INFLAMMATORY RHEUMATIC DISEASE IN ADULT C ELIAC SPRUE

Five adults had inflammatory rheumatic disorders 6 to 20 years before the diagnosis of coeliac disease. It is known that joint inflammation occurs in certain patients with adult coeliac sprue who develop either a specific inflammatory rheumatic disease or an atypical progressive polyarthropathy, sometimes as the first manifestation of the intestina l disorder. The diagnosis of adult coeliac sprue should be entertained in these cases even in absence of major digestive disorders or malabs orption. IgA anti-reticulin antibodies and atrophy of the duodenojejun al villosities are the best indicators for diagnosis. There are two im portant reasons for making the diagnosis of ''asymptomatic adult coeli ac sprue''. First a gluten-free diet can improve or even cure the infl ammatory joint disease, a rare situation which emphasizes the causal r elationship between these two diseases. Second, the risk of developing lymphoma (especially in the small bowel) is apparently lower in patie nts on gluten-free diet. Pathogenesis is unclear. Frequently the two a utoimmune disorders simply appear to coincide in the same patient; mor e rarely, arthritis is a symptom of coeliac disease. The immunological mechanisms probably begin when antigens cross an excessively permeabl e intestinal mucosa.