Celiac Disease and Joint Pain
There is a relationship between celiac disease and joint pain. Anecdotally, many of my symptomatic celiac clients have reported joint pain when they’re glutened. Research-wise, a connection has been identified too.
Additionally, people with celiac may be at higher risk for the development of different forms of arthritis. Further increasing the risk of joint pain. In fact, according to beyondceliac.org, celiac disease patients are four times more likely to have early signs of arthritis.
In this post, we’ll be exploring the relationship in deeper detail and discussing what you can do to support your joints and ease any pain that may arise.
Please note, this post, nor any other content I share is meant to substitute care from your doctor. I am not a doctor or a specialist in joint pain. I am a dietitian specializing in celiac disease and merely presenting my understanding of the connection between the two. If you have questions, your care team is the best place to find answers.
Written with the help of dietetic intern Serenity Dylan.
What is Celiac Disease?
Before we get into why joint pain can happen with celiac disease and what to do about it, we need to understand what celiac is.
Celiac is a serious autoimmune disease that occurs in genetically predisposed people where the ingestion of gluten leads to damage in the small intestine. When people with celiac disease eat gluten (a protein found in wheat, rye, barley, and contaminated foods like oats), their body mounts an immune response that attacks the small intestine.
These attacks lead to damage to the villi, small fingerlike projections that line the small intestine, that promote nutrient absorption. When the villi get damaged, nutrients cannot be absorbed properly into the body.
This inflammatory response to gluten and related nutrient deficiencies can cause a wide variety of symptoms in people with celiac. From bloating, headaches, constipation, joint pain, bone health complications, infertility, weight gain, weight loss, and more.
This can start at any age, and occur in any body, as long as someone is eating gluten and has the celiac genes. If left untreated, celiac disease can lead to additional serious health problems.
What is Gluten?
When talking about celiac and joint pain, we also need to know what gluten is.
Gluten is a protein found in barley, rye, contaminated oats, and wheat. It may be helpful to remember the acronym “BROW” when trying to remember what foods have gluten.
In baked goods, gluten holds things together working as a binding agent. It gives texture and chew to foods.
Most people can safely eat gluten. However, some people have gluten sensitivity or celiac disease which means they need to avoid gluten. It can cause digestive issues such as diarrhea and nausea as well as nonintestinal symptoms such as rashes, headaches, or joint pain.
What is Joint Pain?
To further understand celiac joint pain, we need to get on the same page about joint pain. Joints are where two bones meet. Some joints are highly moveable such as the hip. Some joints involve almost no movement such as the joints between the ilium and the sacrum (pelvic bones). Joint pain is when there is pain at these points of the body.
There are different types of joint pain. There is autoimmune joint pain such as rheumatoid arthritis and there is wear-and-tear pain of standard osteoarthritis. Injuries and disease processes (for example, those below) can cause joint pain too.
What are Some Causes of Joint Pain?
Which takes us to the next part of our conversation on joint pain with celiac, what can cause joint pain? Remember, there are two causes, wear-and-tear and autoimmune. These causes include:
- Inflammation which can swell tissues around the joint and make them painful
- Ankylosing spondylitis is a type of arthritis that causes inflammation in the joints and ligaments of the spine.
- Bursitis is an inflammation in the little cushioning sac of a joint.
- Gout is inflammation usually of the big toe but can affect other joints.
- Arthritis is an inflammation of one or more joints
- Hypothyroid can cause pain, tenderness, and stiffness, esp. in the shoulders & hips
- Lupus can cause joint pain, especially in the hands and feet
- Lyme disease joint pain can occur when the Lyme bacteria enters the joint.
- Tendonitis is an inflammation of the tendons which hold together a joint
- Sprains or injury
In celiac, it may be arthritis that is the cause but gluten is the trigger.
Can Celiac Disease Cause Joint Pain?
All of that said, can celiac disease cause joint pain? Celiac causes inflammation in the body when gluten is consumed. This inflammation can impact the absorption of nutrients essential for bone health and body-wide autoimmune reactions that could trigger joint pain.
Additionally, a 2013 study found an increased risk for inflammation in tissues surrounding bones, ligaments, and tendons in celiac patients. Further increasing the risk of joint pain,
Additionally, people with celiac are at higher risk for certain types of arthritis. According to a study in 2022, children with celiac disease were 3 times as likely to develop Juvenile Idiopathic Arthritis develops than in the general population. This same study found that adults with celiac were 2 times as likely to develop Rheumatoid Arthritis.
For many, it’s reported that gluten exposure either worsens or triggers joint pain. Anecdotal, my celiac clients report the pain improves or goes away after someone has recovered from being glutened.
Can Celiac Disease Cause Joint Pain?
Now that we know celiac causes joint pain in some cases, it’s also important to understand the risk for other conditions related to celiac that may be playing a role. Especially if you’re noticing joint pain is not going away. One of the main conditions to be aware of is the relationship between celiac and rheumatoid arthritis.
Rheumatoid arthritis (RA) is a chronic inflammatory disorder. As an autoimmune disorder, rheumatoid arthritis occurs when your immune system attacks the lining of the joints.
Unlike the wear-and-tear damage of osteoarthritis, rheumatoid arthritis affects the lining of your joints, causing a painful swelling that can eventually result in bone erosion and joint deformity. It can affect more than just your joints. In some people, the condition can damage a wide variety of body systems, including the skin, eyes, lungs, heart, and blood vessels.
Having celiac, an autoimmune condition too, makes you more at risk for other autoimmune disorders such as rheumatoid. A study published in JCHIMP found that celiac patients are at high risk of having rheumatoid (RA) enzymes and should be screened for RA. A study in the journal Gut, found that 1.8% of celiac patients had RA.
I share this not to scare you but to empower you to seek answers if you start experiencing joint pain that is not going away.
Who to See if You are Unsure if Your Joint Pain is Related to Celiac
Now that we know being exposed to gluten can trigger joint pain, and there’s an overall increased risk for it, it’s time to know when to get help. My advice? If you’re worried about your joint pain, it never hurts to speak with a doctor about it. Especially if it’s not improving after avoiding gluten or if it’s not going away.
A rheumatologist is a doctor to see if you think there is some inflammatory process happening in your joints. A rheumatologist is a specialist who diagnoses and treats arthritis and other immune-related diseases and conditions. You might need your primary care provider to refer you, so you might need to start this conversation with them before seeing a rheumatologist.
You might also visit an orthopedist. This is a medical specialist focusing on injuries and diseases affecting your musculoskeletal system (bones, muscles, joints, and soft tissues). Although this type of doctor is a surgeon, they often help people get relief with nonsurgical therapies.
A sports medicine doctor is a primary care doctor who is specially trained to diagnose and treat injuries that are sustained while playing sports and any other type of orthopedic (musculoskeletal) injury or problem. You might visit this provider if you think the pain you’re experiencing is injury related.
Any of these types of doctors will first come up with a diagnosis, then develop a care plan for how to treat it. Sports medicine doctors and orthopedists treat osteoarthritis which is the most common type of arthritis caused by wear or injury.
Rheumatologists treat autoimmune issues such as rheumatoid arthritis. If you are unsure of who you should see, ask your primary care provider for clarification. You might also need them to provide a referral in order to get insurance coverage.
Soothing Joint Pain with Celiac Disease
Now that we’ve talked about causes and getting help with joint pain and celiac, let’s talk about what you can do to soothe the pain.
Joint pain with celiac can be a real problem. Fortunately, there are a variety of ways to soothe inflammation or ease pain. These methods range from foods to eat to supplements to take. Additionally, your doctor might have prescriptions that may help as well. Just be sure you’re checking that these medications are gluten-free.
If you’re not sure how to check prescribed or over-the-counter medications for gluten, and your pharmacist is unsure too, this is something I cover in the Celiac Crash Course. A self-paced course that teaches you how to make avoiding gluten and cross-contact feel routine. In this course, not only do I teach you how to check medications for gluten, but I give you a handout to give to your pharmacist to help them check too. Check it out here.
Below are some specific things to consider. Do keep in mind that if you have any questions, your doctor is the best person to speak with. Nothing below with cure joint pain but may help with making it more manageable.
Gluten-Free Foods for Joint Pain
The first tool that may help soothe joint pain with celiac is gluten-free food. Certain foods may have benefits that ease inflammation and pain. Below are some ideas:
- Ginger is anti-inflammatory. It can be eaten in candies, cooked using raw root, dried powder (spice), or drank as tea. In a meta-analysis in Nutrients, ginger was shown to be as effective as ibuprofen in pain relief.
- Turmeric. This yellow spice packs a powerful anti-inflammatory punch. Sprinkle it on your eggs or on your dinner. A review of the literature found that turmeric was potentially effective for knee pain.
- Omega 3 fatty acids. Eat fish, walnuts, avocados, flax/chia/hemp seeds. You can eat the oils too: olive, avocado, walnut, and flax/chia/hemp seed oils. A study on 250 patients found omega 3s to be as effective as ibuprofen for arthritis pain.
- Pineapple contains an anti-inflammatory enzyme called bromelain. And it makes a tasty snack! Some preliminary studies indicate it may be helpful for osteoarthritis pain.
- Papaya contains an anti-inflammatory enzyme called papain. It is great in smoothies or eaten plain. A few studies have shown that papain has anti-inflammatory effects.
These are just some foods to consider adding to your diet in case it helps you with joint pain. These foods are not a must, so if you don’t like any or all of them, that’s totally fine. However, if you love ginger, it might be easy for you to add more to your diet and potentially see a benefit.
Additionally, I want to add that a balanced gluten-free diet that provides you with essential vitamins and minerals may help with joint pain as well. With celiac, a gluten-free diet plus unhealed damage to the gut can impact nutrient status. If unaddressed, this can play a role in inflammation and joint health.
If you need help with simplifying how to get the nutrition you need from food with celiac, check out my self-paced dietitian-led Celiac Nutrition Course here. It will give you easy strategies plus lots of tips for boosting nutrition enjoyably.
Gluten-Free Over-the-Counter Pain Medications for Joint Pain
Next up, over-the-counter pain medications may help with joint pain. Of course, always discuss the safety of any new medication or supplement with your doctor. However, common pain relievers like Aleve and Motrin are gluten-free.
If you’re not sure how to assess the safety of over-the-counter medications or even prescription medications, and your pharmacist is unsure too, this is something I cover in the Celiac Crash Course. A self-paced course that teaches you how to make avoiding gluten and cross-contact feel routine. In this course, not only do I teach you how to check medications for gluten, but I give you a handout to give to your pharmacist to help them check too. Check it out here.
(P.s. manufacturing and ingredients can change, always check the label and assess safety and suitability for yourself)
Supplements that May Support Joint Health
Another way to support joint help might be with certain supplements. Of course, always discuss the safety of any new medication or supplement with your doctor. However, below are some supplements you might consider.
- Ginger pills to act as an anti-inflammatory. You can find this in the herb section of a health food store. Be careful with this if you have GERD.
- Turmeric or Curcumin. Both are available in pills. Curcumin is a concentrated extract from turmeric and is believed to act stronger as an anti-inflammatory.
- Omega 3 fatty acids or EPA/DHA may help with joint pain. EPA is typically sourced from flax seeds and you can get flax oil pills. DHA is often sourced from algae or fish oil (you can get fish oil pills).
- Bromelain – is an anti-inflammatory extract from pineapple. Take away from medications because they enhance absorption which could affect the dosage.
- Papaya or papain pills are usually chewable. These may have anti-inflammatory impacts. Take away from medications because they enhance absorption which could affect the dosage.
- Glucosamine – A study in Rheumatology International found a positive effect on RA symptoms with the use of glucosamine. A number of other studies validate its use for arthritis.
- Collagen – this may help support joint pain, bone density, and strengthen tendons/ligaments. A 2008 research study on collagen hydrolysate supplementation in athletes, found that those taking collagen had improved joint pain.
What’s important to know about supplements like these with celiac is that quality is absolutely essential. Many supplements are contaminated with gluten because the supplement industry is largely unregulated. This means often, gluten-free claims will likely not be enough like they often are with food.
If you’re not sure how to buy safe gluten-free supplements, I cover this in detail in the Celiac Crash Course (along with education on how to buy safe gluten-free food, medications, alcohol, beauty products, and more in the USA). Check out the course here.
Other Ways to Soothe Joint Pain with Celiac Disease
There are other ways to soothe joint pain with celiac disease beyond food, over-the-counter medications, and supplements. Below are some ideas to help get you started:
- Heat packs. The heat helps to soothe.
- Hot baths or showers. The heat helps to soothe. The heat will also relax the muscles around the joints which may ease some strain on the joints.
- Hot paraffin wax dips. You can get a paraffin dip device for home use.
- Alternate heat with cold. Follow a heat application with a cold pack.
- Massage. It may temporarily relieve pain and stiffness.
- There are topical products that you rub onto the painful area such as BioFreeze and Voltaren.
And don’t forget, meeting with a doctor who specializes in joint pain can be helpful too. Either in identifying the root cause or helping you find relief.
Soothing Joint Pain with Celiac Disease
The relationship between celiac and joint pain is complex. But not only does it affect the small intestine, but it also affects other parts of the body. One of those areas can be the joints.
While pain may be present there are things that can be done to treat it. The celiac gluten-free diet is an important part of treatment should the pain be related to the autoimmune reaction and gluten.
Conventional therapy would include over-the-counter medications. Alternative approaches include foods to eat, supplements, and lifestyle applications. As this shows, there is hope for celiac joint pain.
If you have concerns about your joint health, please discuss them with your doctor in order to find help.