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Celiac Patients Show Higher Rates of Entheseal Abnormality than Healthy Patients

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.

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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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