Rheumatic manifestations in celiac disease
What rheumatic manifestations have been described in patients with celiac disease (gluten sensitive enteropathy)?
• Arthritis (∼25%)—symmetric, nonerosive polyarthritis involving predominantly large joints (knees and ankles > hips and shoulders). May precede enteropathic symptoms in 50% of cases. Notably an oligoarthritis and sacroiliitis have also been reported. The arthritis responds to a gluten-free diet in 40% to 60% of cases.
• Metabolic bone disease occurs in most and can be complicated by secondary hyperparathyroidism and even osteomalacia due to steatorrhea from severe enteropathy causing vitamin D deficiency. Some of these patients are mistakenly diagnosed as fibromyalgia with irritable bowel syndrome.
• Dermatitis herpetiformis is present in 15%–25% of individuals with celiac disease and usually responds to a gluten-free diet. Dapsone can also be used.