https://doi.org/10.4081/reumatismo.2023.1530
Efficacy of a gluten-free diet in reducing the widespread pain index and symptom severity scale in patients affected by fibromyalgia
Submitted: 17 October 2022
Accepted: 12 July 2023
Published: 18 September 2023
Accepted: 12 July 2023
Abstract Views: 1422
PDF: 426
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All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
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Objective. Dietary interventions to improve fibromyalgia (FM) symptoms reported conflicting results. This study aimed to treat FM patients with a gluten-free diet (GFD), alternated with a non-restricted gluten-containing diet, followed by a rechallenge of the GFD.
Methods. Twenty postmenopausal women with FM and no history of celiac disease participated. A GFD was assigned for 6 months. This was followed by 3 months of a non-restricted gluten-containing diet and then a new GFD for another 6 months. At each visit, the widespread pain index (WPI) and the symptom severity scale (SS) scores were evaluated.
Results. The mean age of the patients enrolled was 53.9±10 years. None of the patients had a diagnosis of irritable bowel disease, although they reported vague gastrointestinal symptoms. After 6 months of a GFD, a statistically significant reduction was observed for the WPI (10.3±1.8 vs 7.7±1.4; p<0.0001) and the SS scale (6.4±1.8 vs 4.15±1.6; p=0.0002). The D percentage reduction of the WPI after 6 months of GFD was -24%±9%, while for the SS scale, it was -36%±21%. The following reintroduction of a gluten-containing diet brought about a statistically significant rise in the absolute SS scale and WPI, as well as a D modification of the WPI (21%±13%) and of the SS scale (74%±90%). The rechallenge of the GFD showed a significant improvement in absolute and D WPI (-24%±7%) and SS (-36%±11%). No modifications to the body mass index were found.
Conclusions. A GFD improved FM symptoms evaluated with WPI and SS. This was confirmed for the first time, also with a rechallenge of the GFD that followed a non-restricted gluten-containing diet.
Wolfe F, Clauw D, Fitzcharles MA, Goldenberg DL, Katz RS, Mease P, et al. The American college of rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthritis Care Res 2010; 62: 600-10.
DOI: https://doi.org/10.1002/acr.20140
Wolfe F, Clauw DJ, Fitzcharles MA, Goldenberg DL, Häuser W, Katz RS, et al. Fibromyalgia criteria and severity scales for clinical and epidemiological studies: a modification of the ACR preliminary diagnostic criteria for fibromyalgia. J Rheumatol 2011; 38: 1113-22.
DOI: https://doi.org/10.3899/jrheum.100594
Verdu EF, Armstrong D, Murray JA. Between celiac disease and irritable bowel syndrome: the “no man’s land” of gluten sensitivity. Am J Gastroentrol 2009; 104: 1587-94.
DOI: https://doi.org/10.1038/ajg.2009.188
Al-Toma A, Volta U, Auricchio R, Castillejo G, Sanders DS, Cellier C, et al. European society for the study of coeliac disease (ESsCD) guideline for coeliac disease and other gluten-related disorders. United European Gastroenterol J 2019; 7: 583-613.
DOI: https://doi.org/10.1177/2050640619844125
Volta U, Bardella MT, Calabrò A, Troncone R, Corazza GR, Study Group for Non-Celiac Gluten Sensitivity. An Italian prospective multicenter survey on patients suspected of having non-celiac gluten sensitivity. BMC Med 2014; 2: 85.
DOI: https://doi.org/10.1186/1741-7015-12-85
Aziz I, Hadjivassiliou M, Sanders DS. The spectrum of noncoeliac gluten sensitivity. Nat Rev Gastroenterol Hepatol 2015; 12: 516-26.
DOI: https://doi.org/10.1038/nrgastro.2015.107
Lubrano E, Ciacci C, Ames PR, Mazzacca G, Oriente P, Scarpa R. The arthritis of celiac disease: prevalence and pattern in 200 adult patients. Br J Rheumatol 1996; 35: 1314-8.
DOI: https://doi.org/10.1093/rheumatology/35.12.1314
Nisihara R, Marques AP, Mei A, Skare T. Celiac disease and fibromyalgia: is there an association? Rev Esp Enferm Dig 2016; 108: 107-8.
DOI: https://doi.org/10.17235/reed.2015.3992/2015
Jeffery IB, O’Toole PW, Öhman L, Claesson MJ, Deane J, Quigley EMM, et al. An irritable bowel syndrome by species-specific alteration in faecal microbiota. Gut 2012; 61: 997-1006.
DOI: https://doi.org/10.1136/gutjnl-2011-301501
Shivaji S. We are not alone: a case for the human microbiome in extra intestinal diseases. Gut Pathog 2017; 9: 13.
DOI: https://doi.org/10.1186/s13099-017-0163-3
Jethwa H, Abraham S. The evidence for microbiome manipulation in inflammatory arthritis. Rheumatology 2017; 56: 1452-60.
DOI: https://doi.org/10.1093/rheumatology/kew374
Macfarlane GJ, Kronisch C, Dean LE, Atzeni F, Häuser W, Fluß E, et al. EULAR revised recommendation for the management of fibromyalgia. Ann Rheum Dis 2017; 76: 318-28.
DOI: https://doi.org/10.1136/annrheumdis-2016-209724
Silva AR, Bernardo A, Costa J, Cardoso A, Santos P, de Mesquita MF, et al. Dietary interventions in fibromyalgia: a systematic review. Ann Med 2019; 51: 2-14.
DOI: https://doi.org/10.1080/07853890.2018.1564360
Slim M , Calandre EP, Garcia-Leiva JM, Rico-Villademoros F, Molina-Barea R, Rodriguez-Lopez CM, et al. The effects of a gluten-free diet versus a hypocaloric diet among patients with fibromyalgia experiencing gluten sensitivity-like symptoms: a pilot, open-label randomized clinical trial. J Clin Gastroenterol 2017; 51: 500-7.
DOI: https://doi.org/10.1097/MCG.0000000000000651
Rossi A, Di Lollo AC, Guzzo MP, Giacomelli C, Atzeni F, Bazzichi L, et al. Fibromyalgia and nutrition: what news? Clin Exp Rheumatol 2015; 33: S117-25.
Isasi C, Tejerina E, Moran ML. Non-celiac gluten sensitivity and rheumatic diseases. Reumatol Clin 2016; 12: 4-10. [Article in Spanish]
DOI: https://doi.org/10.1016/j.reumae.2015.11.004
Taubman B, Mamula P, Sherry DD. Prevalence of asymptomatic celiac disease in children with fibromyalgia: a pilot study. Pediatric Rheumatology 2011; 9: 11.
DOI: https://doi.org/10.1186/1546-0096-9-11
Rodrigo L, Blanco I, Bobes J, de Serres FJ, et al. Effect of one year of a gluten-free diet on the clinical evolution of irritable bowel syndrome plus fibromyalgia in patients with associated lymphocytic enteritis: a case-control study. Arthritis Res Ther 2014; 16: 421.
DOI: https://doi.org/10.1186/PREACCEPT-2049244887124904
Volta U. Gluten-free diet in the management of patients with irritable bowel syndrome, fibromyalgia and lymphocytic enteritis. Arthritis Res Ther 2014; 16: 505.
DOI: https://doi.org/10.1186/s13075-014-0505-1
Wolfe F, Clauw DJ, Fitzcharles MA, Goldenberg DL, Häuser W, Katz RL, et al. 2016 revisions to the 2010/2011 fibromyalgia diagnostic criteria. Semin Arthritis Rheum 2016; 46: 319-29.
DOI: https://doi.org/10.1016/j.semarthrit.2016.08.012
Vanuytsel T, Vermeire S, Cleynen I. The role of haptoglobin and its related protein, zonulin, in inflammatory bowel disease. Tissue Barriers 2013; 1: e 27321.
DOI: https://doi.org/10.4161/tisb.27321
Drago S, EJ Asmar R, Di Pierro M, Clemente MG, Tripathi A, Sapone A, et al. Gliadin, zonulin and gut permeability:effect in celiac and non-celiac intestinal mucosa and intestinal cell lines. Scan J Gastroenterol 2006; 41: 408-19.
DOI: https://doi.org/10.1080/00365520500235334
Lerner A, Shoenfeld Y, Matthias T. Adverse effect of gluten ingestion and advantages of gluten withdrawal in non celiac autoimmune disease. Nutr Rev 2017; 72: 1046-58.
DOI: https://doi.org/10.1093/nutrit/nux054
Slim M, Calandre EP, Rico-Villademoros F. An insight into the gastrointestinal component of fibromyalgia: clinical manifestations and potential underlying mechanisms. Rheumatol Int 2015; 35: 433-44.
DOI: https://doi.org/10.1007/s00296-014-3109-9
Rodrigo L, Blanco I, Bobes J, de Serres FJ. Clinical impact of a gluten-free diet on health-related quality of life in seven fibromyalgia syndrome patients with associated celiac disease. BMC Gastroenterol 2013; 13: 157.
DOI: https://doi.org/10.1186/1471-230X-13-157
Aman MM, Jason Yong R, Kaye AD, Urman RD. Evidence-based non-pharmacological therapies for fibromyalgia. Curr Pain Headache 2018; 22: 33.
DOI: https://doi.org/10.1007/s11916-018-0688-2
How to Cite
Bruzzese, V., Marrese, C., Scolieri, P., & Pepe, J. (2023). Efficacy of a gluten-free diet in reducing the widespread pain index and symptom severity scale in patients affected by fibromyalgia. Reumatismo, 75(3). https://doi.org/10.4081/reumatismo.2023.1530
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