to non-celiac gluten sensitivity [7]. Intraepithelial lymphocytosis has been the hallmark of gluten intestinal lesions since the first descriptions of the intestinal pathology of CD [17]. In the current classification criteria, a Marsh 1-type lesion is defined as the presence of more than 25 intraepithelial lymphocytes per one hundred enterocytes in a duodenal biopsy. Intraepithelial lymphocytosis can be overlooked or not considered relevant in a pathology report focused on villous atrophy or can be missed if anti-CD3 staining is not performed [13, 14]. Although intraepithelial lymphocytosis is associated with several other conditions, such as Helicobacter pylori disease, NSAID intake, Crohn’s disease, or parasitic infestation, gluten enteropathy must always be considered [18–20]. For our patients, intraepithelial lymphocytosis was found by experienced pathologists after a specific search. Two examples of intraepithelial lymphocytosis are shown in Fig. 1, which presents images of CD3-stained preparations. The high frequency of HLA alleles related to susceptibility to CD in our patients is similar to that described in non-celiac gluten sensitivity.Fig. 1

Bottom Line: CD was ruled out by negative anti-transglutaminase assay results and absence of villous atrophy in the duodenal biopsy.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).

View Article: PubMed Central - PubMed

Affiliation: Department of Rheumatology, Hospital Puerta de Hierro, Majadahonda, Madrid, Spain, carlos.isasi@gmail.com.

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.

Show MeSH
Related in: MedlinePlus