Rheumatology International

, Volume 30, Issue 4, pp 455–460 | Cite as

Back pain and sacroiliitis in long-standing adult celiac disease: a cross-sectional and follow-up study

  • Edit Vereckei
  • Ádám Mester
  • László Hodinka
  • Péter Temesvári
  • Emese Kiss
  • Gyula Poór
Original Article


There have been only scattered reports suggesting that musculoskeletal manifestations including back pain and sacroiliac joint involvement may be associated with celiac disease. In order to confirm this issue in a larger cohort, rheumatic manifestations were analyzed in 21 adult celiac patients using a comprehensive clinical, laboratory and radiological analysis. The diagnosis of celiac disease was based on the histopathology of jejunal biopsy specimens. The mean duration of celiac disease was 15 (0–31) years. All patients were currently on gluten-free diet and none of the patients had gastrointestinal symptoms at the time of the study. Using various imaging techniques, involvement of the sacroiliac joints was confirmed in 70% of celiac patients. Imaging revealed different morphological changes in the sacroiliac joint, e.g. accumulation of synovial fluid, synovitis, erosion with concomitant sclerosis, sacroiliitis or calcification of the ligament. These changes probably represent different clinical stages and/or manifestations of the same process. In a follow-up study of eight patients, after 11 years on a gluten-free diet, the great majority of patients had no clinical symptoms; yet, a subclinical progression of the sacroiliac joint involvement could be verified. Our results suggest the importance of regular rheumatologic follow-up of patients with celiac disease.


Celiac disease Sacroiliac joint involvement Back pain Comprehensive radiological analysis Follow-up study 



We are greatly thankful to Professor Zoltan Szekanecz for his kind remarks and advice based on his expert opinion.


  1. 1.
    Kallikorn R, Uibo O, Uibo R (2000) Coeliac disease in spondylarthropathy: usefulness serological screen. Clin Rheumatol 19:118–122CrossRefGoogle Scholar
  2. 2.
    Collin P, Korpela M, Viander M et al (1992) Rheumatic complaints as a presenting symptom in patients with coeliac disease. Scand J Rheumatol 21:20–23CrossRefPubMedGoogle Scholar
  3. 3.
    Chakravarty K, Scott DGI (1992) Oligoarthritis: a presenting feature of occult coeliac disease. Br J Rheumatol 31:349–350. doi: 10.1093/rheumatology/31.5.349 CrossRefPubMedGoogle Scholar
  4. 4.
    Slot O, Locht H (2000) Arthritis as presenting symptom in silent adult coeliac disease: two cases and review of the literature. Scand J Rheumatol 4:260–263Google Scholar
  5. 5.
    Bourne JT, Kumar P, Huskisson EC (1985) Arthritis and coeliac disease. Ann Rheum Dis 9:592–598. doi: 10.1136/ard.44.9.592 CrossRefGoogle Scholar
  6. 6.
    Holden W, Orchard T, Wodsworth P (2003) Enteropathic arthritis. Rheum Dis Clin North Am 3:513–530. doi: 10.1016/S0889-857X(03)00043-7 CrossRefGoogle Scholar
  7. 7.
    Carbone MC, Pitzalis G, Ferri M, Nenna R, Thanasi E, Andreoli A, De Lorenzo A, Bonamico M (2003) Body composition in coeliac disease adolescents on gluten-free diet: a longitudinal study. Acta Diabetol 40:171–173. doi: 10.1007/s00592-003-0057-3 CrossRefGoogle Scholar
  8. 8.
    Usai P, Boi MF, Piqa M et al (1995) Adult coeliac disease is frequently associated with sacroiliitis. Dig Dis Sci 9:1906–1908. doi: 10.1007/BF02208654 CrossRefGoogle Scholar
  9. 9.
    The World Medical Association’s Declaration of Helsinki 1964 (2000) of ethical principles for medical research involving human subjects. Bull Med Ethics;162:8–11 or Google Scholar
  10. 10.
    Mester Á, Makó E, Karlinger K et al (2000) Enteropathic arthritis in the sacroiliac joint: imaging and differential diagnosis. Eur J Radiol 35:199–208. doi: 10.1016/S0720-048X(00)00243-6 CrossRefPubMedGoogle Scholar
  11. 11.
    Muche B, Bollw M, Francois RJ, Sieper J, Hamm B, Braun J (2003) Anatomic structure involved in early- and late-stage sacroiliitis in spondylarthritis: a detailed analysis by contrast-enhanced magnetic resonance imaging. Arthritis Rheum 5:1374–1384. doi: 10.1002/art.10934 CrossRefGoogle Scholar
  12. 12.
    Puhakka KB, Jurik AG, Egond N, Schiottz-Christensen B et al (2003) Imaging of sacroiliitis in early seronegative spondylarthropathy: assessment of abnormalities by MR in comparison with radiography and CT. Acta Radiol 2:18–29Google Scholar
  13. 13.
    el Maghraoui A, Lecoules S, Leehevaller D, Magnin J, Eurly F (1999) Acute sacroiliitis as a manifestation of calcium pyrophosphate dihydrate crystal deposition disease. Clin Exp Rheumatol 17(4):477–478PubMedGoogle Scholar
  14. 14.
    Bezza A, Lechevalier D, Monreal M, el Maghraoui A, Magnin J, Eurly F (1999) L’at6teinte sacro-iliaque au cours de la maladie de Paget. Presse Med 28(22):1157–1159PubMedGoogle Scholar
  15. 15.
    Taccari E, Spadaro A, Sorgi ML, Sili Scavalli A (1992) Sacroiliac joint involvement in primary hyperthyroidism: pathogenic considerations. Clin Exp Rheumatol 3:263–265Google Scholar
  16. 16.
    Resnich D, Niwayama G (1976) Subchongral resorption of bone in renal osteodystrophy. Radiology 118:315–321Google Scholar
  17. 17.
    Resnick D (1995) Diagnosis of bone and joint disorders, 3rd edn, vol 19. W.B. Saunders Company, Philadelphia, pp 106, 2015, 2022, 2030, 2033, 2061-2065Google Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Edit Vereckei
    • 1
  • Ádám Mester
    • 1
  • László Hodinka
    • 1
  • Péter Temesvári
    • 1
  • Emese Kiss
    • 1
  • Gyula Poór
    • 1
  1. 1.National Institute of Rheumatology and PhysiotherapyBudapestHungary

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