Department of Internal Medicine and Rheumatology, P.O. S. Spirito-Nuovo Regina Margherita Hospital, Rome.
Departement of Clinical, Internal, Anesthesiological and Cardiovascular Disease, Sapienza University of Rome.
Reumatismo. 2023 Sep 18;75(3). doi: 10.4081/reumatismo.2023.1530.
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.
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.
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.
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.
改善纤维肌痛（FM）症状的饮食干预措施结果相互矛盾。本研究旨在通过无麸质饮食（GFD）治疗 FM 患者，然后交替进行非限制含麸质饮食，再重新进行 GFD 治疗。
20 名绝经后患有 FM 且无乳糜泻病史的女性参与了研究。患者接受 GFD 治疗 6 个月，随后进行 3 个月的非限制含麸质饮食，然后再进行另一个 6 个月的 GFD 治疗。在每次就诊时，评估患者的广泛性疼痛指数（WPI）和症状严重程度量表（SS）评分。
入组患者的平均年龄为 53.9±10 岁。虽然患者报告了模糊的胃肠道症状，但他们均无肠易激综合征的诊断。在 GFD 治疗 6 个月后，WPI（10.3±1.8 与 7.7±1.4；p<0.0001）和 SS 量表评分（6.4±1.8 与 4.15±1.6；p=0.0002）均有统计学显著降低。6 个月 GFD 后 WPI 的 D 百分比降低为-24%±9%，而 SS 量表为-36%±21%。随后重新引入含麸质饮食会导致 SS 量表和 WPI 的绝对值以及 WPI 的 D 改变（21%±13%）和 SS 量表（74%±90%）均有统计学显著增加。再次进行 GFD 治疗后，WPI 和 SS 的绝对和 D 值均显著改善（WPI：-24%±7%；SS：-36%±11%）。体重指数未发生变化。
GFD 可改善 WPI 和 SS 评估的 FM 症状。这是首次得到证实，同时也通过随后进行的非限制含麸质饮食后的 GFD 重新挑战得到证实。
