Is there a connection between celiac disease (CD) and inflammation? If so, would it be wise to treat both at the same time or try a gluten-free diet (GFD) first and see if that controls the inflammation as well? — Leslie Read, Santa Cruz, Calif.

There is an association between CD and inflammation. CD is characterized by an autoimmune response in genetically susceptible individuals, resulting in small-intestine mucosal injury. However, not everyone presents with classical intestinal symptoms; in fact, 50% present with such atypical symptoms as anemia, osteoporosis, infertility, and neurologic and dermatologic problems.

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CD is associated with many other autoimmune diseases, such as type 1 diabetes, Sjögren’s syndrome, psoriasis, thyroiditis, inflammatory arthritis and alopecia. In addition, CD is thought to be associated with an increased risk of malignancies, especially lymphomas or cancer of the immune system (Nat Rev Gastroenterol Hepatol. 2010;7:204-213, accessed August 15, 2011).

Without knowing where the inflammation is located, I can’t be more specific in my answer. However, a GFD is reasonable. For example, in dermatitis herpetiformis — a dermatologic manifestation of CD — treatment aimed solely at the skin is not effective, whereas a GFD improves the skin and the gut.

To test the theory, however, the patient must follow a very strict GFD, which can be quite challenging and costly. Symptomatic relief must be achieved as early as two weeks after beginning a strict GFD. — Sharon Dudley-Brown, PhD, FNP-BC, co-director, gastroenterology & hepatology, nurse practitioner fellowship program, Johns Hopkins University Schools of Medicine & Nursing, Baltimore (155-7)