Arthritis, Gout & Gluten; The Connection

Genetic and metabolic processes found in arthritis and gout are common in both Celiac Disease (CD) and Gluten Sensitivity (GS). I am a sufferer and was thrilled to see a recent article in Simply Gluten Free Magazine written by Dr Alexander Shikhman; it was all about arthritis, gout and gluten. These conditions definitely run in my family and I am lucky to have been cursed with this for most of my life.  I wanted to share this information with all of you because I meet so many customers with the same issues and I get so many questions about this. If you are like me and suffer from Celiac Disease, arthritis and/or gout; this is for you.  If you don’t, you will become aware of the symptoms and understand why arthritis/gout can be a problem for those with CD or GS. Below; I will not only tell you about each; but also the causes, prevention methods and treatments.

The most common forms of arthritis that are seen in people with CD/GS are Calcium Pyrophosphate Depositon Disease (CPPD also known as pseudogout), Gout, Psoriatic Arthritis and Rheumatoid Arthritis. I also will share with you how the above conditions have affected me.

I have had severe issues with most of the above for most of my life; suffering from uric acid stones (jagged crystal stones) and calcium stones (they look very different when you pass them). Often, I had jagged crystals which would get stuck in my ureter when I was trying to pass them.  Sometimes a calcium stone would follow and get stuck on the jagged crystal stone lodged in my ureter.  A few times the urologist or nephrologist would have to go in and remove all of them for me (blessed relief).  I also had arthritis so bad in my shoulder that it took a 5 hour plus surgery to clean/free up my shoulder joint! I had constant gall stones and “gravel” (sand like crystals) until they finally took my gall bladder out back in the early 90’s. While reading the article, it reminded me of the explanation of why I have kidney stones (see post on this). Thankfully, I am now on a combination of diuretics to help flush calcium and uric acid from my system; which reduces the amount of stones and crystals that I get.  If I miss a dose of my diuretics, I brace myself for the oncoming storm of stones and/or severe stabbing pain in my toe joints, knees and some finger joints!

So, lets examine each:

CPPD; Calcium Pyrophosphate Deposition Disease (pseudogout)– most common form associated with GS/CD; characterized by deposition of calcium pryrophosphate crystals in the joints that will trigger acute inflammation.  When untreated the crystals are like abrasive materials and can cause cartilage degeneration and joint and tendon ruptures as well as joint degeneration.

-Caused by: Malabsorption of Vit D and Magnesium, excessive use of proton pump inhibitors (acid reflux meds) and complications of bisphosphonate therapy (drugs to prevent loss of bone mass) in those with osteopenia/osteoporosis, excessive production of parathyroid hormone, advanced hypothyroidism and iron metabolism diseases.  Prevention: methods include Vit D and Magnesium supplementation, address and correct hormonal imbalances, avoidance of proton pump inhibitors & bisphosphonates, physical therapy, anti inflammatory probiotics, and bromelain consumption. Bromelain are enzymes found in pineapples that digest protein. *The trick here is to control flare ups by keeping blood levels of calcium, magnesium, viatmin D and parathyroid hormones consistently in normal limits.  Having a good internal medicine doc who helps manage all of your medical conditions is key..the internist looks at the big picture and how everything interacts! (I was able to get off my Proton Pump Inhibitor because I only get acid reflux if I consume gluten and that is not an issue for me any longer. My first symptom of ingesting gluten is acid reflux! I also went undiagnosed with Hashimoto’s Disease (advanced hypothyroidism) for a long time as well.)

Gout- Gout often shows up in joints; red, tender, hot and swollen, accompanied by pain. The body is overproducing uric acid that form crystals at high concentrations which forms crystals that are then deposited in the joints causing inflammation. It can affect any joint and is most often found in joints of of toes, elbows, knees, ankles and index finger. Often the attacks occur at night when the body temperature is lower. Uric acid forms when purines (natural substances found in foods and our body) are broken down. Foods that are high in purines should be avoided: meat and meat products, seafood, alcoholic beverages, asparagus, cauliflower, spinach, mushrooms, green peas, lentils and beans.

-Causes of Gout: unbalanced diet with high purine foods, disturbances in gastro-intestinal tract such as the gut microflora resulting in decreased breakdown of uric acid in the gut. This causes re-absorption into the bloodstream. Another cause is non-alcoholic fatty liver disease because the liver enzyme, xantine oxidase is not adequate and it is the main regulator of uric acid. Lastly, imbalances in our sex hormones (low estrogen & testosterone and elevated progesterone) that are frequently seen in people with CD/GS. –Prevention of Gout: Treatment Options: non-steroidal anti-inflammatory drugs (NSAIDS), bromelain, fish oil, alpha lipoic acid, folic acid, baking soda, probiotics, prebiotics, etc. (Vitamin C is not recommended because it increases intestinal permeability and can make leaky gut syndrome worse).  The goal is to keep the blood uric acid level below 5.0mg/dl and incorporate Allopurinol and Febuxostat. (I take probiotics daily, Hydrochlorothiazide and Allopurinol. When they finally added the Allopurinol into my regimine back in 2006; that combination finally worked for me… as long as I don’t miss any doses! I can’t take NSAIDS due to previous ulcer. PS: I got a lot better when I took spinach and red wine out of my diet too.)

Psoriatic Arthritis – This is just a type of arthritis that shows up in people who have a skin rash known as psoriasis. The symptoms vary and can affect any joint and the spine. If left untreated it can cause joint deformities and disability. Often those with psoriatic arthritis have increased prevalence of carrying gene HLA-DQ8 (gene associated with CD).      Prevention: GF Diet normalizes absorption of drugs and supplements used for psoriasis and psoriatic arthritis and normalizes our gut microflora that could halt the progression. Also, the GF diet reduces intestinal inflammation which can delay the systemic inflammation. (I don’t have this! My rash was Dermatitis Herpetiformis or DH which is the skin manifestation of Celiac Disease. It flares up when I am exposed to gluten.  When I was younger, I was sent to a dermatologist who perscribed steroids and I also used steroid creams for years to try to clear this up. After my Celiac diagnosis and consistent GF Diet; the rash cleared on it’s own. DH is most often mis-diagnosed as eczema.)

Rheumatoid Arthritis- an autoimmune and systemic disease in which the body’s immune system – which normally protects its health by attacking foreign substances like bacteria and viruses – mistakenly attacks the joints. This creates inflammation that causes the tissue (sinovium) that lines the inside of joints to thicken, resulting in swelling and pain in and around the joints. The synovium makes a fluid that lubricates joints and helps them move smoothly. RA can also affect the other body systems like the heart and lungs and that is why it is an autoimmune disease and a systemic disease and it is hereditary.

If inflammation goes unchecked, it can damage cartilage and the bones themselves. Over time, there is loss of cartilage, and the joint spacing between bones can become smaller. Joints can become loose, unstable, painful and lose their mobility. Joint deformity also can occur and joint damage cannot be reversed sometimes surgery can help. RA can occur at a young age and doctors recommend early diagnosis and aggressive treatment to control RA. Rheumatoid arthritis most commonly affects the joints of the hands, feet, wrists, elbows, knees and ankles. The joint effect is usually symmetrical. That means if one knee or hand if affected, usually the other one is, too.  Diagnosis is through x rays and blood tests and symptoms. There is not one test for it..it is a combination of tests, symptoms and family history.

My father’s aunt was crippled by RA when she was very young.  Many years ago, a Rheumatologist told me that he thought I had RA and I would have to come back for blood work when I was having a flare up. So, I tried that; I called but had to wait several weeks to get back in. By the time I got back in, the flare up had passed.  I decided that I would rather be a hypochondriac and did not attempt to go back the next time I had a flare up. So,  I don’t know..but I can say that once I had the Celiac diagnosis and adhered to my GF diet, the disabling joint pain subsided and my fingers and toes stopped curving.

The key is to know the signs and symptoms of these conditions and know your family history. I can’t stress enough the importance of a primary care physician who is also an internist. He or she manages and understands all of your conditions and how they affect other body systems and will actively work with your other doctors/specialists to keep you healthy. Many customers have asked me about this very issue. I will do a blog post very soon about my internist and why I am so glad I finally made the switch to an internist who also has Celiac Disease!

For more information on arthritis visit the arthritis foundation by clicking here!

As always, talk with your doctor before starting any treatment.

 

 

 

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