Can a Gluten-Free Diet Help In Psoriatic Arthritis?

What is Psoriatic Arthritis?

Psoriatic arthritis is a chronic and progressive autoimmune condition that causes joint stiffness, pain, and swelling.(1,2,3) It is closely related to psoriasis, which is also an autoimmune condition that causes raised, red, and silvery scaly patches on the skin.(4,5) According to estimates of the National Psoriasis Foundation, 85 percent of people who have psoriatic arthritis have experienced psoriasis first, which then developed into psoriatic arthritis.(6)

In people with psoriatic arthritis, the immune system mistakenly starts attacking the healthy cells in your skin and joints, thinking of them as foreign invaders. This causes joint stiffness, pain, inflammation, skin symptoms associated with psoriasis, and fatigue.

While there is no cure as of yet for psoriatic arthritis, your doctor will prescribe medications and therapies to help manage your symptoms. In some cases, lifestyle changes will be recommended. One such lifestyle modification is to avoid gluten. If your doctor suspects that gluten is a trigger for your symptoms, you will be advised to avoid having foods containing gluten. According to statistics released by the National Psoriasis Foundation, at least 25 percent of people with psoriasis are sensitive to gluten.(7) When such people consume foods that contain gluten, their immune system overreacts, thus causing a flare-up of their symptoms.(8) 

What is Gluten and Gluten Intolerance?

Gluten is a type of protein that is found in certain grains, including:

Oats are also said to be contaminated with gluten because, in most cases, oats are processed alongside some gluten-containing grains such as wheat. Baked goods, bread products, and pasta are some of the common sources of gluten. However, gluten can also be found in less familiar or less obvious foods and ingredients, such as salad dressings, sauces, and many seasonings.

If your doctor suspects that your symptoms of psoriatic arthritis are being triggered due to gluten sensitivity, they are going to recommend you to avoid having gluten-rich foods. It is not advisable that you go ahead and cut out gluten from your diet without talking to your doctor, as there are potential benefits and risks to having a gluten-free diet.

People who are not able to tolerate gluten are said to have celiac disease or non-celiac gluten intolerance.(9,10,11)

Celiac disease is another autoimmune disease, and if you have it, your immune system will start mistakenly attacking the inner lining of your small intestine. This can cause various symptoms, such as:

If left untreated, celiac disease can also cause serious complications. Your doctor will prescribe blood tests along with a biopsy of the colon to diagnose celiac disease. Remember that you will need to continue eating gluten regularly in order for these tests to give an accurate result.

If you experience any symptoms while you are eating gluten, but you still get a negative report on the celiac disease diagnostic tests, it may be likely that you have a non-celiac gluten intolerance. There is no one medical test that allows your doctor to diagnose either of these conditions. If they suspect you have either of these conditions, you will be advised to avoid foods that contain gluten from your diet for at least a couple of months. If you find that your symptoms lessen or disappear altogether during this period, your doctor will then encourage you to add gluten back into your diet. If you find that your symptoms increase or return once you start consuming gluten again, it is taken as a sign that you have gluten intolerance or gluten sensitivity.(12,13

Can a Gluten-Free Diet Help In Psoriatic Arthritis?

Psoriatic arthritis, any other psoriatic conditions, and gluten intolerance are all known to trigger faulty immune responses in the body. While more research is still needed to establish the exact link between gluten intolerance and psoriatic conditions, some medical experts believe that there is definitely a strong connection between psoriasis and gluten intolerance. A 2011 study published in the Journal of Investigative Dermatology found that people who have celiac disease are at a greater risk of developing psoriasis before or after they are diagnosed.(14) This Swedish study also discovered that children with celiac disease were at a greater risk of having psoriasis later in life.

Another study done in 2014 and published in the same journal suggests that celiac disease and psoriasis share common inflammatory and genetic pathways.(15)

In people with both psoriatic arthritis and gluten intolerance, eating gluten has been shown to trigger the symptoms of not just one but both conditions. Due to this, your doctor is likely to encourage you to cut out gluten from your diet. 

How to Follow a Gluten-free Diet?

If your doctor has recommended that you remove gluten from your diet, you will need to get rid of all products that contain barley, rye, or wheat from your diet. You should also avoid oats as they are usually not certified as being completely gluten-free. You can ask your doctor or visit a dietitian to get a better understanding of how to follow a gluten-free diet. They will also provide you with a list of foods and ingredients that usually contain gluten. For example, you will need to check food labels for malt as that is made from barley and is a common ingredient in many prepackaged food products.

It is always better to read the ingredient list and ask about certain items at restaurants. When you start with a gluten-free diet, it may feel like a significant change, but there are still plenty of foods and ingredients you can include in a gluten-free diet. Here are some of the things you can include in your gluten-free diet:

  • Red meat, poultry, seafood
  • Fresh fruits and vegetables
  • Gluten-free grains like rice, quinoa, and corn
  • Dried legumes like chickpeas and lentils
  • You can also eat dairy products provided you don’t have a lactose or dairy intolerance.

It is essential that you only follow a gluten-free diet on the advice of your doctor because if your symptoms of psoriatic arthritis are not flaring up due to gluten intolerance and you start avoiding gluten foods, it may end up causing more harm than doing any good. This is primarily because following any kind of restricted diet always makes it more challenging to get all the nutrients your body needs to maintain optimal health. 

Conclusion

There are several studies that indicate that there is a connection between gluten intolerance and psoriatic arthritis. While there is more research needed to determine the exact link, but your doctor may still recommend a gluten intolerance test to see if gluten sensitivity is causing your symptoms. As a result of this, your doctor may encourage you to follow a gluten-free diet. At the end of the day, remember that the most important thing is to find a treatment plan for psoriatic arthritis that works best for you. And you can talk to your doctor to discuss how best to avoid gluten if you are found to be gluten intolerant.

References:

  1. Ritchlin, C.T., Colbert, R.A. and Gladman, D.D., 2017. Psoriatic arthritis. New England Journal of Medicine, 376(10), pp.957-970.
  2. Gladman, D.D., Antoni, C., Mease, P., Clegg, D.O. and Nash, P., 2005. Psoriatic arthritis: epidemiology, clinical features, course, and outcome. Annals of the rheumatic diseases, 64(suppl 2), pp.ii14-ii17.
  3. Moll, J.M.H. and Wright, V., 1973, January. Psoriatic arthritis. In Seminars in arthritis and rheumatism (Vol. 3, No. 1, pp. 55-78). WB Saunders.
  4. SCARPA, R., ORIENTE, P., PUCINO, A., TORELLA, M., VIGNONE, L., RICCIO, A. and ORIENTE, C.B., 1984. Psoriatic arthritis in psoriatic patients. Rheumatology, 23(4), pp.246-250.
  5. Villani, A.P., Rouzaud, M., Sevrain, M., Barnetche, T., Paul, C., Richard, M.A., Beylot-Barry, M., Misery, L., Joly, P., Le Maitre, M. and Aractingi, S., 2015. Prevalence of undiagnosed psoriatic arthritis among psoriasis patients: systematic review and meta-analysis. Journal of the American Academy of Dermatology, 73(2), pp.242-248.
  6. Psoriasis.org. 2020. What Is Psoriatic Arthritis?. [online] Available at: <https://www.psoriasis.org/about-psoriatic-arthritis/> [Accessed 25 November 2020].
  7. Psoriasis.org. 2020. How Does Your Diet Affect Psoriasis?. [online] Available at: <https://www.psoriasis.org/dietary-modifications/> [Accessed 25 November 2020].
  8. Drucker, A.M., Qureshi, A.A., Thompson, J.M., Li, T. and Cho, E., 2020. Gluten intake and risk of psoriasis, psoriatic arthritis, and atopic dermatitis among United States women. Journal of the American Academy of Dermatology, 82(3), pp.661-665.
  9. Czaja-Bulsa, G., 2015. Non coeliac gluten sensitivity–A new disease with gluten intolerance. Clinical Nutrition, 34(2), pp.189-194.
  10. Lundin, K.E. and Alaedini, A., 2012. Non-celiac gluten sensitivity. Gastrointestinal Endoscopy Clinics, 22(4), pp.723-734.
  11. Briani, C., Samaroo, D. and Alaedini, A., 2008. Celiac disease: from gluten to autoimmunity. Autoimmunity reviews, 7(8), pp.644-650.
  12. Fasano, A., Sapone, A., Zevallos, V. and Schuppan, D., 2015. Nonceliac gluten sensitivity. Gastroenterology, 148(6), pp.1195-1204.
  13. Hadjivassiliou, M., Sanders, D.S., Grünewald, R.A., Woodroofe, N., Boscolo, S. and Aeschlimann, D., 2010. Gluten sensitivity: from gut to brain. The Lancet Neurology, 9(3), pp.318-330.
  14. Ludvigsson, J.F., Lindelöf, B., Zingone, F. and Ciacci, C., 2011. Psoriasis in a nationwide cohort study of patients with celiac disease. Journal of Investigative Dermatology, 131(10), pp.2010-2016.
  15. Bhatia, B.K., Millsop, J.W., Debbaneh, M., Koo, J., Linos, E. and Liao, W., 2014. Diet and psoriasis, part II: celiac disease and role of a gluten-free diet. Journal of the American Academy of Dermatology, 71(2), pp.350-358.

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