Should You Go Gluten-Free for Your Psoriatic Arthritis?

Can a gluten-free diet make it easier to live with psoriatic arthritis? It depends on whom you ask.

“There’s no clear scientific evidence that a gluten-free diet helps any form of arthritis,” says Stacy Ardoin, MD, a rheumatologist and professor in the division of rheumatology and immunology at Ohio State University Wexner Medical Center in Columbus.

“It’s a maybe,” says Rochelle Rosian, MD, a rheumatologist at the Cleveland Clinic in Vero Beach, Florida.

Despite the lack of conclusive evidence, some people with psoriatic arthritis say that a gluten-free diet does help them better manage their joint pain.

What Is Gluten, Anyway?

Gluten is a protein found primarily in wheat, barley, and rye, along with foods made with any of these grains, including most breads, cereals, pastas, baked goods, processed foods, and even beer.

People with celiac disease can’t tolerate any gluten, even traces that might be lingering on a cutting board or knife. Celiac disease is an autoimmune condition — in which your immune system mounts an attack on your own body, in this case your small intestine — that causes damage to the digestive system. If celiac disease is not effectively treated, nutrients can't be properly absorbed, which can lead to problems like anemia, osteoporosis, infertility, and neurological conditions.

Many people may have a gluten sensitivity but not celiac disease; in these cases, testing doesn’t reveal any antibodies or inflammation in your small intestine, yet when you stop eating gluten, symptoms like bloating, brain fog, and abdominal pain tend to improve.

What’s the Connection Between Gluten, Psoriatic Arthritis, and Inflammation?

Both psoriasis and psoriatic arthritis are autoimmune disorders that cause inflammation, primarily in the skin and joints. But other parts of the body may be inflamed as well, including the gut. And that inflammation can make you more sensitive to gluten, Dr. Rosian says. “Gluten-free diets have significant overlap with anti-inflammatory diets,” she notes.

RELATED: Can Probiotics Help With Psoriatic Arthritis?

How to Tell if Gluten-Free Is Right for You

Although there’s no science to prove that cutting out gluten helps psoriatic arthritis, it can’t hurt if you want to modify your diet, then gauge the effect on your symptoms, Rosian says.

Keep in mind that if the modifications have any effects, they won’t be instantaneous. “It can take two or three weeks for your gut to calm down, so be patient,” says Rosian. If you go gluten-free and still have gut issues, get checked by your doctor.

Another point to remember: Going gluten-free is no substitute for your prescribed psoriatic arthritis treatment. “It’s meant to be complementary, not alternative,” Rosian emphasizes.

And it’s not always an easy switch. “Some people aren’t huge fans of the texture of gluten-free pasta or bread,” says Julie Stefanski, RDN, a spokesperson for the Academy of Nutrition and Dietetics based in York, Pennsylvania.

How to Go Gluten-Free

If you’re still game to go gluten-free, know that some GF foods can also be more expensive or higher in fat, calories, and carbohydrates than their gluten-containing counterparts. And if you’re eating out, sticking to the plan can be a challenge. “Luckily,” says Stefanski, ”there are many gluten-free options available and it is possible to choose an item that is not only certified gluten-free but also meets nutrition goals.”

Gluten-free food has become so popular that some grocery store chains have their own line of choices and restaurants often offer gluten-free options.

Vegetables, whole fruits, fish, beans, lean cuts of chicken and beef, and dairy products like milk are naturally gluten-free and generally safe to eat, Stefanski says.

With packaged foods it’s important to read every label to check for gluten-based ingredients. Also check out the allergen statement at the end of the list, especially if food has been processed in any way — for instance, some sausages and yogurts contain added gluten as a thickener. “It’s important to find all possible sources of gluten,” says Stefanski. ”Companies may choose to change their product formulations, especially if impacted by supply chain issues or raw ingredient availability.”

Be aware that you could miss out on critical nutrients — another problem for some on a gluten-free diet. Iron and B vitamins are often added back into processed wheat products. “If you’re not using fortified foods, you’ll want to make sure that you have good sources of iron and B vitamins coming from foods like meat, fish, and beans,” says Stefanski.

And while there are plenty of whole foods that are naturally free of gluten, “gluten-free grain products have come a long way in the past 20 years,” adds Stefanski. “You may just be surprised when trying a product that’s not only safe but tasty, too.”