Celiac disease, a gluten-free diet for difficult to treat joint pain
We are joint pain specialists, not gastroenterologists. Yet, we see an amazingly large number of patients with symptoms of GI disturbances such as gas, bloating, indigestion, diarrhea, constipation, and other GI related symptoms. These patients are in our office for joint erosion, joint pain, and a realistic alternative to a joint replacement surgery. That there is a connection between between their joint pain and Celiac disease (the abnormal immune system responses to eating gluten, a protein found in wheat, barley, and rye) is obvious and needs to be addressed for the patient to have optimal joint healing.
Celiac disease is also referred to as gluten sensitive enteropathy (GSE), gluten intolerance, or celiac sprue. It is considered to be one of the most under-diagnosed common diseases today, potentially affecting 1 in every 133 people in the USA. It is the result of an immune-mediated response to the ingestion of gluten (from wheat, rye, and barley) that damages the small intestine.
Joint pain improvements on a gluten-free diet, “more than just coincidental.”
In 2011, doctors in Turkey told a story of a 42 year old woman in the prestigious journal Rheumatology international.(1) The title of their small case report was Celiac disease of the joint. Here is what they recorded:
- A 42-year-old woman presented with a 3-week history of left knee pain and swelling.
- She had suffered dermatitis herpetiformis (chronic itchy skin rash) for 12 years.
- She had never been on gluten-free diet.
- Knee pain increased with motion and her gait was antalgic (in other words she altered the way she walked to avoid causing more knee pain).
- The 42 year old was mainly dependent on wheelchair due to pain and limitation.
- She responded well to gluten-free diet. Association of joint involvement and dermatitis herpetiformis is more than just coincidental.
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,” (2) that showed what happened when a patients’s problems with gluten were not addressed.
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 diarrhea, anemia or associated autoimmune disorders (type 1 diabetes mellitus or autoimmune thyroid issues),
- and in women with secondary amenorrhea or early menopause.
“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.
How Celiac Disease attacks joints
University medical researchers in Italy publishing in the journal Clinical rheumatology write about patients with pain originating from the enthesis attachments of 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 the 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.(3)
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” (4) 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 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 Ozyemisci-Taskiran O, Cengiz M, Atalay F. Celiac disease of the joint. Rheumatology international. 2011 May 1;31(5):573-6. [Google Scholar]
2 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]
3 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]
4 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]