Celiac disease and difficult to treat joint pain
We treat joint pain by repairing the whole joint environment. For instance, meniscus repair will not be long lasting if you do not address the knee instability caused by ligaments and other supporting structures which will constantly compromise the healed meniscus with unnatural stress force.
You cannot stabilize a spine without addressing the problems causing herniated discs such as the instability of damaged spinal ligaments. In some patients you cannot bring healing to their chronic joint pain without stabilizing their general health
In this article we will concentrate on the problems of gluten intolerance and Celiac disease.
We see a large number of patients with symptoms of GI disturbances such as gas, bloating, indigestion, diarrhea, constipation and the like. They also may notice that they experience joint pain when they eat certain foods like pizza or pasta. When we suggest testing for food allergies, we often find that the patients have allergy to wheat and/or gluten.
Celiac disease is an intolerance of the small intestine to gluten. Celiac disease is also referred to as gluten sensitive enteropathy (GSE), gluten intolerance, or celiac sprue, is considered to be one of the most under-diagnosed common diseases today.
Here are the bullet points of their research:
- Celiac disease (gluten-sensitive enteropathy) is currently regarded as a multisystem autoimmune disorder; its clinical signs and symptoms do not involve merely the gastrointestinal tract but are associated with several other medical specialties, including orthopaedics and traumatology (diseases of the musculoskeletal system such as arthritis).
- In orthopaedic and trauma patients, celiac disease should be suspected in the following diagnoses:
- osteomalacia (softening of the bones),
- premenopausal osteoporosis,
- post-menopausal osteoporosis more severe than expected and unresponsive to most medications,
- osteoporosis in men under 55 years of age,
- recurrent bone fractures in the limbs,
- pain in the large joints
- or arthritis of unclear origins,
- erosive spondyloarthropathy (chronic joint disease) particularly in patients with the history of chronic diarrhoea, anaemia or associated autoimmune disorders (type 1 diabetes mellitus or autoimmune thyroid issues),
- and in women with secondary amenorrhea or early menopause.
The Czech researchers recommend that the orthopaedist 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.
Further 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.1
How Celiac Disease attacks joints
- The aim of this study was to determine the prevalence of lower limb enthesopathy (weakness or injury to the attachment of a tendon or ligament to a bone.)
- Fifty-five untreated Celiac disease patients (group A) and 55 Celiac disease patients on a gluten-free diet for at least 1 year (group B), were matched for age and sex for accuracy of results.
- Among group A, 27 (49.8 %) patients presented at least one entheseal alteration as compared with 15 patients (27.2 %) of group B
- The Glasgow ultrasound enthesitis scoring system (GUESS) was significantly higher in patients of group A than in patients of group B.
- In conclusion, this study shows that enthesopathy is more frequent in untreated Celiac disease patients.2
Not all joint pain is driven by Celiac Disease
As mentioned above Celiac Disease and gluten intolerance is 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” comes from Italian researchers and gives this warning:
- Many people follow a self-prescribed gluten-free diet, despite the fact that the majority have not first been previously excluded, or confirmed, as having gluten disorders.
- They rely on claims that a gluten-free diet improves general health.
- KEY MESSAGE Incidence of gluten-related disorders is increased in the last decade and self-diagnosis is frequent with inappropriate starting of a gluten-free diet.
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 wehat and grain products and in fact can thrive on them, some cannot. A patient who tolerates and absobs gluten well can be compromised if they go on a gluten-free diet.
Decisions about going gluten-free should be made with advise from your health care giver.
1 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.
2 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.
3 Valenti S, Corica D, Ricciardi L, Romano C. Gluten-related disorders: certainties, questions and doubts. Annals of Medicine. 2017 May 11:1-3.