Celiac disease, a gluten-free diet for difficult to treat joint pain

Ross Hauser MD, Marion Hauser, MS, RD

We are joint pain specialists, not gastroenterologists. Yet, we see a very large number of patients with symptoms of GI disturbances such as gas, bloating, indigestion, diarrhea, constipation, and other GI-related symptoms. This group of patients can be subdivided into two groups. Those with suspected cervical spine instability causing compression on nerves in the neck. Please see our article Nausea and gastroparesis caused by cervical spine instability, and those patients in our office for problems of joint pain, such as a knee, hip, shoulder, and ankle problems looking for non-surgical treatments and possible avoidance of surgery.

For some of these patients, and as you are now reading this article, probably like yourself,  joint pain and inflammatory disease has been connected as a problem with Celiac disease (the abnormal immune system responses to eating gluten, a protein found in wheat, barley, and rye) that damages the small intestine. Nutrients then quickly pass through the small intestine, rather than being absorbed.

To develop Celiac disease (CD) three (3) things must be present:

1) you must inherit the gene,

2) consume gluten, and

3) have the gene triggered.

Common triggers may include stress, trauma (surgeries, pregnancy, etc.), and viral infections. Gluten intolerance is a very common finding in the chronically ill. Many people with chronic fatigue, chronic pain, insomnia, digestive complaints, and stomach pains are found to be allergic to gluten (sensitive to it) when they undergo food blood allergy testing.

Up to 75% of patients with untreated celiac disease have osteopenia or osteoporosis.

For many people, undiagnosed celiac disease presents problems for their bones. Researchers at Sapienza University in Rome made the above finding that up to 75% of patients with untreated celiac disease have osteopenia (bone loss) or osteoporosis, and published this finding in the August 2018 issue of the United European Gastroenterology Journal. (1)

If you think that osteoporosis means just women, read what the researchers found:

Celiac diseases cause bone damage and tendon damage

In the above study, the researchers pointed to the high risk of bone erosion and bone damage in diagnosed and untreated celiac disease. Clearly, if you have bone damage and bone loss, you will have joint and spine pain. According to other researchers, you will also have joint pain coming from the tendons. This pain too is caused by celiac disease.

How Celiac Disease attacks the point of tendon-bone attachment – The enthesis

The enthesis is the point at which the connective tissue structures, such as a joint capsule, fascia, ligament, tendon, or muscle attach to the bone. The term enthesopathy typically refers to a degenerated enthesis; though when some doctors use this term, they typically mean enthesitis (inflammation of the enthesis).

University medical researchers in Italy publishing in the journal Clinical Rheumatology (2) write about patients with pain originating from the enthesis attachments of joints.

Now let’s look at an August 2018 study in the medical journal Rheumatology. (3) This is a multi-medical university research study led by the University of Ottawa Faculty of Medicine and includes teams from the United States, the United Kingdom, and Turkey. Watch the way the study ends.

What does all this mean? The answer was not anti-inflammatory treatment, but diet. Change the diet to help seal up a “Leaky Gut.”

Joint pain improvements on a gluten-free diet, “more than just coincidental.”

In 2011, doctors in Turkey told the story of a 42-year-old woman in the prestigious journal Rheumatology International. (4) The title of their small case report was Celiac disease of the joint. Here is what they recorded:

The Turkish doctors emphasized that her joint pain and skin rashes improved when she went on a gluten-free diet, so much so that they stressed in their paper, that these improvements were “more than just coincidental.”

Understanding how devastating Celiac disease can be for your joint pain and your ability to repair joint damage

In the above paper, we have a case study significant enough to show the benefits of a gluten-free diet on a patient with joint pain and skin rashes. Doctors in the Czech Republic recently presented their research in their paper: “Bone and Joint Involvement in Celiac Disease,” (5) that showed what happened when a patients’ problems with gluten were not addressed.

Here are the bullet points of their research:

“A long-life gluten-free diet in these patients results in the alleviation of metabolic-related  joint and muscle problems, in reduced requirements of analgesic and anti-inflammatory drugs as well as in reduced risks of fracture.”

The Czech researchers recommend that the orthopedist or trauma surgeon should be aware of suspected celiac disease in patients who do not respond adequately to the standard treatment of pain related to the musculoskeletal system, in patients with recurrent fractures of the limb bones and in young patients with suspected secondary osteoporosis.

The good news about this research is, as stated above, the recommendation that: A long-life gluten-free diet in these patients results in the alleviation of metabolic-related joint and muscle problems, in reduced requirements of analgesic and anti-inflammatory drugs as well as in reduced risks of fracture.

Not all joint pain is driven by Celiac Disease

As mentioned above, celiac disease and gluten intolerance are underdiagnosed in many difficult-to-treat joint pain patients. However, just as it is under-diagnosed, self-diagnosis and starting a gluten-free diet may not be the answer to all joint pain.

A November 2017 paper in the Annals of Medicine entitled: “Gluten-related disorders: certainties, questions and doubts” (6) comes from Italian researchers and gives this warning:

In our many years putting together information on guiding patients to healthier eating, we found that one diet type did not fit all. Some patients are okay with wheat and grain products and in fact, can thrive on them, some cannot. A patient who tolerates and absorbs gluten well can be compromised if they go on a gluten-free diet.

Decisions about going gluten-free should be made with advice from your healthcare provider.

If you have questions about difficult to treat joint pain and treatment options, get help and information from Caring Medical

1 Galli G, Lahner E, Conti L, Esposito G, Sacchi MC, Annibale B. Risk factors associated with osteoporosis in a cohort of prospectively diagnosed adult coeliac patients. United European Gastroenterology Journal. 2018 Jun 12:2050640618784340. [Google Scholar]
Atteno M, Costa L, Cozzolino A, Tortora R, Caso F, Del Puente A, Cantarini L, Scarpa R, Ciacci C. The enthesopathy of celiac patients: effects of gluten-free diet. Clinical rheumatology. 2014 Apr 1;33(4):537-41. [Google Scholar]
3 Bakirci Ureyen S, Karacaer C, Toka B, Erturk Z, Eminler AT, Kaya M, Tascilar K, Tamer A, Uslan I, Kurum E, McGonagle D. Similar subclinical enthesitis in celiac and inflammatory bowel diseases by ultrasound suggests a gut enthesis axis independent of spondyloarthropathy spectrum. Rheumatology. 2018 May 8. [Google Scholar]
4 Ozyemisci-Taskiran O, Cengiz M, Atalay F. Celiac disease of the joint. Rheumatology international. 2011 May 1;31(5):573-6. [Google Scholar]
5 Hoffmanová I, Sánchez D, Džupa V. Bone and Joint Involvement in Celiac Disease. Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca. 2014 Dec;82(4):308-12. [Google Scholar]
6 Valenti S, Corica D, Ricciardi L, Romano C. Gluten-related disorders: certainties, questions and doubts. Annals of Medicine. 2017 May 11:1-3. [Google Scholar]

This page was updated October 30, 2021


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