Celiac.com 06/23/2025 - Doctors and researchers have long suspected that people with one autoimmune disease may be at higher risk for developing others. This study focused on two such conditions: rheumatoid arthritis and celiac disease. The main goal was to find out how common celiac disease is among people who have rheumatoid arthritis, compared to people who do not have it. The researchers also wanted to track how often new cases of celiac disease appeared in both groups over time.

How Was the Study Done?

The study used healthcare records from a large database in the Lombardy region of Italy, which covers over 10 million people. The researchers looked at data from 2004 to 2013.

They identified over 70,000 adults diagnosed with rheumatoid arthritis and compared them to over 270,000 people without rheumatoid arthritis, carefully matching them by age and sex. These records included diagnosis codes from doctors, prescriptions, and certifications for chronic illnesses.

Importantly, the researchers used official diagnostic codes to confirm both rheumatoid arthritis and celiac disease diagnoses, meaning the results are based on medically verified cases—not just suspected or mild cases.

What Did the Researchers Find?

Celiac Disease Was More Common in People With Rheumatoid Arthritis

One of the clearest findings was that people with rheumatoid arthritis were more likely to also have celiac disease. Specifically:

• 0.24% of those with rheumatoid arthritis had celiac disease
• 0.14% of the people without rheumatoid arthritis had celiac disease

While these percentages may seem small, this actually means that celiac disease was nearly twice as common among those with rheumatoid arthritis.

Women With Rheumatoid Arthritis Were at Higher Risk

The connection between the two diseases was especially strong in women. Women with rheumatoid arthritis were much more likely to have celiac disease than women without it. However, this pattern was not seen in men, whose rates of celiac disease were about the same regardless of whether they had rheumatoid arthritis.

The study also found that younger women with rheumatoid arthritis—especially those under age 60—had the highest rates of celiac disease, suggesting that this might be a key group to monitor closely.

The Rate of New Celiac Diagnoses Stayed Stable

Another question the researchers asked was whether new cases of celiac disease were becoming more common over time in people with rheumatoid arthritis. Interestingly, they found that the incidence, or rate of new cases, remained stable during the 9-year follow-up period. This is in contrast to some other studies that have shown rising rates of celiac disease in the general population, especially among young people.

How Reliable Are the Results?

The study's large size and long follow-up period add weight to its conclusions. Additionally, because the researchers only included medically confirmed diagnoses, the findings are likely to reflect true disease patterns.

However, there are some limitations to keep in mind. Since the study relied on administrative data, it lacked detailed clinical information like symptoms, test results, or dietary habits. Also, because both conditions are relatively rare in the general population, the total number of people with both diseases was still fairly small, which can limit deeper analysis.

Moreover, since the non-arthritis control group was matched by age and gender to people with rheumatoid arthritis, it may not represent the broader population perfectly. This could slightly affect how the results compare to other studies.

Why Does This Matter for People With Celiac Disease?

This study highlights an important connection between two autoimmune conditions. If you or someone you know has rheumatoid arthritis—especially if you are a woman under 60—it may be worthwhile to talk to your doctor about the possibility of celiac disease, especially if you experience symptoms like unexplained digestive problems, fatigue, or nutrient deficiencies.

Currently, routine celiac screening is recommended for people with certain other autoimmune diseases, like type 1 diabetes or autoimmune thyroid disease. Rheumatoid arthritis has not traditionally been part of that list, but this study suggests it may deserve more attention—at least for certain patients.

By identifying celiac disease earlier in people with rheumatoid arthritis, doctors might be able to reduce complications, improve quality of life, and ensure proper nutrition through a gluten-free diet.

Read more at: frontiersin.org

Watch the video version of this article:

Celiac.com 02/08/2023 - Arthritis is a common problem for many people with celiac disease. And patients with celiac disease get rheumatoid arthritis twice as much as non-celiacs. However, the connection between arthritis and celiac disease is not well understood. A number of studies have found connections between celiac disease and arthritis. The connections are still not well understood, but here are some of the main findings.

Celiac Disease and Juvenile Idiopathic Arthritis

A recent study shows that JIA is nearly three times more common among children with celiac disease than in the general population. Other studies support this finding. We also know that celiac disease can occur in JIA patients with no celiac symptoms.

Celiac Disease and Rheumatoid Arthritis

In adults with celiac disease, rheumatoid arthritis strikes nearly 9 per 10,000 person-years and about 5 per 10,000 person-years in matched factors over a follow-up of about nine years.

Rheumatoid arthritis occurs nearly twice as often among adults with celiac disease. It's important for individuals with celiac disease to be aware of the possibility of developing rheumatoid arthritis and to inform their doctor if they have any joint symptoms. 

High rates of Celiac Disease Antibodies in Adult Rheumatology Patients

We know that studies have shown high rates of celiac antibodies in adult rheumatology patients. A recent study showed celiac antibodies in 3% of adult rheumatology patients, which provides support for celiac screening in people with rheumatological issues might be good practice.

Because of the extra risk, it is important for clinicians to watch closely for signs of arthritis in celiac patients with joint symptoms, as early arthritis detection and treatment leads to much better outcomes.

Look for researchers to learn more about the connections between arthritis and celiac disease going forward. Stay tuned for more on this and other important stories about celiac disease.

Read more on celiac disease and arthritis

• Could an Old Arthritis Drug Treat Celiac Disease and Allow Celiacs to Eat Gluten Again?
• Celiac Disease More Common in Patients With Juvenile Idiopathic Arthritis
• Celiac Disease Possible in Juvenile Idiopathic Arthritis Patients with no Celiac Symptoms

Celiac.com 12/23/2022 - Compared with the general population, children with celiac disease are nearly three times as likely to develop juvenile idiopathic arthritis, while adults with celiac disease are nearly twice as likely to be diagnosed with rheumatoid arthritis. Celiac disease is tied to numerous immune-mediated conditions, but, so far, researchers haven't nailed down any solid epidemiological connection between celiac disease and juvenile idiopathic arthritis or rheumatoid arthritis. A new study changes that. Here's how.

Population-based Cohort Study

Using a population-based cohort, a team of researchers recently set out to determine the risk of juvenile idiopathic arthritis and rheumatoid arthritis in people with celiac disease.

The research team included John B. Doyle, MD; Benjamin Lebwohl, MD, MS; Johan Askling, PhD; Anders Forss, MD; Peter H.R. Green MD; Bjorn Roelstraete, PhD; Jonas Söderling, PhD; Jans F. Ludvigsson, and Jonas MD, PhD.

They are variously affiliated with the Celiac Disease Center, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA; the Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; the Department of Pediatrics, Orebro University Hospital, Orebro, Sweden.

Celiac Disease Data Used to Spot Patients

Using a national histopathology database in Sweden, the team identified patients diagnosed with biopsy-proven celiac disease between 2004 and 2017. They then matched each patient by age, sex, calendar year, and geographic region against people from the general population. 

They then used Cox proportional hazards models to calculate the incidence and estimated the relative risk of juvenile idiopathic arthritis in celiacs aged eighteen and under, and of rheumatoid arthritis in people with celiac disease aged eighteen and over.

The team found just over 24,000 celiacs, whom they then matched to more than 117,000 people from the general population. 

Juvenile Idiopathic Arthritis Rates Triple for Celiac Youth & Rheumatoid Arthritis Rates Double for Adults 

Among people under 18 years old, the incidence rate of juvenile idiopathic arthritis was 5.9 per 10,000 person-years in patients with celiac disease and 2.2 per 10,000 person-years in the general population over a seven year follow-up. 

Among individuals 18 or over, the incidence of rheumatoid arthritis was 8.4 per 10,000 person-years in celiac disease and 5.1 per 10,000 person-years in matched comparators over a follow-up of 8.8 years.

KIA is nearly three times more common among children with celiac disease than in the general population, while rheumatoid arthritis occurs nearly twice as often among adults with celiac disease. 

Based on their findings, the team advises clinicians caring for celiac patients with joint symptoms to be vigilant for signs of juvenile idiopathic arthritis or rheumatoid arthritis in those patients.

Read more in the American Journal of Gastroenterology

Celiac.com 05/30/2022 - A recent Italian study published in Pediatric Rheumatology indicates that juvenile idiopathic arthritis patients have higher rates of celiac disease, which suggests that celiac screening would be beneficial for IA sufferers, especially those with a family history of autoimmunity. 

Since many autoimmune disorders share similar immune triggers, mechanics and contributing factors, including genetics and environment, understanding the connections, along with the factors associated with an increased susceptibility, could help researchers and clinicians to design better case-finding strategies for certain at-risk populations.

For their retrospective study, the team gathered information, including age at diagnosis, family history, other autoimmune disorders, juvenile idiopathic arthritis subtype, and medications, from a Southern Italian group of patients with juvenile idiopathic arthritis who were admitted to the Pediatric Rheumatology Unit between January 2001 and June 2019 who underwent celiac disease screening.

Using the data, they were able to assess clinical features and disease course, along with associated risk factors when juvenile idiopathic arthritis and celiac disease happen together. 

The team evaluated juvenile idiopathic arthritis patients every 3 to 6 months and adjusted treatment in response to adverse events and disease effects.

The team's analysis is limited in part by small sample size of patients with both juvenile idiopathic arthritis and celiac disease, and because patients with juvenile idiopathic arthritis and celiac disease had longer follow-up periods than patients with juvenile idiopathic arthritis alone. 

However, since most celiac disease diagnosis occurred within 12 months of juvenile idiopathic arthritis onset, the team believes this does not influence bias.

The team concluded that:

Quote

Of 329 patients with JIA (mean age 12.5 years, 74.8% female), 8 (2.4%) were diagnosed with CD, resulting in a higher prevalence of CD when compared with the general Italian population (2.4% vs 0.93%, p < 0.05). Autoimmunity of at least 1 first- or second-degree relative was found in 87.5% (n = 7) of patients with both JIA and CD, compared with only 45.8% of those without CD (p < 0.05).

Further, 87.5% (n =7) of patients with both JIA and CD needed a disease-modifying antirheumatic drug (DMARD) and a biological DMARD (bDMARD), compared with 36.4% of patients without CD (p < 0.05), suggesting more severe JIA course in this patient population.

They also added that the "results highlight the importance of celiac disease screening in pediatric juvenile idiopathic arthritis patients." These results are also significant for juvenile idiopathic arthritis patients who also have celiac disease, as juvenile idiopathic arthritis looks to be more aggressive in those patients, who often need step-up therapy. They note that these patients might benefit from an early introduction of a biologic drug, but more study is needed to know for sure.

They plan future studies to test whether first-line genetic testing followed by celiac disease-specific serological screening will produce better results than first-line serological screening.

Stay tuned for more on this and related stories.

Read more in Rheumatology Network

Celiac.com 12/13/2021 - Celiac disease is potentially connected to juvenile idiopathic arthritis (JIA).  A team of researchers recently set out to determine the serological incidence of celiac disease in patients with JIA. 

For their study, the team enrolled seventy-eight patients children under 16 years of age with JIA, who had not responded well to routine treatment, and who visited the pediatric centers of Tehran University of Medical Sciences between 2017 and 2019. The team also assessed the various manifestations of celiac disease, and measured celiac disease-related serological screening tests. 

Average subject age was about 8 years old, plus or minus about 4 years. years. Three patients with oligoarticular JIA had Anti-TTG-Ab levels above normal. None had celiac symptoms. 

Data showed no significant statistical differences in terms of growth disorders, sex distribution, and different subtypes of JIA between the sero-positive and sero-negative groups. 

The team confirmed one case of celiac disease by pathology, and recommended a gluten-free diet for the patient. 

Their main takeaway from the data is that celiac disease is still possible, even in JIA patients with no celiac symptoms.

Read more in the Archives of Iranian Medicine. 2021 Oct 1;24(10):783-785.

The research team included N Payman Sadeghi, Kobra Salari, Vahid Ziaee, Nima Rezaei, and Kambiz Eftekhari. They are variously affiliated with the Children's Medical Center, Pediatrics Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran; the Pediatric Rheumatology Iranian Society; the Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran; the Pediatric Gastroenterology and Hepatology Research Center, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran and the Department of Pediatrics, Bahrami Children's Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Celiac.com 09/24/2019 - Currently, physicians do not routinely conduct celiac disease screening in patients with rheumatological diseases, as these people are not considered to have high risk for celiac disease.

A team of researchers recently set out to determine rates of celiac disease serological markers in a group of patients with rheumatological issues. The research team included Giacomo Caio, Roberto De Giorgio, Francesco Ursini, Silvia Fanaro, and Umberto Volta.

They are variously affiliated with the Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy; the Mucosal Immunology and Biology Research Center, Massachusetts General Hospital – Harvard Medical School, Boston, Massachusetts, USA; the Department of Medical Sciences, University of Ferrara, Ferrara, Italy; the Department of Health Sciences, University of Catanzaro “Magna Graecia”; and the Centre of Experimental Medicine and Rheumatology, William Harvey Research Institute, Queen Mary University of London.

The team screened blood from 230 rheumatological patients for celiac disease by testing IgA antitransglutaminase (TTG IgA), IgG deamidated gliadin peptides (DGP IgG) and IgA antiendomysium (EMA) antibodies.

Of the 230 total patients, the team found 67 patients with rheumatoid arthritis (RA), 52 with Sjögren’s syndrome (SjS), 42 with systemic sclerosis (SCL), 35 with systemic lupus erythematosus (SLE), 15 with mixed connective tissue disease, 11 with polymyositis and 10 with dermatomyositis.

The results showed TTG IgA antibodies in a total of 7 out of 230 cases, or 3%. They also showed such antibodies in 3 of 42 SJS cases, 2 of 42 SCL cases, 1 of 67 RA cases, and 1 of 35 SLE sera. All seven samples were also positive for DGP IgG and EMA IgA. DGP IgG antibodies were the most common, showing up in 16 total samples.

High rates of celiac disease antibodies in adult rheumatology patients suggest that celiac disease screening might be a good idea for people with rheumatological issues.

Read more at Gastroenterology Hepatology Bed Bench. 2018 Summer; 11(3): 244–249.

Celiac.com 03/16/2017 - When screening arthritis patients for celiac disease, should HLA be done before serology? During the past decades, an accumulating evidence shows a dramatic rise in the frequency of autoimmune diseases, including rheumatoid arthritis and gastrointestinal conditions, such as celiac disease.

HLA genes have been shown to be strongly associated with numerous autoimmune diseases, including rheumatoid arthritis (RA), juvenile idiopathic arthritis (JIA) and celiac disease. A team of researchers recently set out to assess the performance of celiac disease associated serology in face of a rheumatologic patient, when gluten enteropaty is suspected.

The research team included Hakim Rahmoune, Nada Boutrid, Mounira Amrane, and Belkacem Bioud. They are variously affiliated with the Pediatrics Department and the Biochemistry Department of Setif University Hospital at Setif-1 University in Algeria.

The main question they sought to answer was: Should HLA be done prior to the serology? Could unnecessary serial serological celiac disease screening in such rheumatology patient be avoided by performing an HLA typing, as a long-life marker of genetically celiac disease-susceptible patients?

Serogenetic screening without the requirement for follow-up small bowel biopsies provides a flexible, cost-effective methodology that could be widely applied to obtain accurate estimates of the prevalence of celiac disease in large group studies.

Source:

• International Journal of Celiac Disease, 2017, Vol. 5, No. 1, xx. DOI:10.12691/ijceliac disease-5-1-2

However, current clinical guidelines do not consider patients with rheumatic conditions to be at high risk for celiac disease despite numerous reported associations between the two in adults and children.

A team of researchers set out to assess the prevalence of celiac disease among kids receiving a rheumatology evaluation. The research team included Yekaterina Sherman, BA, Rose Karanicolas, MD, Brittany DiMarco, BA, Nancy Pan, MD, Alexa B. Adams, MD, Laura V. Barinstein, MD, L. Nandini Moorthy, MD, and Thomas J. A. Lehman, MD. They are variously affiliated with the Division of Pediatric Rheumatology, Hospital for Special Surgery, New York, New York; the Division of Rheumatology, Mount Sinai Medical Center, New York, New York; and the Division of Pediatric Rheumatology, Robert Wood Johnson Medical School in New Brunswick, New Jersey.

The team conducted celiac disease screenings on a total of 2,125 patients presenting for initial evaluation by the Division of Pediatric Rheumatology at the Hospital for Special Surgery between June 2006 and December 201, as a part of the standard initial serologic evaluation. The team then reviewed the charts at the end of this period. From this information, the team diagnosed celiac disease in a total of 36 patients (30 girls, 6 boys, mean age 9.4 ± 4.3 years, range 2–16 years), after serologic testing and evaluation by pediatric gastroenterology.

Eight additional patients with known celiac disease diagnoses presented during this time period. The total prevalence of celiac disease over this 6.5-year period was 2.0%. The most commonly reported complaints among patients diagnosed with celiac disease were myalgias, arthralgias, and skin rash.

Less frequently, patients reported gastrointestinal complaints including abdominal pain, nausea, and diarrhea.

All patients reported improvement or complete resolution of their musculoskeletal symptoms after beginning a gluten-free diet.

In this study, the team found 36 new cases of celiac disease among children presenting for rheumatology evaluation, for an overall prevalence rate of 2.0%.

The majority of patients who ultimately received a diagnosis of celiac disease presented with extra-intestinal manifestations.

These results underscore the importance of celiac disease screening in children receiving a rheumatology evaluation.

Source:

• Open Original Shared Link

A 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.

Source:

• Open Original Shared Link.

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)

In 9 of 74 patients with spondyloarthropathies, results show increased level of antigliadin antibodies, with 1 patient showing elevated antiendomysium antibodies and biopsy proven celiac disease (6). These results show that antiendomysial antibody testing is recommended as a screening tool in patients with suspected gluten enteropathy. Another study found that 3.3% of sprue patients had Sjogrens syndrome (7).

55 celiac patients who were tested for serial bone density showed osteoporosis in 50% of men and 47% of women. These findings confirm that celiac disease was an independent risk factor for osteoporosis (8).

Bulletin on the Rheumatic Diseases, Volume 51, Number 2.

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:

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.