pmc.ncbi.nlm.nih.gov

Arthritis and coeliac disease

Abstract

We report six patients with coeliac disease in whom arthritis was prominent at diagnosis and who improved with dietary therapy. Joint pain preceded diagnosis by up to three years in five patients and 15 years in one patient. Joints most commonly involved were lumbar spine, hips, and knees (four cases). In three cases there were no bowel symptoms. All were seronegative. X-rays were abnormal in two cases. HLA-type A1, B8, DR3 was present in five and B27 in two patients. Circulating immune complexes showed no consistent pattern before or after treatment. Coeliac disease was diagnosed in all patients by jejunal biopsy, and joint symptoms in all responded to a gluten-free diet. Gluten challenge (for up to three weeks) failed to provoke arthritis in three patients tested. In a separate study of 160 treated coeliac patients attending regular follow up no arthritis attributable to coeliac disease and no ankylosing spondylitis was identified, though in a control group of 100 patients with Crohn's disease the expected incidence of seronegative polyarthritis (23%) and ankylosing spondylitis (5%) was found (p less than 0.01). Arthritis appears to be a rare manifestation of coeliac disease. This relationship may provide important clues to the role of gastrointestinal antigens in rheumatic diseases.

592

Images in this article

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Adelizzi R. A., Pecora A. A., Chiesa J. C. Celiac disease: case report with an associated arthropathy. Am J Gastroenterol. 1982 Jul;77(7):481–485. [PubMed] [Google Scholar]
  2. Dawes P. T., Atherton S. T. Coeliac disease presenting as recurrent pericarditis. Lancet. 1981 May 9;1(8228):1021–1022. doi: 10.1016/s0140-6736(81)92187-5. [DOI] [PubMed] [Google Scholar]
  3. Doe W. F., Booth C. C., Brown D. L. Evidence for complement-binding immune complexes in adult coeliac disease, Crohn's disease, and ulcerative colitis. Lancet. 1973 Feb 24;1(7800):402–403. doi: 10.1016/s0140-6736(73)90254-7. [DOI] [PubMed] [Google Scholar]
  4. Falchuk Z. M. Gluten-sensitive enteropathy. Clin Gastroenterol. 1983 May;12(2):475–494. [PubMed] [Google Scholar]
  5. Hallert C., Tobiasson P., Walan A. Serum folate determinations in tracing adult coeliacs. Scand J Gastroenterol. 1981;16(2):263–267. doi: 10.3109/00365528109181966. [DOI] [PubMed] [Google Scholar]
  6. Hamilton I., Cobden I., Rothwell J., Axon A. T. Intestinal permeability in coeliac disease: the response to gluten withdrawal and single-dose gluten challenge. Gut. 1982 Mar;23(3):202–210. doi: 10.1136/gut.23.3.202. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Hay F. C., Nineham L. J., Roitt I. M. Routine assay for the detection of immune complexes of known immunoglobulin class using solid phase C1q. Clin Exp Immunol. 1976 Jun;24(3):396–400. [PMC free article] [PubMed] [Google Scholar]
  8. Henriksson K. G., Hallert C., Norrby K., Walan A. Polymyositis and adult coeliac disease. Acta Neurol Scand. 1982 Apr;65(4):301–319. doi: 10.1111/j.1600-0404.1982.tb03088.x. [DOI] [PubMed] [Google Scholar]
  9. Kenrick K. G., Walker-Smith J. A. Immunoglobulins and dietary protein antibodies in childhood coeliac disease. Gut. 1970 Aug;11(8):635–640. doi: 10.1136/gut.11.8.635. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Meyers S., Dikman S., Spiera H., Schultz N., Janowitz H. D. Cutaneous vasculitis complicating coeliac disease. Gut. 1981 Jan;22(1):61–64. doi: 10.1136/gut.22.1.61. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Mohammed I., Holborow E. J., Fry L., Thompson B. R., Hoffbrand A. V., Stewart J. S. Multiple immune complexes and hypocomplementaemia in dermatitis herpetiformis and coeliac disease. Lancet. 1976 Sep 4;1(7984):487–490. doi: 10.1016/s0140-6736(76)90787-x. [DOI] [PubMed] [Google Scholar]
  12. Neumann V., Wright V. Arthritis associated with bowel disease. Clin Gastroenterol. 1983 Sep;12(3):767–795. [PubMed] [Google Scholar]
  13. Prier A., Le Quintrec Y., Camus J. P., Gendre J. P., Pradel B. Polyarthritis inflammatoires associées a une atrophie villositaire du grêle. Etude de deux observations. Rev Rhum Mal Osteoartic. 1980 Nov;47(11):661–665. [PubMed] [Google Scholar]
  14. Scott H., Brandtzaeg P., Thorsby E., Baklien K., Fausa O., Ek J. Mucosal and systemic immune response patterns in celiac disease. Ann Allergy. 1983 Aug;51(2 Pt 2):233–239. [PubMed] [Google Scholar]
  15. Seah P. P., Fry L., Hoffbrand A. V., Holborow E. J. Tissue antibodies in dermatitis herpetiformis and adult coeliac disease. Lancet. 1971 Apr 24;1(7704):834–836. doi: 10.1016/s0140-6736(71)91499-1. [DOI] [PubMed] [Google Scholar]
  16. Smith R. THE SURGICAL RELIEF OF INTESTINAL FOCI OF INFECTION IN CASES OF ARTHRITIS DEFORMANS. Ann Surg. 1922 Oct;76(4):515–518. doi: 10.1097/00000658-192210000-00016. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Unsworth D. J., Leonard J. N., McMinn R. M., Swain A. F., Holborow E. J., Fry L. Anti-gliadin antibodies and small intestinal mucosal damage in dermatitis herpetiformis. Br J Dermatol. 1981 Dec;105(6):653–658. doi: 10.1111/j.1365-2133.1981.tb00975.x. [DOI] [PubMed] [Google Scholar]
  18. Unsworth D. J., Manuel P. D., Walker-Smith J. A., Campbell C. A., Johnson G. D., Holborow E. J. New immunofluorescent blood test for gluten sensitivity. Arch Dis Child. 1981 Nov;56(11):864–868. doi: 10.1136/adc.56.11.864. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. WRIGHT V., WATKINSON G. The arthritis of ulcerative colitis. Medicine (Baltimore) 1959 Sep;38:243–262. doi: 10.1097/00005792-195909000-00003. [DOI] [PubMed] [Google Scholar]
  20. Zubler R. H., Lange G., Lambert P. H., Miescher P. A. Detection of immune complexes in unheated sera by modified 125I-Clq binding test. Effect of heating on the binding of Clq by immune complexes and application of the test to systemic lupus erythematosus. J Immunol. 1976 Jan;116(1):232–235. [PubMed] [Google Scholar]
  21. van Rood J. J., van Leeuwen A., Ploem J. S. Simultaneous detection of two cell populations by two-colour fluorescence and application to the recognition of B-cell determinants. Nature. 1976 Aug 26;262(5571):795–797. doi: 10.1038/262795a0. [DOI] [PubMed] [Google Scholar]