FeaturesOct/Nov 2014 Issue

Gluten and Arthritis

Can the gluten-free diet help ease arthritic pain?

Body with Pain spots

Body with Pain spots photo by shutterstock/sebastian kaulitzki

Shortly after the birth of her second child, Brandy Uekman, 33, was hit with severe joint pain. It started in her hands. “My fingers were so swollen and tender, they wouldn’t work right,” says the stay-at-home mom from Maumelle, Arkansas. “I couldn’t tighten a bottle top or open a jar of baby food. Forget changing a squirmy baby’s diaper.”

Soon the terrible aching struck her feet and knees—and the pain was particularly bad at night. It took Uekman so long to get out of bed, her husband began bringing the baby to her for night feedings.

Diagnosis: Inflammation

Uekman was diagnosed with rheumatoid arthritis (RA), an autoimmune disorder characterized by joint pain and inflammation. However, Uekman balked at the strong RA medication she was prescribed, which would force her to abruptly wean her infant daughter.

Uekman’s aunt, diagnosed with RA more than 20 years earlier, suggested she try the gluten-free diet. Cutting out gluten had seemed to dramatically improve her aunt’s joint pain, as well as boost her energy level.

“I told my doctor I’d try the gluten-free diet for a month and if it didn’t help, I’d start whatever treatment he recommended,” Uekman recalls.

But before the month was up, her joint pain and swelling were gone. Now six years later, Uekman is still gluten-free and has no joint complaints.

It doesn’t surprise Susan Goodman, MD, when her RA patients ask her about the gluten-free diet. Goodman is a rheumatologist at the Hospital for Special Surgery in New York City. Since celiac disease is seen more frequently in the relatives of those with RA than the population in general—the two conditions share some genetic links—there’s heightened awareness of the benefits of the gluten-free diet in the RA community, Goodman explains.

What’s more, nearly a third of RA patients don’t respond satisfactorily to therapy. That means there’s a significant group of people who are looking for improvement elsewhere, Goodman says. “I think it’s understandable that people with a chronic disease like RA will try measures that have clearly been successful for others with similar symptoms.”

Indeed, the gluten-free diet can dramatically improve—and even resolve—joint symptoms in celiac adults, as well as children. A 2014 study of celiac children showed half had joint abnormalities (such as swelling) before going gluten-free. Just 11 percent had these abnormalities after eliminating gluten.

The gluten-free diet can reduce inflammation in the intestines and elsewhere in the body, including the joints. That’s probably why joints feel better, says Daniel A. Leffler, MD, MS, director of clinical research at the Celiac Center at Beth Israel Deaconess Medical Center in Boston.

However, celiacs are also at risk for the other big category of arthritis—osteoarthritis (OA), the everyday wear and tear of joint cartilage. Joint symptoms due to OA, also known as non-inflammatory arthritis, aren’t thought to improve on the gluten-free diet, says Leffler. Research in this area is lacking.

Dietary Trial

The growing number of individuals with non-celiac gluten sensitivity—gluten sensitivity,* for short—often report muscle and joint pain.

“There’s clearly a subset of gluten-sensitive individuals who say their joint symptoms improve when they avoid gluten,” says Leffler. “Whether there’s something specific in gluten that’s somehow affecting the joint is unclear.”

For those who don’t have celiac disease or gluten sensitivity, experts are less optimistic the gluten-free diet will help—but it may be worth a shot. There’s no evidence to support the gluten-free diet as treatment for arthritis (OA or RA), but some patients may have a gluten issue that hasn’t been diagnosed, says Goodman. “If a patient is interested, they should pursue the diet as a trial,” she says, adding, “It’s important that people stay off gluten long enough for a trial to be successful.” She recommends following the diet for a month.

Leffler agrees that eliminating gluten isn’t unreasonable, but he and other celiac experts stress the importance of testing for celiac disease before embarking on a gluten-free diet. For accurate celiac test results, people must be regularly eating gluten. After Brandy Uekman responded so well to the gluten-free diet, she was tested for celiac. However, the fact that she’d been gluten-free for several months made her negative celiac test results unreliable.

If you have severe or unexplained joint pain, talk to your doctor about testing for serious inflammatory joint diseases like RA, Leffler underscores. RA can be very destructive to joints and treating it early is important to preserve joint function.

*Gluten sensitivity can be thorny to diagnose because there’s not yet a definitive test for the condition. When wheat allergy and celiac disease have been ruled out and symptoms improve on the gluten-free diet, doctors may diagnose gluten sensitivity.

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