Isasi Carlos, Stadnitsky Alexander, Casco Fernando, Tejerina Eva, Royuela Ana, Esteban Blanca, Puga Natalia Fernandez
Rheumatology Department of Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain.
Family Medicine at Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain.
Med Hypotheses. 2020 Feb 28;140:109646. doi: 10.1016/j.mehy.2020.109646.
To propose the hypothesis that non-celiac gluten sensitivity is associated with chronic low-back pain related to spondyloarthritis, and a gluten free diet has a therapeutic benefit in a subgroup of patients. Gut involvement is a well-known association of spondyloarthritis but limited to a few disorders such as inflammatory bowel disease. Currently the therapeutic implication of this association is pharmacologic treatment for inflammation with immunosupresive drugs for both diseases. Here is a case series of patients with chronic low-back pain, spondyloarthritis related features, and response to gluten free diet despite celiac disease being ruled out.
Retrospective case report of 110 patients from a tertiary hospital rheumatology clinic specialized in chronic pain and gluten sensitivity. These are patients with refractory low-back pain and spondyloarthritis features who followed a gluten free diet despite celiac disease being ruled out. Demanding improvement was defined based on the achievement of at least one of the following objectives: asymptomatic status, remission of chronic low-back pain, returning to normal life, returning to work, changing from confinement to bed/wheelchair to being able to walk, returning to self-sufficiency for hygiene and personal care, discontinuation of opioids.
Average age at low-back onset pain was 30. Average disease duration was 15 years. 87 (79%) of the patients experienced improvement. 69 (62%) of the patients achieved demanding improvement. Average duration of gluten-free diet in patients with demanding improvement was 60 months. 56 out of 69 patients with demanding improvement ingested gluten. Of these 56 patients, 54 experienced clinical worsening and were considered as having non-celiac gluten sensitivity. Oral aphthae and having a relative with celiac disease were associated with demanding improvement. Out of 28 patients retrospectively classified as having axial spondyloarthritis, 23 had demanding improvement. Out of 16 patients with uveitis, 13 had demanding improvement. Out of 83 patients with fibromyalgia, 48 had demanding improvement.
These observational data support the proposed hypothesis and offer information regarding possible clinical predictors of response to diet.
提出假说，即非乳糜泻性麸质敏感与脊柱关节炎相关的慢性下背痛有关，且无麸质饮食对部分患者具有治疗益处。肠道受累是脊柱关节炎的一个众所周知的关联因素，但仅限于少数疾病，如炎症性肠病。目前，这种关联的治疗意义是使用免疫抑制药物对两种疾病的炎症进行药物治疗。本文是一系列慢性下背痛、具有脊柱关节炎相关特征且排除乳糜泻后对无麸质饮食有反应的患者的病例报告。
对一家专门治疗慢性疼痛和麸质敏感的三级医院风湿病门诊的110例患者进行回顾性病例报告。这些患者患有难治性下背痛且具有脊柱关节炎特征，尽管排除了乳糜泻，但仍遵循无麸质饮食。显著改善的定义基于至少实现以下目标之一：无症状状态、慢性下背痛缓解、恢复正常生活、重返工作岗位、从卧床/轮椅受限状态转变为能够行走、恢复卫生和个人护理的自理能力、停用阿片类药物。
下背痛发病的平均年龄为30岁。平均病程为15年。87例（79%）患者病情有所改善。69例（62%）患者实现了显著改善。实现显著改善的患者无麸质饮食的平均持续时间为60个月。69例实现显著改善的患者中有56例摄入了麸质。在这56例患者中，54例病情临床恶化，被认为患有非乳糜泻性麸质敏感。口腔溃疡和有乳糜泻亲属与显著改善相关。在28例回顾性分类为轴向脊柱关节炎的患者中，23例实现了显著改善。在16例葡萄膜炎患者中，13例实现了显著改善。在83例纤维肌痛患者中，48例实现了显著改善。
这些观察数据支持所提出的假说，并提供了关于饮食反应可能的临床预测指标的信息。
