Osteoarticular manifestations of celiac disease and non-celiac gluten hypersensitivity.
Celiac disease is a chronic inflammatory autoimmune enteropathy based disorder that is triggered by the ingestion of gluten in genetically susceptible individuals. The global prevalence of 1% to 2% represents only the tip of the iceberg. The diagnosis is confirmed by positive specific antibody, anti-transglutaminase or anti-endomysium, specific lesions of the small intestine and a response to strict gluten-free diet. The diagnosis is difficult and often delayed because the clinical variability is very large, ranging from digestive clinical presentation "classic" to "atypical" symptoms, often extra-intestinal, that are sometimes attributed to a concomitant disease or a complication. Among them, there are frequent musculoskeletal manifestations such as osteoporosis and osteomalacia. In the absence of risk factor, osteoporosis, in a premenopausal women or in a man less than 55 years, more is if it is severe and refractory to medications, need to rheumatologists on the track of celiac disease in the absence of digestive symptoms. Osteomalacia is related to secondary hypovitaminosis D malabsorption. Supplementation by calcifediol, water-soluble vitamin D, may be indicated. Celiac disease is associated with an autoimmune disease in almost 1/3 of the cases. Knowing these potential associations allows earlier diagnosis in patients whose only manifestation, a concomitant disease. Anemia, chronic fatigue or unexplained polyarthralgia are symptoms associated with celiac disease to look for specific antibodies. The aim of early diagnosis is to prevent the emergence of other systemic disorders and avoid complications such as bone fractures and cancer, especially intestinal lymphoma. Non-celiac gluten intolerance is a new entity defined by symptomatology similar to that of celiac disease induced by the ingestion of gluten and disappearing after crowding-out, among patients without specific antibodies and without intestinal lesion of celiac disease. This entity is a cause, at least in part, of increasing interest in gluten-free diet in the general population.
Université Paris Diderot, Sorbonne Paris Cité, 75005 Paris, France; Service de rhumatologie, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Lariboisière, 2, rue Ambroise Paré, 75010 Paris, France. Electronic address: stephanie.dossantos@aphp.fr.
Stéphanie
S
Dos Santos
Université Paris Diderot, Sorbonne Paris Cité, 75005 Paris, France; Service de rhumatologie, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Lariboisière, 2, rue Ambroise Paré, 75010 Paris, France; Inserm, UMR 1132, centre Viggo-Petersen, Hôpital Lariboisière, 75010 Paris, France.
Frédéric
F
Lioté
D001847:Bone Diseases / Q000276:immunology*; D002446:Celiac Disease / Q000175:diagnosis* / Q000276:immunology; D005983:Glutens / Q000009:adverse effects*; D006801:Humans; D006967:Hypersensitivity; D007592:Joint Diseases / Q000276:immunology*
D005983:Glutens
Arthritis; Autoimmune disease; Celiac disease; Osteoporosis; Polyarthralgia