Anti-tTG, EMA Antibodies Implicated in Fibromyalgia in Patients With Celiac Disease

The presence of anti-tissue transglutaminase (anti-tTG) and anti-endomysial (EMA) antibodies in people with celiac disease was associated with the incidence of fibromyalgia in a recent study.¹

“Many of the gastrointestinal symptoms seen in fibromyalgia, such as abdominal pain, bloating, diarrhea, or constipation, are characteristic of people with CD or gluten sensitivity. In contrast, gastrointestinal symptoms such as joint and/or muscle pain, chronic fatigue, or changes in elevated values have been observed in patients with CD or gluten sensitivity in fibromyalgia patients,” lead investigator Mehmet Serkan Kilicoglu, MD, Department of Physical Medicine and Rehabilitation, Bezmialem Vakif University, Istanbul, Fatih, Turkey, and colleagues wrote.¹

Kilicoglu and colleagues conducted a single center cross-sectional clinical study including 60 patients who were diagnosed with celiac disease by the Gastroenterology Clinic based on American College of Gastroenterology (ACG) criteria. Study participants completed the Widespread Pain Index (WPI), Symptom Severity Scale (SSS), and Fibromyalgia Impact Questionnaire (FIQ) to diagnose fibromyalgia and assess its severity, and the investigators compared the concomitance and relationship between fibromyalgia and celiac disease.¹

The investigators found that the relationship between the clinical types of celiac disease and the presence of fibromyalgia was not significant. Similarly, the pathologic typing of biopsy was not significantly associated with fibromyalgia frequency. They did find that patients with anti-tTG (P = 0.04) and anti-EMA (P = 0.04) antibodies more frequently met criteria for fibromyalgia.

The investigators offer that the data suggest that the autoimmune inflammatory process associated with gluten in the digestive tract of people with celiac disease may lead to the development or exacerbation of central nervous system sensitivity, which is responsible in some individuals with CD or gluten sensitivity for fibromyalgia symptoms. They noted that limitations of the study include the small number of patients involved, its single center nature, and the lack of long-term follow-up.¹

“Presence of clinical extraintestinal manifestations in patients with CD should lead clinicians to consider FMS as a possible diagnosis. This suggests that physicians of all specialties should be aware of the many symptoms and conditions associated with FMS. This approach can both increase the success of treatment and prevent infections related to FMS treatment. This issue warrants controlled studies with longer follow-up periods,” Kilicoglu and colleagues concluded.¹

Other recent research exploring associations with fibromyalgia and other etiologies explored outcomes in patients with fibromyalgia and nasal septum deviation after septoplasty surgery.²

These investigators found that of the 9 patients that had FM at baseline, none met FM criteria after the surgery. After septoplasty, patients experienced statistically significant decreases in widespread pain index (P = .006), symptom severity scale (P = .004), and Revised Fibromyalgia Impact Questionnaire scores (P < .001). They also experienced decreases in total score and Pittsburgh Sleep Quality Index, although these were not statistically significant (P = .028 and P = .014, respectively).2

“Although septoplasty alone cannot eradicate FM, it can be incorporated into a comprehensive treatment plan to potentially alleviate FM symptoms, improve nasal breathing, and thereby elevate patients’ quality of life,” Cilesizoglu Yavuz and Coluk concluded.²

REFERENCES
1. Kilicoglu MS, Sayilir S, Yurdakul OV, et al. Association between celiac disease and fibromyalgia and their severity: a cross-sectional study. Peer J. 2024 (12):e17949 doi: 10.7717/peerj.17949
2. Cilesizoglu Yavuz N, Coluk Y. Fibromyalgia symptoms before and after septoplasty: A cross-sectional study. Medicine 103(35):p e39473, August 30, 2024. | DOI: 10.1097/MD.0000000000039473