Persistent monoarthritis and occult coeliac disease

Area of Science:

• Gastroenterology
• Rheumatology
• Immunology

Background:

• Coeliac disease is an autoimmune disorder triggered by gluten ingestion.
• Arthritis is a known, though less common, manifestation of untreated coeliac disease.
• Gluten-free diets typically resolve coeliac disease-related symptoms, including joint pain.

Observation:

• A case of previously undiagnosed (occult) coeliac disease presented with monoarthritis.
• The patient's arthritis affected the talo-navicular joint.
• Initial response to a gluten-free diet was observed.

Findings:

• Despite adherence to a gluten-free diet, the patient experienced severe and progressive erosive damage.
• The talo-navicular joint was significantly impacted by the ongoing inflammatory process.
• This suggests a complex interplay between coeliac disease, joint inflammation, and dietary response.

Implications:

• Occult coeliac disease can present with severe joint manifestations.
• Standard gluten-free dietary treatment may not always prevent joint damage progression in coeliac disease.
• Further research is needed to understand and manage refractory arthritis in coeliac patients.