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    Celiac Patients Show Higher Rates of Entheseal Abnormality than Healthy Patients


    Jefferson Adams

    Celiac.com 04/08/2013 - Numerous studies have shown a connection between celiac disease and various types of arthritis.

    Photo: CC--muffet68A team of researchers recently set out to investigate the occurrence of lower limb enthesopathy in celiac disease patients without clinical signs of articular involvement. Entheses are the places where collagen fibers of a tendon, ligament or muscle are mineralized and connected into bone tissue. Entheseal abnormalities are abnormalities of these areas, and are often associated with arthritis.

    The team wanted to use ultrasound to investigate the presence of entheseal abnormalities in patients with celiac disease without clinical signs of articular involvement, and then compare the results with healthy control subjects.

    The research team included M. Atteno, L. Costa, R. Tortora, A. Cozzolino , A. Del Puente, F. Caso, P. Sfriso, R. Scarpa, and C. Ciacci. They are affiliated with the Rheumatology Research Unit in the Department of Clinical and Experimental Medicine of the Gastroenterology Research Unit in the Department of Clinical and Experimental Medicine at University Federico II of Naples, Naples, the Gastroenterology Unit at Santo Ottone Hospital in Ariano Irpino, Avellino, the Rheumatology Research Unit of the Department of Clinical and Experimental Medicine at the University of Padova in Padova, and the Department of Medicine and Surgery, Gastroenterology, at the University of Salerno in Salerno, Italy.

    For their study, the team looked at sixty patients with asymptomatic celiac disease who attended the gastroenterology outpatient clinic of the University Federico II of Naples. They then compared the celiac patients with sixty healthy control subjects matched for age and sex. Both groups of patients received clinical and ultrasound examination.

    The results showed that 24 of the sixty celiac disease patients (40%) showed at least one entheseal abnormality, compared with just six of the sixty (10%) healthy control subjects (P < 0.01).

    Interestingly, the celiac disease patients more commonly showed abnormalities of the patella (distal and proximal), while nearly all abnormalities in the healthy controls were found in the Achilles tendon.

    The results of this study demonstrate the ability of ultrasound to detect signs of subclinical entheseal abnormalities, and reveal higher rates of subclinical entheseal abnormalities in people with asymptomatic celiac disease.

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  • About Me

    Jefferson Adams earned his B.A. and M.F.A. at Arizona State University, and has authored more than 2,000 articles on celiac disease. His coursework includes studies in biology, anatomy, medicine, and science. He previously served as Health News Examiner for Examiner.com, and provided health and medical content for Sharecare.com.

    Jefferson has spoken about celiac disease to the media, including an appearance on the KQED radio show Forum, and is the editor of the book Dangerous Grains by James Braly, MD and Ron Hoggan, MA.

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    Jefferson Adams
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    A related study by Usai, et al found that 63% of patients with celiac disease show axial joint inflammation (2).
    In that study, doctors conducted bone scintigraphy using 99m Tc methylene diphosphonate. 14 of these patients (65%) signs compatible with sacroiliitis. 11 of the 14 suffered from low back pain. In five of the 11 patients with low back pain, scintigraphy was negative. Sacroiliac radiographs were conducted on 4 of those 5 patients, and all of them were shown to have bilateral sacroiliitis. One patient had rheumatoid arthritis, but all patients in the studied showed negative HLA-B27 results.
    Rheumatoid Symptoms Less Common in Celiacs on Gluten-free Diet
    In patients with gluten enteropathy, symptoms of arthritis and other rheumatic complaints are common, and the associated clinical abnormalities routinely show improvement on a gluten-free diet. (3,4,5)
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    Bulletin on the Rheumatic Diseases, Volume 51, Number 2.
    Usai P. Adult celiac disease is frequently associated with sacroiliitis. Dig Dis Sci 1995;40:1906-8 Lubrano E, Ciacci C, Ames PR, et al. The arthritis of celiac disease: prevalence and pattern in 200 adult patients. Br J Rheumatol 1996;35:1314-8. Usai P. Adult celiac disease is frequently associated with sacroiliitis. Dig Dis Sci 1995;40:1906-8. Bagnato gluten-free, Quattrocchi E, Gulli S, et al. Unusual polyarthritis as a unique clinical manifestation of celiac disease. Rheumatol Int 2000;20:29-30. Borg AA, Dawes PT, Swan CH, Hothersall TE. Persistent monoarthritis and occult celiac disease. Postgrad Med J 1994;70:51-3. Collin P, Korpela M, Hallstrom O, et al. Rheumatic complaints as a presenting symptom in patients with celiac disease. Scan J Rheumatol 1992;21:20-3. Kallilorm R, Uibo O, Uibo R. Clin Rheumatol 2000;19:118-22. health writer who lives in San Francisco and is a frequent author of articles for Celiac.com.

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