A gut feeling for joint inflammation – using coeliac disease to understand rheumatoid arthritis

Major advances have been made in the molecular understanding of coeliac disease, initiated by the identification of intestinal gluten-reactive T cells. It is now clear that this common intestinal disorder, which is precipitated by the ingestion of wheat gluten, is mediated by DQ2-restricted T cells specific for gluten peptides modified by transglutaminase 2, the same enzyme that is targeted by disease-specific autoantibodies. Interestingly, many of the important features identified in coeliac disease, including HLA association, target organ T-cell infiltration, disease-specific autoantibodies and the distinct targeting of in vivo modified antigens, are also present in rheumatoid arthritis. The experiences from coeliac disease should therefore help identify disease-relevant T-cell epitopes in rheumatoid arthritis.