BMJ  2007;335:627 (29 September), doi:10.1136/bmj.39346.499005.3A

Letters

Adult coeliac disease

Rheumatic presentations are common

The first 150 words of the full text of this article appear below.

Hopper et al highlight the non-specific way in which coeliac disease can present in adults 1. Presentations to rheumatology services are not uncommon with symptoms including fatigue, weakness, non-specific arthralgia, muscle cramps, and myalgia. A good argument therefore exists for screening for this disease when patients present with what may seem initially to be fibromyalgia or chronic fatigue syndrome (CFS), using combined serological testing. Such screening for coeliac disease is included in the recently published NICE guidance on the management of CFS.2 A true arthritis has also long been recognised.3 4 Presentation in elderly people is rare but also described and deserves mentioning 4.

A gluten-free diet is the mainstay of treatment of the metabolic bone disease that may complicate coeliac disease. A mixture picture of osteomalacia and osteoporosis may be seen, and vitamin D replacement may have an additional role to improve both symptoms and to reduce the risk of . . . [Full text of this article]

Alastair L Hepburn, consultant rheumatologist

Worthing Hospital, Worthing BN11 2DH

alnhepburn@doctors.org.uk


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