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Osteoarthritis — UKMLA MCQ

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A 28-year-old woman has chronic diarrhoea, iron-deficiency anaemia and weight loss. She started a strict gluten-free diet three weeks ago after reading online. Which approach is most appropriate before routine coeliac serology, assuming she can tolerate gluten?

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Correct answer: D — Resume gluten for at least 6 weeks, then test total IgA and IgA tTG

Reducing gluten can make coeliac serology falsely negative. If tolerated, advise gluten in more than one meal each day for at least six weeks before testing. First-line serology is total IgA plus IgA tissue transglutaminase (tTG), with IgG-based testing if IgA deficient. Symptom response to a gluten-free diet is not diagnostic, HLA typing is not routine first-line confirmation, and correction of iron deficiency does not exclude coeliac disease. If she cannot reintroduce gluten, refer for specialist advice rather than interpreting an unreliable negative test.

Reference: NICE. NG20 Coeliac disease: recognition, assessment and management, recommendations. https://www.nice.org.uk/guidance/ng20/chapter/recommendations