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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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    Excellent information, great site.

    Oats, kidney bean and Beer flares up my joint pain. I will have stiff finger and palm, starts with left hand first and then right foot. If we keep off these items then there will be no pain.

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    I was also suffering from elbow pain and then pain in my hip. I had attended several sessions of physical therapy and was not buying the arthritis diagnosis. After eliminating gluten from my diet for one week I noticed a difference; I was healed! I tried the gluten based foods again and even a small amount triggered the pain again. I have shared this information with everyone who has been having problems. Thank you for sharing this information. These testimonies confirm my beliefs. Thank You.

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    I was diagnosed with celiac disease about 7 years ago after being anemic for about 35 years. I thought I had a lactose intolerance but when I went gluten free, the lactose intolerance went away. I do have some type of arthritis that causes swelling that comes and goes. However being gluten free has not helped the swelling problem so I wonder if another food group could be causing it. No doctor has been able to figure it out but then again they haven't tested me for any other food intolerance. (Being gluten free did get rid of my anemia.) Any suggestions?

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    To test allergy to wheat or dairy ELIMINATE IT ALL with an ''ELIMINATION DIET'' of only SWEET POTATOES for a few days, they are filling and usually safe.

     

    Then add back a food per day and see what happens.

    Read Eat To Live book, they are anti-wheat mostly and anti-dairy. Or try a RAW FOODS vegetarian diet, it cures many things too.

     

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    My 4 year old son is suffering with swelling in the knees and ankles.. other symptoms include swollen eyes and dark circles. Neck pain and stiffness as well. I am going to try this and see what happens. He already avoids Dairy. Thanks for sharing!

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    My husband has been on a strict gluten-free diet ever since being diagnosed with celiac 6 years ago. Now he was recently diagnosed with RA! He is terrified of the drugs they want to put him on. But seriously, more dietary restrictions? I can't even imagine -- the poor man already watches everything he eats and is so limited! Ugh. This is just depressing.

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    Guest jyothikumar.k iyer

    Posted

    Excellent article apart from persons suffering from celiac disease even normal medical practitioners need to read this lest they do not keep prescribing pain killers instead of chaning the diet and relieving the pain of patients.

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    I've had severe RA from the onset, nearly nine years ago. I've been on nearly every drug out there for RA, most recently a combo of Enbrel and Mobic, which worked amazingly. I'd been told repeatedly that stress contributes greatly to the severity of RA, but didn't really believe it much, till I switched jobs nearly a year ago. Since then I have been able to slowly go off of the Enbrel, while adding Omega-3's to help control the symptoms. It worked great until about a month ago (month 5 of no Enbrel). I have also had severe allergies most of my life, I broke out with a serious rash yesterday and have an appointment with my PCP later today. I'm planning to ask about a correlation with celiac or other food allergy. I have a good friend who was diagnosed with celiac about two years ago, and hadn't known about it before then, but after researching it have wondered if maybe that's been my problem all along. Does anyone know if an elevated SED rate is linked to celiac?

    Elevated SED (aka. ESR) is a very NON-SPECIFIC indicator of inflammation. While it can detect inflammation in the body, it does not detect the source of that inflammation.

     

    If the inflammation associated with celiac is severe enough, then it can cause an elevated ESR.

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    This article confirmed what I have been suffering for years without knowing the cause. I start my day with a cup and a half of oatmeal and suffer form knee joint aches and taking acetaminiphen whenever there is a flare up. stopped eating oats knee joints are fine.

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    I discovered this link 2 years ago on the net and everyone thought I was mad! So pleased that it is becoming more well recognized. On the whole I have improved but am looking into other potential allergens with a naturopath. Feels good to read these articles.

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    Guest Sarah Calcagno

    Posted

    At age 45, I was healthy, slightly above average in weight and in fair health. I had just entered nursing school and found that I could not lift my arm. Strange! Weeks later, I could not walk as the pain was so acute on both feet. I was soon diagnosed with R/A and my Rheumatologist placed me on a daily regimen of Methotrexate and Folic Acid (Folic Acid protects the liver and should always be taken with Methotrexate). The medication allowed me my mobility again, but did not eliminate much of the pain and swelling. Sadly, I was forced to leave nursing school.

     

    Last year in 2010 (three years later), I began changing my diet. I eliminated beef, pork, most nightshades, and most processed foods. This reduced the pain and swelling further. Then I began aerobic exercising 2-4 times a week, working up to 45 minutes per session while greatly increasing my water intake. This reduced things further. In October, 2010, I additionally began a gluten-free diet. Since November, 2010, (seven months now) I have been off of the Methotrexate all together, and drug free. Traditionally, this would signify only a temporary period of remission in R/A, however; with what we now know about maintaining a TOTAL health program, I think the odds of sustaining a remission period for a decade or more are greatly increased, and may even significantly reduce the long term effects and outcome of disease progression, both for celiac and R/A.

     

    My recommendation for others would be to incorporate a total health program of:

    1. daily AEROBIC exercise, increasing time length as able.

    2. water (four to six 8 oz bottles per day),

    3. reduce beef, pork, dairy, eggs, and nightshades

    4. go gluten-free

    5. get 8-9 hours of sleep per day if possible.

    6. recommend having several positive, social external interests and goals to help motivate oneself, help others, and add meaning/purpose/joy to living.

     

    Having now graduated at age 50 with a bachelor's in business, my new goals are to continue on towards a graduate degree and on a person health note....reduce my sugar intake to possibly eliminate the occasional slight remaining swelling and minor discomfort. What a phenomenal relief from being formerly unable to walk under excruciating pain!

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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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