Celiac Disease and Rheumatoid Arthritis: How are Autoimmune Conditions Related?

The link between celiac disease and autoimmune conditions is hard to ignore. According to the Celiac Disease Foundation, your risk of developing an autoimmune disorder increases significantly if you have celiac disease (10.5% to 34% increased risk depending on age of diagnosis). And while celiac disease diagnoses continue to rise in the United States, so does the prevalence of autoimmune arthritis. How are the two diseases related, and how does celiac disease lead to arthritis?

It starts with the immune system, and how this defense system identifies and responds to potential threats.

Celiac Disease and Rheumatoid Arthritis

Celiac disease and rheumatoid arthritis are both autoimmune conditions. Symptoms of autoimmune conditions are caused by an immune response that results in inflammation. When the immune system is working properly, it is able to identify real threats and tell them apart from harmless substances found in the body. A properly functioning immune system will target germs and bacteria that can cause illness. However, in people with an autoimmune condition, their immune system attacks healthy tissues.

Celiac disease is caused when your immune response is triggered by gluten, a protein found in wheat, rye, and barley. When gluten enters the small intestine, your immune system begins to attack it. The response causes damage to the villi that line the small intestines. Villi are essential for absorbing vital nutrients, but when they are damaged, your small intestine is not able to absorb them.

Symptoms of celiac disease vary, but may include bloating, constipation or chronic diarrhea, nausea and vomiting, abdominal pain, weight loss, fatigue, anemia, headaches, joint pain, numbness in the hands and feet, and reduced spleen function. Some people with celiac disease don’t experience any of these typical symptoms. Many of the common symptoms of celiac disease are a result of malabsorption of vital nutrients.

Rheumatoid arthritis and psoriatic arthritis are also caused by a triggered immune system. But instead of the immune system attacking the small intestine, it targets the joints and tendons. Symptoms of autoimmune arthritis include joint pain, swelling, redness, fatigue, and psoriasis.

Celiac Disease vs Gluten Intolerance

It is possible to have an intolerance to gluten without your immune system recognizing gluten as a threat. Gluten sensitivity can cause abdominal discomfort, bloating, and diarrhea, but does not lead to serious long-term health consequences. That is because these symptoms are not from an immune response. Instead, gluten sensitivity is similar to other food sensitivities, and reducing the amount of gluten can improve symptoms.

If you have arthritis and are gluten sensitive, cutting out gluten can still help decrease joint pain and inflammation, even if you don’t have celiac disease. Gluten is shown to have an inflammatory effect even for some without celiac disease. In a gluten elimination study for people with rheumatoid arthritis, patients experienced an improvement in their overall arthritis symptoms. Research is still ongoing to further explore the benefits of a gluten-free diet for patients specifically with arthritis.

Does Celiac Disease Cause Arthritis?

Researchers at the University of Frederica ll of Naples found that patients with celiac disease are 4 times more likely to experience signs of arthritis, specifically in the knees and ankles. Furthermore, there is also evidence that suggests some people with rheumatoid arthritis may be misdiagnosed as “seronegative arthritis” while having underlying celiac disease. This can occur because celiac disease can trigger symptoms that mimic rheumatoid arthritis.

But does celiac disease directly cause rheumatoid arthritis?

There is a correlation between celiac disease and rheumatoid arthritis in regards to genetic predisposition and the chances of developing one of the two autoimmune conditions. The genes that cause celiac disease may also be linked to the genes that can trigger rheumatoid arthritis. Therefore, both diseases may occur independently from each other. There are also environmental factors that make a person more likely to develop an autoimmune disease, which is independent of genetic factors.

However, in a 1996 study by Kadioglu and Sheldon, research suggested that it may be possible for circulating gut lymphocytes (type of white blood cells) to migrate to the joints. This phenomenon may be explained by a gut-joint axis, which means the environment in the gut (intestinal track) can directly influence reactions in the joints. According to additional research, autoimmune inflammation may start in the gut years prior to any detectable joint inflammation associated with rheumatoid arthritis.

Therefore, it is possible that inflammation in the intestines caused by celiac disease may lead to the development of rheumatoid arthritis in some individuals.

Dangers of Untreated Celiac Disease

Because of the connection between celiac disease and other autoimmune disorders, if celiac disease goes unnoticed, there may be damage that occurs over time. There is also a strong connection between celiac disease and the development of autoimmune thyroid disease, Crohn’s Disease and ulcerative colitis, systemic lupus, multiple sclerosis, and psoriasis.

Other risks of undiagnosed celiac disease include intestinal cancers, infertility, malnutrition, and bone loss leading to osteoporosis. There is no cure or medication specifically for celiac disease, but when gluten is eliminated from the diet, the inflammatory reaction decreases as the gluten antibodies do not have gluten molecules to react against. Gluten must be eliminated entirely—even exposure to gluten in small amounts can trigger the autoimmune response.

Gluten-Free Diet for Rheumatoid Arthritis

If you have been diagnosed with rheumatoid arthritis, a gluten-free diet may be beneficial to improve symptoms and reduce inflammation, even if you don’t have celiac disease.

“There is more and more research to show that certain food products can trigger symptoms, including joint pain and even swelling, in patients who have an underlying autoimmune condition,” says Dr Panico, Chief of Rheumatology at Summit Rheumatology in Arizona. “We are starting to really see the health benefits of cutting out processed and refined food products, sugar, and flour. There is definitely a connection between what we eat and how our bodies feel, and this includes pain.”
If you have rheumatoid arthritis and suspect that you may have celiac disease, it is important to get screened by your provider. This involves having a blood test to detect if gluten antibodies are present in your body. A diagnosis can help determine if a gluten-free diet will be beneficial. You can also eliminate gluten and monitor how you feel. For some people, it may take as little as 2-4 weeks to notice if your symptoms change or improve. If you do not notice a change in your symptoms by eliminating gluten, there are still health benefits to consuming whole grains, so it is not necessary for all individuals with rheumatoid arthritis to give up gluten-containing products.

Dr. Panico emphasizes the importance of alerting your provider if you are experiencing any symptoms of celiac disease:
“If you have symptoms of abdominal pain and cramping, chronic diarrhea or constipation, a skin rash that is not explained, and chronic vitamin deficiencies, along with joint pain and swelling of joints like the knees and ankles, it is important to tell your doctor about ALL of your symptoms because they may actually be linked to one another. Blood tests for celiac antibodies are very reliable and easy to have checked. That way, we can determine which medication and diet plan would be more helpful to you specifically as an individual.”

Dr. Panico and the providers at Summit Rheumatology acknowledge the connection between diet and autoimmune disease and can help determine ways to identify if you have either celiac disease or rheumatoid arthritis. Ready to schedule an appointment? Give Summit a call at (480) 494-2770 or send our team a message.