Gastrointestinally mediated food allergy causing Spondyloarthritis-like disease

Abstract

Gastrointestinally-mediated food allergy (GMA) incidentally may cause non-erosive oligoarthritis.A 56-year-old woman with seronegative spondyloarthritis observed arthritic fl ares following ingestion of certain foods. Blood analyses were unremarkable. Segmental gut lavage revealed plasmacellular infi ltrates and eosinophilia in terminal ileum. Food allergen-specifi c IgE-analysis of lavage fl uid showed signifi cant polyvalent intestinal IgE-sensitization (>0.35kU/mg protein) towards wheat, rye, egg, soybean, pork, beef, nuts. Repeated exposure to the aforementioned foods caused arthritis within 48 hours; elimination diet engendered long-term remission. Seronegative local IgE-mediated GMA (type I) was diagnosed.Especially seronegative rheumatoid arthritis and undifferentiated oligoarthritis should be scrutinized for food-related muscoloskeletal symptoms before initiating immunosuppression.