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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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    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.

    PLEASE go back on your gluten they can NOT diagnose you is yo are gluten free it needs to be in your body for a correct diagnoses. Look up the celiac diagnosis pages and it will explain.

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    I think I have celiac and I am ANGRY my doctors have not mentioned this to me I have a GP doctor I have IBS and I have have several test I have RA and I have terrible stomach pain. I am not to the point where I can not eat at all. Anything I eat make me hurt I end up in a ball in pain. I have diarrhea or I am constipated and I was in tears when I read you wrote the book cereal kills. I LIVE off of cereal I love it and for some reason I do not hurt after I eat it well lets say it doesn't seem like it the pain comes later so it must take awhile to effect me. I am in tears reading an writing this I NEED help I am losing weight I am so depressed I need someone to diagnose me so I can get my life back.

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    I was diagnosed with suspected rheumatoid arthritis nearly 2 years ago. I was prescribed Plaquenil for the pain and swelling. The Plaquenil worked but I started to experience side effects after 5 months. It was due to a posting like this that I saw the connection to RA and eating gluten free.

     

    My father has celiac disease so I started eating gluten free within a week. I bought an excellent book called Dangerous Grains and got in contact with the author who incidentally, is a friend of my fathers. The RA went into remission though it took 6 - 9 months for my joints and swelling to return to normal.

     

    Any ingestion of gluten including gluten free oats (Bobs Red Mill) induces arthritic pain. Large amounts such as what I ingested before the small bowel biopsy also cause problems with what I call a mind/body connection, something like brain fog.

     

    I just did a 4 day gluten challenge before a colonoscopy and small bowel biopsy which showed I don't have celiac disease. The arthritis hit me like a wall and 3 1/2 weeks later, I am still limping, having joint problems but I can already feel myself getting better.

     

    The gastroenterologist said that I have a manifestation similar to celiac disease which just does not affect my small intestine. I have seen it called "gluten sydrome" in a book I read recently by Scott Adams and Ron Hoggan. I look at the arthritis as being equivalent to problems that gluten causes such as gluten ataxia which can occur without damage to the small intestine.

     

    I just consider myself so lucky to have seen information on line and whenever I can, I try to pass the information on.

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    Guest Lisa in San Diego, Ca

    Posted

    Excellent article, thank you. I was ill for 30 years, and thought I just had bad genes, but it turned out to be true. I am celiac, my brother has RA, and my other brother has arthritis and celiac and IBD. All were told it was many other things, for many years. A gluten free diet saved my life - actually. Celiac made me so anemic, my hemoglobin was down to 7.0 HGC- I was almost dead. When you have celiac, you cannot digest iron, because your upper intestine is ruined, so you can drink iron liquid, take iron pills, eat steaks - all to no avail. I finally found a doctor that knew of it and taught me about celiac disease and then sent me to a Hematologist/Oncologist, and he gave me IV drip Iron, 13 bags time 13 weeks. My Hemoglobin went back up to 14.00 and now my body functions like normal- you know, walking, standing, healing, thinking well, breathing, all that good stuff - living - that I was unable to do well when I was so sick for so long. The celiac diet keeps celiac symptoms at bay, and may heal my digestive tract over time - you must be diligent forever. Now I will try deleting nightshade vegetables too, as I've read that they are harmful to your immune system if you are celiac, have RA, IBD, and other AI problems. Good luck to all, keep reading, keep trying, keep searching out really good Doctors - they are out there.

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    Guest Theresa Schaefer

    Posted

    PLEASE go back on your gluten they can NOT diagnose you is yo are gluten free it needs to be in your body for a correct diagnoses. Look up the celiac diagnosis pages and it will explain.

    My husband was on gluten and the blood test was negative yet WE went gluten free and 4 days later the 25 lbs. of water he was carrying left. It is a digestive problem and that is why it rarely shows up in the blood. As its not a blood problem.

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    I cured my RA through the elimination of diary, eggs and yeast. I was already on a gluten free diet as I have celiac disease. I've now come off all 9 of the medications I was on and manage my illness through diet. I'm shocked at how little support and information there is out there to help people try to find the right solution. Unfortunately there is no funding for alternative approaches as there is no big money making drug at the end of it. Great article though. I did the York test and it changed my life.

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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.

    Get him on Minocycline ASAP!! www.roadback.org they saved my life!

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    I'm glad I found this article. In the past few years I've had terrible hip and knee pain, especially in the fall. I was diagnosed several years ago with IBS too. This past fall the tops of my shoulders have also hurt as if I were trying to lift heavy weights and were tearing the muscle from the bone.

     

    A couple of years ago I went on the Atkins diet for 4 months and never felt better. This last summer my aunt was diagnosed with Celiac. I finally, after trying the gluten free diet put two and two together and realized that Atkins made me gluten free. When I am 100% gluten free all my joint and muscle pains nearly vanish. When I've had a lapse in the gluten free diet, the pains return within hours and even worse than before. So, I'll remain gluten free. With that diet, my pains go away and all IBS symptoms also disappear. Imagine that! Now I'm moving to an area that has few gluten free foods available so am very happy for the Internet and online ordering.

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    PLEASE go back on your gluten they can NOT diagnose you is yo are gluten free it needs to be in your body for a correct diagnoses. Look up the celiac diagnosis pages and it will explain.

    Even if not diagnosed with celiac you can still be gluten intolerant and have the same problems. My daughter had problems for years, she was so sick and in pain. We tested everything. When she spent a week with her cousin who has celiac and ate like her all week, my daughter's symptoms vanished. I was just diagnosed with RA and I think I am going to go gluten free as well.

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    Is the nightshade thing an absolute???

    Absolutely YES! Many years ago, thirty plus years, I heard this and experimented, Tomatoes are the worst, and Green Peppers, I feel badly for days if I consume these. Potatoes are alright for me used sparingly. Any acidic fruits also make me feel bad for days, including oranges, grapefruit, limes and lemons. I once ate some cookies with a lemon glaze on top and felt bad two days later. I can use some wine watered down 1/2 is tolerable but other beers and alcohols do affect me at times. I have arthritis really bad, have had 6 operations due to arthritis, and replacement joints, and still suffering, GET on a gluten-free diet, good luck you all.

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    Is the nightshade thing an absolute???

    I would say you should try giving up the nightshades and see if it applies to you.

    I am ANA and rheumatoid factor negative but positive for the anti-CCP test and have elevated C Reactive Protein for at least 5 yrs. In 2002, I was positive for celiac on blood test and got rid of 30 yrs of irritable bowel when I gave up gluten.

    I also have received considerable relief from joint and muscle pain and stiffness by giving up gluten. If I get contaminated or cheat I really pay for it.

    Recently I thought about nightshades and decided to try giving them up. Within a few days my joints were feeling looser and moved more freely. I tried eating tomato sauce again and before too many hours my fingers felt fat and achey. Tonight I ate potato salad which I have missed and my feet are feeling swollen and itching. I used to eat nightshades every day in some form, but when I am off them for a week or so I really start to feel like my old self. There is RA in both of my parents families.

    My daughter who is also celiac, has ulcerative colitis and throat burning has given up the nightshades and she has gotten rid of most of that reflux-like feeling of inflammation in her throat.

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  • About Me

    In 1994 I was diagnosed with celiac disease, which led me to create Celiac.com in 1995. I created this site for a single purpose: To help as many people as possible with celiac disease get diagnosed so they can begin to live happy, healthy gluten-free lives. Celiac.com was the first site on the Internet dedicated solely to celiac disease. In 1998 I founded The Gluten-Free Mall, Your Special Diet Superstore!, and I am the co-author of the book Cereal Killers, and founder and publisher of Journal of Gluten Sensitivity.

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