ARTHROPATHY AND CELIAC-DISEASE

Arthritis in association with celiac disease (CD) was first reported, in 1982 (1) and initially considered rare, with only eight cases descr ibed by 1992 (2). Recent larger studies report arthritis in untreated CD in >25% of patients (3), with sacroiliitis reported in up to 63% of patients when evaluated by sensitive bone scintigraphy (2). Arthritis stems to be rare in CD patients treated with a gluten-free diet (4). Endomysial antibodies (EMA) and anti-gliadin antibodies (AGA) have bee n reported in up to 100% of CD patients presenting with arthritis (2); these uniformly resolve when treated with a gluten-free diet (4). The diagnosis of CD is confirmed by proximal small bowel biopsy showing u niformly flattened villous mucosa (5), which also normalizes with trea tment with a gluten-free diet. We report a woman with arthralgias asso ciated with a prolonged, unexplained diarrheal illness. EMA and AGA we re positive, and CD was confirmed by small bowel biopsy after two prev ious nondiagnostic endoscopic evaluations. Joint pain and diarrhea pro mptly resolved, and EMA and AGA antibodies became negative with treatm ent with a gluten-free diet. Because 50% of patients with arthritis as sociated with CD may have no gastrointestinal symptoms (4), CD should be considered in any patient with a seronegative arthritis or arthralg ias and especially with unexplained microcytic or macrocytic anemia (4 ), weight loss (4), or laboratory evidence of malabsorption (1, 4, 6, 7). Laboratory screening with EMA and AGA is often positive in untreat ed CD patients presenting with arthritis and should prompt gastroenter ologic evaluation to confirm a diagnosis of CD.