An unusual case study published in the journal Annals of Internal Medicine describes a male patient who when treated with a medication used for rheumatoid arthritis and alopecia later returned to the hospital to find his celiac disease had gone into remission. Following the unexpected side effect, the patient could eat gluten without suffering symptoms of celiac disease.
Celiac disease is a debilitating condition that prevents sufferers from being able to tolerate gluten, and currently the best treatment is to avoid dietary gluten for life. Unfortunately, gluten is a key ingredient in carbohydrates such as bread and pasta, and gluten-free alternatives are often more expensive and lack the stretchy texture that makes certain foods enjoyable. Furthermore, any accidental deviations from the gluten-free diet result in significant and sometimes long-term damage to the mucosa in a patient's digestive tract. Avoiding gluten completely is difficult for even the most practiced of celiacs, so alternative treatments are an exciting area of investigation.
A patient with alopecia and celiac disease at the University Hospitals Leuven, Belgium, had attempted to reduce his celiac severity by following a gluten-free diet. His progress revealed some remission but after returning to gluten again he began to experience symptoms. The patient decided to continue with a watchful waiting approach for his celiac, but in the meantime began taking off-label Tofacitinib for his alopecia. Tofacitinib is a medication that inhibits enzymes associated with worsening severity of rheumatoid arthritis, but it’s also used to treat alopecia and certain bowel diseases.
To the surprise of his clinicians, the patient returned for follow-up investigations that showed complete histologic and serologic remission of celiac disease despite the fact that he had returned to a gluten-containing diet. Blood tests also revealed promising results with all reports coming back in the normal range.
The result is promising and if it can be replicated on a larger scale could bring a new normal to celiac patients for whom managing the disease can be time-consuming and distressing. The authors on the case study caution, however, that the potential side effects of Tofacitinib should not be overlooked, as their future studies looking at more patients could reveal that the drug isn’t suitable for long-term use.