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  • Scott Adams
    Scott Adams

    Arthritis and Celiac Disease

    Reviewed and edited by a celiac disease expert.

    Arthritis may be an allergic response to materials in the food supply. Diet revision may be helpful in reducing the activity of inflammatory arthritis and in some instances may halt the progression of the disease. There are many patterns of arthritis. A group of related joint and connective disorders have been called rheumatic diseases. All these diseases are immune-mediated, and all are expressions of inflammation in connective tissues. Inflammation damages joints and surrounding tissues resulting in loss of function and deformities. Variations in the patterns of these diseases reflect the many possibilities for immune damage to disturb and distort structure and function. Severity ranges from mildly painful, chronic activity to drastic, disabling disease. Rheumatoid arthritis, often severe and disabling, is the dominant rheumatic disease that can attack all joints in the body.

    Rheumatoid arthritis is often considered to be an autoimmune disease. Our idea is that no disease is just internally generated and must involve outside contributions. Arthritis is often associated with inflammatory bowel disease. The mechanisms of food allergy link abnormal Gastrointestinal Tract (GIT) function with immune attacks on connective tissue. In all arthritic patients, normal GIT function should be rigorously sought by adaptive dietary adjustments.

    Simple allergic arthritis is a definite entity that is often not recognized as a food allergy. Typically, a dramatic, acute, and painful swelling develops in one or more joints asymmetrically. Eating a food, either an unusual food eaten for the first time or sometimes a regular food eaten in excess usually brings on the joint inflammation. This presentation is similar to and often confused with gout. Any food can cause allergic arthritis. Staple foods such as milk, eggs, and wheat (rye, oats, barley), coffee, beef, pork, and food additives are the most common food triggers. Carinini and Brostroff reviewed the concepts of and evidence for food-induced arthritis. They stated:

    Despite an increasing interest in food allergy and the conviction of innumerable patients with joint disease that certain foods exacerbate their symptoms, relatively little scientific attention has been paid to this relationship. Abnormalities of the gastrointestinal tract are commonly found in rheumatic disease...Support for an intestinal origin of antigens comes from studies of patients whose joint symptoms have improved on the avoidance of certain foods antigens, and become worse on consuming them. These have included patients with both intermittent symptoms, palindromic rheumatism and more chronic disease.

    In another study, 33 of 45 patients with rheumatoid arthritis improved significantly on a hypoallergenic diet. The authors concluded: Increasing numbers of scientific studies suggest that dietary manipulation may help at least some rheumatoid patients and perhaps the greatest need now is for more careful and well-designed research so that preconceptions may be put aside and role of diet, as a specific or even a nonspecific adjunctive therapy, may be determined.

    Unfortunately, dairy products, wheat and its close relatives, oats, barley, and rye, have proved to be a major problem in the diets of our patients. There are many possible reasons for cereal grains to become pathogenic. Hypersensitivity mechanisms triggered by grain proteins, collectively called Gluten, are the likely cause of the illnesses related to intake of cereal grains. Gluten is a mixture of individual proteins classified in two groups, the Prolamines and the Glutelins. The prolamine fraction of gluten concerns us the most when grain intolerance is suspected. The prolamine, Gliadin, seems to be a problem in celiac disease; gliadin antibodies are commonly found in the immune complexes associated with this disease. Recently marketed grains, spelt and kamut, are wheat variants (despite claims to the contrary) and are likely to cause problems similar to other wheat varieties.

    A wheat gluten mechanism has been studied in rheumatoid arthritis patients. The clinical observation is that wheat ingestion is followed within hours by increased joint swelling and pain. Little and his colleagues studied the mechanism, as it developed sequentially following gluten ingestion. Dr. Parke and colleagues concurred with this explanation of the gut-arthritis link in their report of three patients with celiac disease and rheumatoid arthritis. The mechanism involves several stages:

    • GIT must be permeable to antigenic proteins or peptide fragments, derived from digested gluten.
    • The food antigens appear in the blood stream and are bound by a specific antibody (probably of IgA or IgG, not IgE class), forming an antigen-antibody complex, a circulating immune complex (CIC).
    • The antigen-antibody complex then activates the rest of the immune response, beginning with the release of mediators - serotonin is released from the blood platelets.
    • Serotonin release causes symptoms as it circulates in the blood stream and enhances the deposition of CICs in joint tissues.

    Once in the joint, the immune complexes activate complement, which in turn damages cells and activates inflammation. More inflammation results in more pain, swelling, stiffness, and loss of mobility.

    Arthritis is usually treated with salicylates or related anti-inflammatory drugs generally referred to as NSAIDs. These drugs alleviate the terrible pain of active arthritis but do not favorably affect the outcome of the disease. All anti-arthritic medication can produce asthma or chronic rhinitis and a variety of allergic skin rashes. Gastrointestinal surface irritation, bleeding, and ulceration are routine problems of anti-arthritic medication.

    The first attack of joint swelling and pain should be treated as an urgent problem to be solved. Inflammation may damage joints. Often NSAIDs and physiotherapy are the only treatments prescribed and inflammation is given every opportunity to ravage tissues. We have seen countless patients, just treated with NSAIDs, who progressed rapidly to a severe disabling disease, often with poor pain control. In unlucky patients, severe deformities of joints accumulate in the first few months of a severe attack. There is a trend to recommend more aggressive treatments, using drugs that impair the immune response. The best drug is prednisone, but it is seldom used because it has long-term side effects which scare both physicians and patients. Prednisone is often a magic drug that relieves terrible pain and suffering often in the first 48 hours of therapy. Beyond prednisone, there is a grab bag of immune suppressant drugs to treat arthritis-chloroquine, penicillamine, gold and methotrexate have emerged as the favored drug therapies. All these drugs have impressive side effects and great potential for toxicity.

    Our preference is to try to stop the inflammatory activity as soon as possible with diet revision. All inflammation is likened to a fire. You get out the fire-extinguishers and go to work. No matter what pattern the immune attack assumes, our standard defense can be tried first. The Core Program method of diet revision is used. Food is replaced with an elemental nutrient formula, ENFood, for a clearing period of 10 to 20 days. Prednisone and/or NSAIDs are drug options during the clearing period and then the dosage is reduced after pain and swelling have subsided. Improvement is followed by slow food reintroduction (see Core Program). Each returning food is carefully screened for arthritis- triggering effects. You hope that food allergy caused the problem and that food control can be successful controlling the disease in the long- term. Nothing is lost by taking this approach and complete control of the disease can sometimes be obtained. If strict food control proves to be inadequate, then other drug treatments can be instituted.

    End Notes/Sources:

    • Carinini C, Brostroff J. Gut and joint disease. Annals of Allergy 1985;55:624-625.
    • Darlington et al. Lancet Feb 1 1986;236-238.
    • Keiffer M et al. Wheat gliadin fractions and other cereal antigens reactive with antibodies in the sera of of celiac patients. Clin Exp Immunol 1982;50:651-60.
    • Little C, Stewart AG, Fennesy MR. Platelet serotonin release in rheumatoid arthritis: a study in food intolerant patients. Lancet 1983;297-9.
    • Parke AI et al. Celiac disease and rheumatoid arthritis.
    • Annals of Rheum Dis 1984;43:378-380.
    • Voorneveld CR, Rubin LA Disease-modifying antirheumatic drugs: early use is better. Medicine North Amer. Oct 1991 3177-3184.

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    My daughter suffers from celiac and rheumatoid arthritis, and I read anything I can on this subject. She has recently changed rheumatologists, and this doctor suspects that her arthritis is food-related. When she was diagnosed 13 years ago, there was no information on this connection, so I'm grateful that this is being studied!

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    After countless doctors visits with little help I have come to the conclusion that I most likely have celiac disease. I have taken myself off gluten while my new rheumatologist confirms this diagnosis. While conducting my own research I have found that many celiacs have a low B12 level causing anemia and many of the problems associated with celiacs. I have been taking 100% Himylain goji juice (no I do not sell it) and have experienced great relief from the symptoms. It is expensive but it has been well worth the cost. I suggest anyone with joint and muscle pain to try it. I have tried some of the less expensive generic brands but the don't seem to work. It is amazing the roller coaster ride I have been on for the last year and I am so thankful that there is so much information available on the internet. If not for the web I think I would still be in a great deal of pain and not able to function from day to day.

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    Well done!!! As a person with personal and hereditary Celiac and Rheumatoid Arthritis and as a professional who often assists others with these conditions via homeopathy & diet I know the info out there well. Yours is the best, most comprehensive article I've seen. Wish you would suggest seeing a qualified alternative practitioner - homeopath, ND, herbalist... whatever a person feels will help them best, in addition to diet. Best, Ellen

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    I found out that I have the celiac disease three years ago. I watch my diet carefully to avoid gluten. Last fall after being on a trip in which I walked allot, I had pain in my knees. I didn't know that it had anything to do with the celiac disease. In March I took another trip in which I walked a lot. My knees have been hurting allot. I'm going to the doctor tomorrow. I'm glad I read this article - I'm going to print it and show him. Thanks!

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    I have celiac and thought I was doing well on my diet until joint pain in my hands, elbows, knees and feet slowly joined in about six months ago. Good to read this info.

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    Firstly, great article. I have been suffering for about 2.5 years now and the medical system failed me. I have done a lot of self research and thanks to articles like this I have learned that my pain (knees, elbows, ankles, wrists, shortness of breath, bloating etc.) is due to my diet. I have eliminated dairy, soy, gluten and eggs in the past week or so and I am feeling a lot of relief. I am planning to take a food intolerance test soon to confirm. Thanks again and best wishes to all.

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    Guest Stewart Edgington


    About one year ago I developed psoriatic arthritis. I pointed this out to my internist who insisted that I just was having discomfort with osteoarthritis. I pointed to all the appropriate symptoms and correlations and so she looked it up and asked one more question. Then she said, 'oh, you have psoriatic arthritis.' I was sent to a rheumatologist who wanted to put me on methotrexate. I have type I diabetes and did not feel I needed any addition suppression of my immune system. Then I a new client came into my office. She is a widow whose husband had had rheumatoid arthritis. She is a widow because of the methotrexate. I have two sisters with full blown celiac disease. So I consulted a naturopathic doctor. She suggested several possibilities including an auto immune response to gluten. I tried going gluten free and my symptoms have decreased by about 90%. Any time I have inadvertently consumed even a tiny amount of gluten the arthritis returns. Then this past Sunday I decided to test a single beer. Alas, the symptoms returned severely for two days and only now, 5 days latter am I approaching becoming symptom free again. I suspect there are other things I should eliminate but gluten seem to be the monster for me.

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  • About Me

    Celiac.com's Founder and CEO, Scott was diagnosed with celiac disease  in 1994, and, due to the nearly total lack of information available at that time, was forced to become an expert on the disease in order to recover. Scott launched the site that later became Celiac.com in 1995 "To help as many people as possible with celiac disease get diagnosed so they can begin to live happy, healthy gluten-free lives."  In 1998 he founded The Gluten-Free Mall which he sold in 2014. He is co-author of the book Cereal Killers, and founder and publisher of Journal of Gluten Sensitivity.

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