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Self-reported food intolerance and mucosal reactivity after rectal food protein challenge in patients with rheumatoid arthritis
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Internal Medicine. (Reumatologi)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Internal Medicine. (Gastroenterology)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Internal Medicine. (Reumatologi)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Chemistry.
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2010 (English)In: Scandinavian Journal of Rheumatology, ISSN 0300-9742, Vol. 39, no 4, 292-298 p.Article in journal (Refereed) Published
Abstract [en]

Objectives: A dietary link to rheumatoid arthritis (RA) has been suspected and an influence on arthritic symptoms by different diets has been reported. Our primary aim was to record the self-experienced adverse food reactions in patients with RA. A secondary aim was to relate self-experienced adverse reactions to dairy produce and wheat to the local mucosal reactivity observed after rectal challenge with cow's milk protein (CM) and wheat gluten. Methods: A questionnaire about self-experienced adverse reaction to food was sent to 347 RA patients. Rectal challenge with CM and gluten was performed in 27 of these patients and in healthy controls (n = 18). After a 15-h challenge the mucosal production of nitric oxide (NO) and the mucosal release of myeloperoxidase (MPO) and eosinophil cationic protein (ECP) were measured by using the mucosal patch technique. Results: Twenty-seven per cent of the RA patients reported food intolerance (FI) to various foods, and in particular to CM, meat, and wheat gluten. Strong mucosal reactivity to CM was observed in 11% of the patients. Moderately increased mucosal reactivity to CM and gluten was found in 22% and 33%, respectively, of the patients. No relationship was found between self-experienced adverse reactions to CM or gluten and mucosal reactivity to these proteins. Conclusions: Perceived FI is reported frequently by RA patients, with a prevalence similar to that reported previously in the general population. Mucosal reactivity to CM and gluten is seen in a minor fraction of RA patients and is not related to the frequently perceived intolerance to these proteins.

Place, publisher, year, edition, pages
Informa Healthcare , 2010. Vol. 39, no 4, 292-298 p.
Keyword [en]
Rheumatoid arthritis, Cow's milk protein, Gluten, Nitric oxide, Myeoloperoxidase, Food Intolerance
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-110294DOI: 10.3109/03009740903379630ISI: 000281388000004PubMedID: 20141485OAI: oai:DiVA.org:uu-110294DiVA: diva2:277341
Available from: 2009-11-17 Created: 2009-11-09 Last updated: 2010-12-03Bibliographically approved
In thesis
1. Gut Mucosal Reactivity to Gluten and Cow´s Milk Protein in Rheumatic Diseases
Open this publication in new window or tab >>Gut Mucosal Reactivity to Gluten and Cow´s Milk Protein in Rheumatic Diseases
2009 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

This thesis comprised patients with chronic rheumatic diseases. The studies aimed to elucidate food sensitivity by measuring mucosal inflammatory reactivity and thereby a possible link between the gut and joints. In all the studies, the mucosal path technique was used to evaluate the rectal mucosal response to rectal challenge with gluten and/or cow’s milk protein (CM).

In some patients with primary Sjögren’s syndrome (pSS) and the genetic susceptibility genes HLA DQ2, mucosal reactivity measured with nitric oxide (NO) was found after rectal gluten challenge without detectable serum antibodies to gluten or transglutaminase. This gluten sensitivity was not linked to coeliac disease.

After rectal CM challenge, a rectal mucosal inflammatory response measured with NO and myeloperoxidase (MPO) was detected in 38% of pSS patients, all of whom fulfilled the criteria for irritable bowel syndrome.

In a questionnaire study of self-experienced adverse reactions to food, 27% of patients with rheumatoid arthritis (RA) reported intolerance to various foods and CM in particular. After rectal CM challenge performed in RA patients (n=27), strong mucosal reactivity to CM was observed in a few patients and a moderate increase in 23%. After gluten challenge, a moderate increase in mucosal reactivity was found in 35% of patients. No correlation to self-perceived intolerance and mucosal reactivity measured with NO and MPO was seen.

Inflammation of the gut is a prominent feature of spondyloarthropathies (SpA). After rectal challenges with CM protein and gluten, an increase in rectal NO production was seen in 26% and 19% respectively (p<0.001). An increase in the mucosal release of MPO as a sign of neutrophil activation was seen in the CM- and gluten-sensitive patients. NO production in SpA patients was more enhanced compared with RA and pSS patients and could contribute to the increased barrier permeability described in SpA patients.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2009. 76 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 502
Keyword
Primary Sjögren’s syndrome, rheumatoid arthritis, spondyloarthropathies, rectal challenge, food sensitivity, myeloperoxidase, nitric oxide and barrier permeability
National Category
Rheumatology and Autoimmunity
Research subject
Medicine
Identifiers
urn:nbn:se:uu:diva-110297 (URN)978-91-554-7666-3 (ISBN)
Public defence
2010-01-20, Enghoffsalen ingång 50, Akademiska Sjukhuset, Uppsala, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2009-12-07 Created: 2009-11-09 Last updated: 2009-12-14

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Lidén, MariaKristjánsson, GudjónValtysdóttir, SigridurVenge, PerHällgren, Roger

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