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Occurrence of lower limb enthesopathy in coeliac disease patients

Occurrence of lower limb enthesopathy in coeliac disease patients

We see quite a number of people complaining of knee pain. Well, there is a possibility this is related to coeliac disease...

All too often we blame everything on thyroid, but maybe not this time?

FYI: WIki says...


In medicine, an enthesopathy refers to a disorder of entheses (bone attachments).

If the condition is known to be inflammatory, it can more precisely be called an enthesitis.

Enthesopathies are disorders of peripheral ligamentous or muscular attachments, abnormalities in the zones of attachment, for ligaments and tendons to bone.

And the patella is the kneecap.

Oxford Journals



Advance Access


The occurrence of lower limb enthesopathy in coeliac disease patients without clinical signs of articular involvement

Mariangela Atteno1, Luisa Costa1, Raffaella Tortora2, Antonio Cozzolino3,

Antonio Del Puente1, Francesco Caso4, Paolo Sfriso4, Raffaele Scarpa1 and

Carolina Ciacci5

+ Author Affiliations

1Rheumatology Research Unit, Department of Clinical and Experimental Medicine, 2Gastroenterology Research Unit, Department of Clinical and Experimental Medicine, University Federico II of Naples, Naples, 3Gastroenterology Unit, Santo Ottone Hospital, Ariano Irpino, Avellino, 4Rheumatology Research Unit, Department of Clinical and Experimental Medicine, University of Padova, Padova and 5Department of Medicine and Surgery, Gastroenterology, University of Salerno, Salerno, Italy.

Correspondence to: Mariangela Atteno, Rheumatology Research Unit, Department of Clinical and Experimental Medicine, University Federico II of Naples, via S. Pansini 5, 80131 Naples, Italy. E-mail:

Submitted 4 August 2012

revised version accepted 5 November 2012


Objective. Coeliac disease (CD) is a systemic autoimmune condition induced by gluten consumption in genetically predisposed people, affecting ~1% of the general population. In the literature, there are many studies that report the association between CD and different kinds of arthritis. The aim of this study was to investigate the presence of entheseal abnormalities by US in patients with CD without clinical signs of articular involvement as compared with healthy control subjects.

Methods. Sixty patients with CD attending the gastroenterology outpatient clinic of the University Federico II of Naples and 60 healthy control subjects matched for age and sex were enrolled in this study. Coeliac patients and healthy controls underwent clinical and US examination.

Results. Among 60 CD patients, 24 (40%) presented at least one entheseal alteration as compared with 6 (10%) control subjects (P < 0.01). In CD patients, the entheseal site more frequently involved was patellar (distal and proximal), while in the healthy controls the enthesopathies were all localized at the Achilles tendon.

Conclusion. In conclusion, the results of this study underline the ability of US to detect signs of subclinical enthesopathy and indicate the presence of a higher prevalence of subclinical enthesopathies in asymptomatic CD patients.

Rheumatology (2013) doi: 10.1093/rheumatology/kes380

First published online: January 7, 2013



4 Replies

Rod, you're working ovetime on information for us lately. Well done and thank you very much. Janeet.


I have to say that I have had far fewer aches and pains in my knees since I gave up gluten.....makes you think eh?



I have excluded all wheat and gluten (also anything containing Soy/Soya)from my diet many times and for as long as six months over decades.To date have not noticed any difference except in my face! get a puffy doughy face when eating bread the saliva glands feel and look larger.

I try to avoid any foods with these added and cook basic foods as much as possible.

Just gone back to my home baked bread after seven weeks without any gluten or wheat as was so longing for toasted bread. In fact obsessed about having a bit of toast, Gluten free bread exacerbated gut problems.

Have read from reliable source that European flour contains little or no Selenium.

See: Oxford Dictionary of Food & Nutrition 'a dietary essential mineral,which is part of *enzymes glutothione peroxidase and thyroxine deiodinase'

Some of these words i do not understand.

But what I have taken from it is...if I must eat will be made from flour containing the enzyme thyroxine deidinase and to that end I use Canadian flour. Added to this rye flour (low in gluten and carraway nutritious..not to all tastes though.

Have been tested for gluten/wheat intolerance which was negative. I am also aware that the current NHS test is not absolute!

What does help with long term knee pain/weakness is as recommended by physio is...standing on one leg and doing a 'knee press up' just bending it a little bouncing with putting full weight on knee. For decade have worn tubi grip bandage on knees as cold knees are painful ones for me. My left is the most painful as i am shorter on right and left takes the weight.

There is an exhaustive list of foods and drinks that cause inflammatory reactions..tea orange Having excluded all and been miserable and still in pain have gone back to all but in moderation with cooking from basic ingredients and never buying a ready made meal or sauce.

Forgive my ramble but this is of special interest to as so many young folk suffer knee pain whether sporty fit or wearing interesting shoes or not! But really that 'knee press up' has helped more than anything together with footwear with a good bouncy sole.

Hope this was not too wooly exit wyn


The enzymes glutathione peroxidase and the three Iodothyronine deiodinases (often called D1, D2 and D3) and actually made within your body.

D1, D2 and D3 are called seleno-proteins and each molecule of the enzyme does contain a selenium atom.

You can get selenium from various sources - often mentioned are brazil nuts - and supplements.

Yes - UK (and some European) soils do seem to be low in selenium. So UK and European wheat (and other products) tend to be low in selenium. Supplementation may be needed - but it is difficult to know. And it should be at a modest level.

The abstract does not, however, suggest that giving up gluten will cure the problem! Has nothing to say on that point.

Glad the exercise does help.


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