Prevalence of asymptomatic celiac disease in children with fibromyalgia: a pilot study
Bruce Taubman1, Peter Mamula, David D Sherry
1Division of General Pediatrics, University of Pennsylvania School of Medicine, The Children's Hospital of Philadelphia, Advocare Cherry Hill Pediatric Group, Cherry Hill, NJ, USA. taubman@email.chop.edu.
Insights
This study found that children with fibromyalgia rarely have undiagnosed celiac disease. A gluten-free diet did not improve symptoms in the one patient diagnosed with celiac disease.
Area of Science:
- Pediatric Rheumatology
- Gastroenterology
- Autoimmune Diseases
Background:
- Fibromyalgia is a chronic pain condition affecting children.
- Celiac disease is an autoimmune disorder triggered by gluten.
- The link between fibromyalgia and undiagnosed celiac disease in children is not well understood.
Purpose of the Study:
- To determine the prevalence of asymptomatic celiac disease in children with fibromyalgia.
- To assess symptom resolution on a gluten-free diet in these patients.
Main Methods:
- Prospective study of children aged 12-17 meeting fibromyalgia criteria.
- Screening for celiac disease using IgA anti-endomysial (EMA) and IgA anti-TTG antibodies.
- Small bowel biopsy for diagnosis, followed by a gluten-free diet and symptom assessment.
Main Results:
- Only 1 out of 50 pediatric fibromyalgia patients had celiac disease.
- The patient's celiac antibodies normalized on a gluten-free diet.
- Pain and functional disability scores did not improve, and pain scores increased.
Conclusions:
- Children with fibromyalgia do not appear to have a higher prevalence of occult celiac disease than the general population.
- A gluten-free diet may not be beneficial for fibromyalgia symptoms in this population.
Background:
The objective of this study was to prospectively determine the prevalence of asymptomatic celiac disease among children presenting with fibromyalgia. The secondary objective was to investigate if their symptoms resolved on a gluten free diet.
Findings:
All children seen in the Amplified Musculoskeletal Pain clinic between the ages of 12 and 17 years of age who fulfilled the 1990 American College of Rheumatology diagnostic criteria for fibromyalgia were invited to participate. A total immunoglobulin A (IgA) level, IgA antiendomysial (EMA) and IgA anti-TTG antibodies was obtained on all study subjects. A visual analog scale for pain and a functional disability inventory were obtained on all patients. If a patient had elevated EMA or TTG a small bowel biopsy was done. Patients with celiac disease were placed on a gluten-free diet and observed to see if their symptoms resolved.50 patients, 45 females, completed the study. Only one patient was found to have celiac disease. On a gluten-free diet her tissue transglutaminase antibody level returned to normal but her visual analog scale scores increased and her functional disability inventory was 40 initially and 21 at follow up.
Conclusions:
In this pilot, single center study at a tertiary children's hospital patients with fibromyalgia do not seem to have occult celiac disease at an increased rate over the population as a whole.
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