Fibromyalgia and coeliac disease: a media hype or an emerging clinical problem?

Fibromyalgia (FM) association with autoimmune diseases has been widely reported in literature. Coeliac disease (CD) 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. The aim of our study was to verify a possible association between FM and CD, by assessing the prevalence of CD in a cohort of FM patients and vice versa.

90 consecutive subjects from our Rheumatologic outpatient clinic who had been diagnosed with FM were serologically tested for CD and positive patients underwent esophagogastroduodenoscopy to obtain duodenal biopsies. A second group of 114 consecutive subjects from our Coeliac Disease outpatient clinic were investigated for the presence of FM-like symptoms through a questionnaire. Patients reporting chronic widespread pain were addressed to a rheumatologist for further evaluation.

The overall prevalence of CD in our FM patients was identical to that expected in general population (around 1%). In our CD group 17 patients (14.9%) reported chronic widespread pain at the questionnaire and 13 (11.4%) satisfied ACR 1990 criteria for FM. Their symptoms had not been modified by GFD.

A serological screening for CD is not recommended in FM patients but rather a case-finding strategy should be performed. At the same time, proposals of GFD in FM patients, in absence of a well-established diagnosis of CD, should be rigorously avoided.