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Musculoskeletal Complications of Celiac Disease: A Case-Based Review
Gerasimos Evangelatos1, Konstantina Kouna2, Alexios Iliopoulos2
1First Department of Propaedeutic Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece.
Insights
Celiac disease (CD) can present with musculoskeletal pain and low bone density, often missed in rheumatology. Early diagnosis and a gluten-free diet with supplements significantly improve symptoms and bone health.
Area of Science:
- Rheumatology
- Gastroenterology
- Endocrinology
Background:
- Celiac disease (CD) diagnosis in rheumatology is infrequent, as diarrhea is often the primary symptom.
- Musculoskeletal manifestations like arthralgia, myalgia, osteomalacia, and osteoporosis are common in CD patients.
- Reduced bone mineral density (BMD) affects up to 75% of CD patients, increasing fracture risk.
Purpose of the Study:
- To highlight the importance of recognizing celiac disease's musculoskeletal manifestations in rheumatology.
- To present a case study illustrating the diagnostic and management pathway for CD presenting with bone pain.
- To emphasize the impact of gluten-free diet and supplementation on symptom and BMD improvement.
Main Methods:
- Case report of a 66-year-old male presenting with back and knee pain.
- Radiographic assessment revealing osteopenia.
- Laboratory testing for celiac disease, vitamin D deficiency, and BMD measurement.
Main Results:
- Celiac disease, vitamin D deficiency, and osteomalacia with extremely low BMD were diagnosed.
- Gluten-free diet (GFD) and vitamin D/calcium supplementation led to significant symptom and BMD improvement within 6 months.
- The patient experienced substantial amelioration of pain and bone density.
Conclusions:
- Celiac disease should be considered in patients with unexplained arthralgia, arthritis, or bone pain.
- Early diagnosis and management with GFD and supplements are crucial for improving musculoskeletal symptoms and BMD in CD.
- Increased rheumatologist awareness of CD's skeletal complications can enhance patient outcomes.
Abstract:
Primary diagnosis of celiac disease (CD) in rheumatology department is not common in daily clinical practice, due to the fact that diarrhoea is usually the dominant symptom. Extra-intestinal manifestations, such as arthralgia, myalgia, osteomalacia, and osteoporosis are not rare in these patients. We present a case of a 66-year-old man, who came to the outpatient rheumatology clinic, complaining of back and knee pain. Osteopenia was observed in plain radiographs, whereas extensive laboratory testing revealed celiac disease, vitamin D deficiency, and extremely low bone mineral density (BMD) due to osteomalacia. Gluten-free diet (GFD) initiation and administration of vitamin D and calcium supplements resulted in significant symptom and BMD improvement over 6 months. A significant proportion of CD patients might present with arthralgia, arthritis, back pain, myalgia, or bone pain. Importantly, up to 75% of patients might have reduced BMD, due to osteoporosis or osteomalacia, while they also carry a significant risk for fracture. However, the introduction of GFD and calcium/vitamin D supplementation significantly ameliorates symptoms and BMD in most cases. Increased awareness of CD's musculoskeletal manifestations by rheumatologists is important for early recognition and management of this condition and its complications.
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