Gluten-Free Diet Provides Relief for Patients with Chronic Lower Back Pain

Celiac.com 08/22/2022 - Researchers present a case series of patients with chronic low-back pain and spondyloarthritis related features, who respond well to the gluten-free diet, despite celiac disease being ruled out.

Currently, people who suffer from chronic low-back pain, with spondyloarthritis related features, are treated with immunosupresive drugs for both diseases. 

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Prior studies have shown that gut involvement is a well-known association of spondyloarthritis, but limited to a few disorders, such as inflammatory bowel disease.  A team of researchers recently set out to test the hypothesis that non-celiac gluten sensitivity is associated with chronic low-back pain related to spondyloarthritis, and that treatment with a gluten-free diet would be beneficial in certain patients. 

Researchers Carlos Isasi, Alexander Stadnitsky, Fernando Casco, Eva Tejerina, Ana Royuela, Blanca Esteban, and Natalia Fernandez Puga present results from a case series of patients with chronic low-back pain, spondyloarthritis related features, and positive response to a gluten-free diet, despite celiac disease being ruled out.

The team's retrospective case report covers 110 patients from a tertiary hospital rheumatology clinic, which specializes in treating chronic pain and gluten sensitivity.  All patients suffered from refractory low-back pain and spondyloarthritis features, and all patients followed a gluten-free diet despite celiac disease being ruled out. 

The team sought a measure of improvement called, "demanding improvement," which they defined based on the achievement of at least one of the following improvements:

• Asymptomatic status, remission of chronic low-back pain, returning to normal life, returning to work, changing from confinement to bed/wheelchair to being able to walk, returning to self-sufficiency for hygiene and personal care, discontinuation of opioids.

Average patient age at low-back onset pain was 30 years old, while the average disease duration was 15 years. Nearly eighty percent of the patients experienced improvement, while nearly seventy percent achieved demanding improvement. 

Average duration of a gluten-free diet in patients with demanding improvement was five years. A total of 56 out of 69 patients with demanding improvement ingested gluten, with 54 of those experiencing clinically worse symptoms, considered to have non-celiac gluten sensitivity. 

Two main factors for making demanding improvement were oral aphthae and having a relative with celiac disease. Nearly four out of five patients retrospectively classified with axial spondyloarthritis showed demanding improvement. Nearly all patients with uveitis showed demanding improvement. Meanwhile, well over half of patients with fibromyalgia showed demanding improvement.

The team's data support the hypothesis that non-celiac gluten sensitivity is associated with chronic low-back pain related to spondyloarthritis, and a gluten free diet has a therapeutic benefit for some patients. 

These results are important, because the could point the way to using a positive response to a gluten-free diet in people with non-gluten sensitivity to help improve chronic low-back pain related to spondyloarthritis in those patients. 

Read more in Med Hypotheses. 2020 Feb 28;140:109646

The researchers in this study are variously affiliated with the Rheumatology Department of Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain; Family Medicine at Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain; the Pathological Anatomy Department of Unilabs, Madrid, Spain; the Pathological Anatomy Department of Hospital Universitario Puerta de Hierro, Majadahonda Madrid, Spain; the Biostatistics Unit, Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana, Majadahonda, Madrid, Spain; the Asociación de celíacos y sensibles al gluten de Madrid (Association of Celiacs and Gluten-Sensitives of Madrid, Spain; and the Digestive Medicine Department of Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain.