1
|
Sotoodeh A, Nguyen Hoang M, Hellgren K, Forss A. Prevalence of coeliac disease in patients with systemic lupus erythematosus: a systematic review and meta-analysis. Lupus Sci Med 2024; 11:e001106. [PMID: 38351098 PMCID: PMC10868192 DOI: 10.1136/lupus-2023-001106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 02/03/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND There is some evidence of a higher prevalence of coeliac disease (CD) among patients with SLE than in the general population. However, the prevalence estimates vary substantially. OBJECTIVE To investigate the prevalence of CD among patients with SLE through systematic review and meta-analysis. METHODS We performed searches in the databases of Medline, Embase, Cochrane and Web of Science Core Collection between 1 January 1990 and 9 July 2023. A total of 2053 publications were rendered in the searches, of which 68 were reviewed in full text and 14 included in the analyses. Primary analysis estimated the pooled prevalence of biopsy-verified CD in patients with SLE. In the secondary analysis, the prevalence of serological markers indicative of CD was investigated. The quality of studies was appraised using the Joanna Briggs Institute Critical Appraisal Tool. We conducted meta-regression analyses to investigate associations between the prevalence of CD in individuals with SLE and publication year, study population size, CD prevalence in the general population, proportion of females and quality assessment score. RESULTS A total of 14 studies met the inclusion criteria, of which 11 were included in the primary analysis of biopsy-verified CD. Among 1238 patients with SLE, 14 had CD. The weighted pooled prevalence of CD was 0.7% (95% CI 0.0 to 1.8). The weighted pooled prevalence of CD serological markers in 1063 patients with SLE was 3.7% (95% CI 1.4 to 6.7). In meta-regression analyses, no associations between CD prevalence and study characteristics, demographics and quality assessment scores were found. CONCLUSIONS In this meta-analysis, we found a weighted pooled prevalence of biopsy-verified CD in patients with SLE comparable with the prevalence in the general population. Our findings do not support routine screening for CD in patients with SLE. However, individual screening could be considered in cases of clinical suspicion and additional risk factors for CD. PROSPERO REGISTRATION NUMBER CRD42022339594.
Collapse
Affiliation(s)
- Adonis Sotoodeh
- Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | | | - Karin Hellgren
- Gastroenterology Unit, Department of Gastroenterology, Dermatovenereology and Rheumatology, Karolinska University Hospital, Stockholm, Sweden
| | - Anders Forss
- Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Medicine, Solna, Division of Clinical Epidemiology, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
2
|
Kohli AT, Hersh AO, Ponder L, Chan LHK, Rouster-Stevens KA, Tebo AE, Kugathasan S, Guthery SL, Bohnsack JF, Prahalad S. Prevalence of tissue transglutaminase antibodies and IgA deficiency are not increased in juvenile idiopathic arthritis: a case-control study. Pediatr Rheumatol Online J 2023; 21:110. [PMID: 37798643 PMCID: PMC10557180 DOI: 10.1186/s12969-023-00890-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 09/01/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND The prevalence of Celiac Disease (CD) in Juvenile Idiopathic Arthritis (JIA) has been reported to be 0.1-7% in various small studies. As a result of the limited number of research and their inconclusive results there are no clear recommendations for routine CD screening in asymptomatic patients with JIA. Our aim is to estimate the prevalence of IgA deficiency and tissue transglutaminase (tTG) IgA in a cohort of JIA followed in two large academic medical centers. METHODS Serum was collected and stored from all subjects and analyzed in a reference laboratory for total IgA (Quantitative Nephelometry) and tTG IgA antibody levels (Semi-Quantitative Enzyme-Linked Immunosorbent Assay). Fisher's exact tests were performed for statistical significance. Risk estimates (odds ratios) with 95% confidence intervals were calculated. RESULTS 808 JIA cases and 140 controls were analyzed. Majority were non-Hispanic whites (72% vs. 68% p = 0.309). A total of 1.2% of cases were IgA deficient compared to none of the controls (p = 0.373). After excluding IgA deficient subjects, 2% of cases had tTG IgA ≥ 4u/mL compared to 3.6% of controls (p = 0.216) (OR = 0.5; 95% C.I = 0.1-1.4); and 0.8% of cases had tTG IgA > 10u/mL compared to 1.4% of controls (p = 0.627) (OR = 0.5; 95%C.I = 0.1-2.9). CONCLUSIONS Using the largest JIA cohort to date to investigate prevalence of celiac antibodies, the prevalence of positive tTG IgA was 0.8% and of IgA deficiency was 1.2%. The results did not demonstrate a higher prevalence of abnormal tTG IgA in JIA. The study did not support the routine screening of asymptomatic JIA patients for CD.
Collapse
Affiliation(s)
- Angela Taneja Kohli
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.
- Children's Healthcare of Atlanta, Atlanta, GA, USA.
| | - Aimee O Hersh
- Department of Pediatrics, Spencer F. Eccles School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Lori Ponder
- Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Lai Hin Kimi Chan
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Kelly A Rouster-Stevens
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
- Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Anne E Tebo
- University of Utah, Salt Lake City, UT, USA
- ARUP Laboratories, Salt Lake City, USA
| | - Subra Kugathasan
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
- Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Stephen L Guthery
- Department of Pediatrics, Spencer F. Eccles School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - John F Bohnsack
- Department of Pediatrics, Spencer F. Eccles School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Sampath Prahalad
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
- Children's Healthcare of Atlanta, Atlanta, GA, USA
| |
Collapse
|
3
|
Mougui A, El Bouchti I. Isolated polyarthritis revealing celiac disease: A case report. SAGE Open Med Case Rep 2023; 11:2050313X231186305. [PMID: 37434897 PMCID: PMC10331331 DOI: 10.1177/2050313x231186305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 06/19/2023] [Indexed: 07/13/2023] Open
Abstract
Nonclassical celiac disease is a diagnostic challenge for the practitioner. We report a case of a 28-year-old Moroccan woman who had been experiencing polyarthralgia and joint swelling for 8 weeks, despite treatment with nonsteroidal anti-inflammatory drugs and corticosteroids. On physical examination, there was effusion in the proximal interphalangeal joints, metacarpophalangeal joints, wrists, knees, and ankles. Laboratory tests revealed microcytic anemia, elevated levels of inflammation markers, low ferritin, and a low vitamin D level. An upper gastrointestinal endoscopy was performed to investigate the cause of anemia, revealing the loss of duodenal folds. Subsequently, a duodenal biopsy was performed, and serological testing for celiac disease was requested. Anti-transglutaminase-2 antibodies were elevated at 200 U/ml (normal < 15U/ml). The duodenal biopsy showed flattened duodenal mucosal epithelium. The patient was diagnosed with celiac disease. A gluten-free diet was started. Her joint symptoms resolved in 3 weeks. All blood tests returned to normal levels after 48 weeks. This case illustrates that celiac disease should be considered in cases of arthritis with an initial negative etiological workup.
Collapse
Affiliation(s)
- Ahmed Mougui
- Ahmed Mougui, Department of Rheumatology, Arrazi University Hospital, Marrakech, Morocco.
| | | |
Collapse
|
4
|
Risk of Juvenile Idiopathic Arthritis and Rheumatoid Arthritis in Patients With Celiac Disease: A Population-Based Cohort Study. Am J Gastroenterol 2022; 117:1971-1981. [PMID: 36114769 DOI: 10.14309/ajg.0000000000002014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 09/09/2022] [Indexed: 01/30/2023]
Abstract
INTRODUCTION Celiac disease (CD) is associated with many immune-mediated conditions, but a definitive epidemiological association between CD and juvenile idiopathic arthritis (JIA) or rheumatoid arthritis (RA) has not been established. We quantified the risk of JIA and RA among patients with CD using a population-based cohort. METHODS We identified patients diagnosed with biopsy-proven CD between 2004 and 2017 using data from a national histopathology cohort in Sweden. Each patient was matched by age, sex, calendar year, and geographic region to reference individuals in the general population. We calculated the incidence and estimated the relative risk, through Cox proportional hazards models, of JIA in individuals with CD aged <18 and of RA in individuals with CD aged ≥18. RESULTS We identified 24,014 individuals with CD who were matched to 117,397 reference individuals from the general population. Among individuals aged <18, the incidence rate of JIA was 5.9 per 10,000 person-years in patients with CD and 2.2 per 10,000 person-years in the general population (n events = 40 and 73, respectively; hazard ratio [HR] 2.68, 95% confidence interval 1.82-3.95) over a follow-up of 7.0 years. Among individuals aged ≥ 18, the incidence of RA was 8.4 per 10,000 person-years in CD and 5.1 per 10,000 person-years in matched comparators (n events = 110 and 322, respectively; HR 1.70, 95% confidence interval 1.36-2.12) over a follow-up of 8.8 years. DISCUSSION Among children with CD, JIA develops nearly 3 times as often as it does in the general population, and among adults with CD, RA occurs nearly 2 times as often. Clinicians caring for patients with CD with joint symptoms should have a low threshold to evaluate for JIA or RA.
Collapse
|
5
|
Celiac Disease in Juvenile Idiopathic Arthritis and Other Pediatric Rheumatic Disorders. J Clin Med 2022; 11:jcm11041089. [PMID: 35207358 PMCID: PMC8878661 DOI: 10.3390/jcm11041089] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 02/10/2022] [Accepted: 02/16/2022] [Indexed: 02/08/2023] Open
Abstract
Celiac Disease (CD) is an immune-mediated and gluten-related disorder whose prevalence is higher in children affected with other autoimmune disorders, including diabetes mellitus type 1, autoimmune thyroiditis, and others. As regards Juvenile Idiopathic Arthritis (JIA) and other pediatric rheumatic disorders, there is no clear recommendation for CD serological screening. In this review, we analyze all the available clinical studies investigating CD among children with JIA (and other rheumatic diseases), in order to provide objective data to better understand the necessity of CD serological screening during the follow-up. Based on the present literature review and analysis, >2.5% patients with JIA were diagnosed with CD; however, the CD prevalence in JIA patients may be even higher (>3–3.5%) due to several study limitations that could have underestimated CD diagnosis to a variable extent. Therefore, serological screening for CD in children affected with JIA could be recommended due to the increased CD prevalence in these patients (compared to the general pediatric population), and because these JIA patients diagnosed with CD were mostly asymptomatic. However, further research is needed to establish a cost-effective approach in terms of CD screening frequency and modalities during the follow-up for JIA patients. Conversely, at the moment, there is no evidence supporting a periodical CD screening in children affected with other rheumatic diseases (including pediatric systemic lupus erythematosus, juvenile dermatomyositis, and systemic sclerosis).
Collapse
|
6
|
Ghozzi M, Melayah S, Adaily N, Ghedira I. Frequency of serological markers of rheumatoid arthritis in adult patients with active celiac disease. J Clin Lab Anal 2022; 36:e24249. [PMID: 35060192 DOI: 10.1002/jcla.24249] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/05/2022] [Accepted: 01/06/2022] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Celiac disease (CD) and rheumatoid arthritis (RA) are multisystem autoimmune diseases affecting 1% of general populationa. Both diseases share genetic and immunological features. AIM In this retrospective study, we aim to determine the frequency of auto-antibodies of RA in adult patients with CD. MATERIALS AND METHODS Seventy seven adult patients with active CD were included in the present study. Ninety healthy blood donors (HBD) served as control group. Anti-cyclic citrullinated peptides antibodies (CCP-Ab) and rheumatoid factors (RF; IgA, IgG and IgM) were determined by enzyme linked immunosorbent assay (ELISA) for patients and control group. For statistical analysis, we used Chi-square or Fisher's exact test. RESULTS Our study included 77 adult patients with active celiac disease (57 female, 20 male). Twenty-four (31.2%) active celiac patients and 7 (7.8%) blood donors had CCP-Ab or RF (31.2% vs 7.8%, p < 10-4). Only two patients (2.6%) had both CCP-Ab and RF. IgA was the predominant isotype of RF in celiac patients (n = 18; 23.4%) while none of healthy blood donors had RF-IgA (23.4% vs 0.0%, p < 10-4). CONCLUSION The current study has shown that CD is associated with a high frequency of RF-IgA suggesting that celiac patients could be at a higher risk of developing RA.
Collapse
Affiliation(s)
- Mariam Ghozzi
- Laboratory of Immunology, Farhat Hached University Hospital, Sousse, Tunisia.,Faculty of Pharmacy, Department of Immunology, University of Monastir, Monastir, Tunisia.,Research Laboratory for "Epidemiology and Immunogenetics of Viral Infections" (LR14SP02), Sahloul University Hospital, University of Sousse, Sousse, Tunisia
| | - Sarra Melayah
- Laboratory of Immunology, Farhat Hached University Hospital, Sousse, Tunisia.,Faculty of Pharmacy, Department of Immunology, University of Monastir, Monastir, Tunisia
| | - Najeh Adaily
- Laboratory of Immunology, Farhat Hached University Hospital, Sousse, Tunisia
| | - Ibtissem Ghedira
- Laboratory of Immunology, Farhat Hached University Hospital, Sousse, Tunisia.,Faculty of Pharmacy, Department of Immunology, University of Monastir, Monastir, Tunisia
| |
Collapse
|
7
|
Nyborg GA, Molberg Ø. Small intestinal biopsy findings consistent with celiac disease in patients with idiopathic inflammatory myopathy: Review of existing literature. Semin Arthritis Rheum 2021; 51:1033-1044. [PMID: 34416625 DOI: 10.1016/j.semarthrit.2021.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 07/03/2021] [Accepted: 07/21/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Case reports have described patients with idiopathic inflammatory myopathies (IIM) and a concurrent diagnosis of celiac disease (CeD) for whom the muscle inflammation (myositis) component of IIM improves after the patients start standard treatment with gluten-free diet (GFD). A connection between IIM and CeD is not commonly recognized. AIM In this first systematic review of the topic, we aimed to explore all peer-reviewed publications of IIM cases and concomitant small intestinal biopsy findings consistent with CeD, published after 1975. METHODS Systematic literature searches were performed in MEDLINE, PubMed, and EMBASE, supplemented by screening of references and non-systematic searches via Google and Google Scholar. RESULTS Altogether 30 cases published between 1976 and 2017 were uncovered. Information about gastrointestinal symptoms prior to CeD diagnosis was available for 19 patients, with 6/19 (32%) reporting no GI symptoms. CeD-related serological data were available in 23/30 patients. Endomysial antibodies were present in 10/18 (56%), while only 2/9 (22%) had antibodies against tissue transglutaminase. Serum antibodies to native gliadin were present in 16/18 (89%). Clinical effects of a GFD on the IIM were reported for 24 patients, with signs of improvement in 14/24 (58%), including three patients with otherwise therapy-resistant inclusion body myositis. Longitudinal follow-up data available from the published studies indicated that 7/24 (29%) remained in clinical IIM remission with GFD as the sole therapeutic intervention. CONCLUSION In the IIM cases presented here, duodenal biopsy findings consistent with celiac disease was sometimes present without classical CeD symptoms or positive traditional CeD serology, and in the majority of cases, the IIM improved after introduction of a gluten-free diet. While extra vigilance towards CeD in IIM patients seems warranted, there is need for more research to clarify if GFD has effects on organ systems other than the small intestine in patients with IIM and small intestinal biopsy findings consistent with CeD.
Collapse
Affiliation(s)
- Gunhild Alvik Nyborg
- Department of Rheumatology, Oslo University Hospital - Rikshospitalet, P.O. box 4950 Nydalen, 0424 Oslo, Norway.
| | - Øyvind Molberg
- Department of Rheumatology, Oslo University Hospital - Rikshospitalet, P.O. box 4950 Nydalen, 0424 Oslo, Norway; Department of Rheumatology and Infectious Diseases, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| |
Collapse
|
8
|
Study of serology and genetics of celiac disease in patients with juvenile systemic lupus erythematosus 'celiac in juvenile systemic lupus'. Eur J Gastroenterol Hepatol 2020; 32:1322-1327. [PMID: 32732814 DOI: 10.1097/meg.0000000000001865] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Several case reports and case series have suggested a possible association between celiac disease (CD) and systemic lupus erythematosus (SLE). Patients with CD developing SLE and vice versa have been reported, highlighting a possible association. Up to 23% of patients with CD have raised anti-double-stranded DNA and likewise 5-22% of SLE patients are seropositive for CD. OBJECTIVE Aim was to screen for CD in the serum of patients suffering from juvenile SLE (JSLE). METHODS One hundred JSLE patients and 40 (age- and sex-matched) healthy subjects were subjected to laboratory screening for CD, endoscopic examination and histopathological examination of the duodenal biopsies to confirm CD diagnosis (in seropositive cases only). RESULTS tTG Ab tested positive in 10% and negative in 90% of patients. tTG Ab correlated significantly with Systemic Lupus Erythematosus Disease Activity Index score (P < 0.001) and insignificantly with hemoglobin and C-reactive protein. Esophago-gastro-duodenoscopy was done to all 10 patients with positive serology for CD revealing six patients with manifest celiac (positive serology and positive endoscopy/biopsy) and four cases of latent celiac (positive serology and negative endoscopy/biopsy). CONCLUSION Most CD patients with articular symptoms remain undiagnosed, which makes screening justified in high-risk patients with autoimmune diseases. This study highlights the strong relationship between JSLE and CD and the need to screen JSLE patients and also other auto-immune rheumatic diseases for the concomitant existence of CD.
Collapse
|
9
|
AlEnzi F, Yateem M, Shaikh M, AlSohaibani F, Alhaymouni B, Ahmed A, Al-Mayouf SM. The Value of Screening for Celiac Disease in Systemic Lupus Erythematosus: A Single Experience of a Tertiary Medical Center. Rheumatol Ther 2020; 7:649-656. [PMID: 32705576 PMCID: PMC7410907 DOI: 10.1007/s40744-020-00223-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Systemic lupus erythematosus (SLE) is a multi-organ inflammatory disease associated with autoimmune diseases. The aim of the study is to assessed the frequency of celiac disease (CD) in adults and children with SLE (aSLE and cSLE, respectively) and compare them with rheumatoid arthritis (RA) and juvenile idiopathic arthritis (JIA) patients; the study also explored the clinical impact of CD serologic markers on SLE disease activity and severity. METHODS This was a cross-sectional study. Patients with SLE who had regular follow-up in rheumatology clinics were evaluated for laboratory and clinical variables using serology and the SLE Disease Activity Index (SLEDAI). To assess the occurrence of CD serology in cSLE and aSLE and the clinical impact of CD serologic markers on SLE, patients were tested for antigliadin (AGA), anti-endomysium (EmA) and anti-tissue transglutaminase (tTG) antibodies. RA and JIA patients were included for comparison. Duodenal biopsy was conducted in patients who exhibited CD markers. RESULTS The CD marker was found in 29 (11.6%) of the 250 patients. AGA was present in seven aSLE patients and tTG in two (11.1%). Among cSLE patients, the autoantibody was present in 17.6% (AGA in four, tTG in two, and EmA in three). For RA patients, five had AGA and tTG and one had EmA, with an overall positivity of 9.7%. Five JIA patients had AGA (four with EmA and five with tTG) with overall positivity of 10.9%; the serum IgA level was normal in all patients except one. Duodenal endoscopic biopsy was performed in patients with positive CD markers (two declined). Histologic confirmation of CD was reported in one RA and one JIA patient but in none of the SLE patients. There was no correlation between the presence of CD markers and autoantibodies in SLE. CONCLUSION CD antibodies did not influence SLE activity. Thus, SLE patients may not need to be screened for CD antibodies.
Collapse
Affiliation(s)
- Fahidah AlEnzi
- Clinical Sciences, College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia.
| | - Mada Yateem
- Pediatric Rheumatology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Manal Shaikh
- Pediatric Rheumatology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Fahad AlSohaibani
- Adult Gastroenterology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Badryah Alhaymouni
- Adult Rheumatology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - AlShaikh Ahmed
- Adult Rheumatology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Sulaiman M Al-Mayouf
- Pediatric Rheumatology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| |
Collapse
|
10
|
Sahin Y, Sahin S, Barut K, Cokugras FC, Erkan T, Adrovic A, Kutlu T, Kasapcopur O. Serological screening for coeliac disease in patients with juvenile idiopathic arthritis. Arab J Gastroenterol 2019; 20:95-98. [PMID: 31182344 DOI: 10.1016/j.ajg.2019.05.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 03/27/2019] [Accepted: 05/26/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND STUDY AIMS Juvenile idiopathic arthritis (JIA) is characterized by autoimmune aetiology. A gene locus 4q27 related to rheumatoid arthritis, psoriatic arthritis, and coeliac disease is associated with susceptibility to JIA. There are reports indicating several patients with JIA had been diagnosed with CD. We aimed to assess the frequency of coeliac disease (CD) in patients with juvenile idiopathic arthritis (JIA). PATIENTS AND METHODS This prospective study was carried out from October 2015 to August 2016 and included 96 patients with JIA. All patients were evaluated in terms of clinical and laboratory findings of CD. Levels of total IgA and tissue transglutaminase antibody (tTG) IgA were measured in all patients. Those with increased level of tTG IgA were further tested for anti-endomysium IgA antibodies (EMA). Gastroduodenoscopy were planned for a definite diagnosis of CD in patients with positive EMA. RESULTS Of the 96 patients in our study, 34 (35.4%) had oligoarticular form of JIA, 29 (30.2%) had polyarticular form, 12 (12.5%) had ERA form, 11 (11.5%) had systemic form, and 10 (10.4%) had psoriatic form. Sixteen of our patients (16.6%) were not using any drugs during the study. Neither EMA IgA antibodies were analysed nor gastro-duodenoscopy was performed because no patients were positive for tTG IgA. There was no difference in terms of tTG levels between the patients using NSAIDs or other drugs. CONCLUSION We did not find CD in children with JIA. Long term studies with more JIA patients are needed to provide more precise interpretation.
Collapse
Affiliation(s)
- Yasin Sahin
- Department of Paediatric Gastroenterology, Cerrahpasa Medical School, Istanbul University, Turkey.
| | - Sezgin Sahin
- Paediatric Rheumatology, Cerrahpasa Medical School, Istanbul University, Turkey
| | - Kenan Barut
- Paediatric Rheumatology, Cerrahpasa Medical School, Istanbul University, Turkey
| | - Fugen Cullu Cokugras
- Department of Paediatric Gastroenterology, Cerrahpasa Medical School, Istanbul University, Turkey
| | - Tulay Erkan
- Department of Paediatric Gastroenterology, Cerrahpasa Medical School, Istanbul University, Turkey
| | - Amra Adrovic
- Paediatric Rheumatology, Cerrahpasa Medical School, Istanbul University, Turkey
| | - Tufan Kutlu
- Department of Paediatric Gastroenterology, Cerrahpasa Medical School, Istanbul University, Turkey
| | - Ozgur Kasapcopur
- Paediatric Rheumatology, Cerrahpasa Medical School, Istanbul University, Turkey
| |
Collapse
|
11
|
Şahin Y, Şahin S, Adrovic A, Kutlu T, Çokuğras FÇ, Barut K, Erkan T, Kasapçopur Ö. Serological screening for celiac disease in children with systemic lupus erythematosus. Eur J Rheumatol 2019; 6:142-145. [PMID: 31070578 DOI: 10.5152/eurjrheum.2019.18130] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Accepted: 03/11/2019] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE The aim of the present study was to investigate the frequency of celiac disease (CD) in patients with juvenile systemic lupus erythematosus (JSLE) and the potential association of JSLE and CD. METHODS This was a cross-sectional study performed from October 2015 to October 2017. A total of 50 patients with JSLE were included in the study. The levels of total IgA and tissue transglutaminase (tTG) IgA antibody were measured in all patients. Subjects with increased tTG were further evaluated for anti-endomysial antibodies (EMAs). Gastroduodenoscopy and intestinal biopsy were performed in those with increased EMA levels to confirm the diagnosis of CD. RESULTS The study included 44 (88.0%) female and 6 (12.0%) male patients. Of the 50 patients, 30 (60.0%) received corticosteroids, and only 4 (8.0%) received no therapy at the time of the study. Only 3 (6.0%) patients were positive for tTG IgA. Patients with positive tTG IgA were then tested for EMA IgA antibodies, and none of them had a positive result. CONCLUSION We did not find CD in children with systemic lupus erythematosus. Studies with more patients with JSLE are needed to conclude a more precise result.
Collapse
Affiliation(s)
- Yasin Şahin
- Department of Pediatric Gastroenterology, İstanbul University-Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Sezgin Şahin
- Department of Pediatric Rheumatology, İstanbul University-Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Amra Adrovic
- Department of Pediatric Rheumatology, İstanbul University-Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Tufan Kutlu
- Department of Pediatric Gastroenterology, İstanbul University-Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Fügen Çullu Çokuğras
- Department of Pediatric Gastroenterology, İstanbul University-Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Kenan Barut
- Department of Pediatric Rheumatology, İstanbul University-Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Tülay Erkan
- Department of Pediatric Gastroenterology, İstanbul University-Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Özgür Kasapçopur
- Department of Pediatric Rheumatology, İstanbul University-Cerrahpaşa School of Medicine, İstanbul, Turkey
| |
Collapse
|
12
|
Bartoloni E, Bistoni O, Alunno A, Cavagna L, Nalotto L, Baldini C, Priori R, Fischetti C, Fredi M, Quartuccio L, Carubbi F, Montecucco C, Doria A, Mosca M, Valesini G, Franceschini F, De Vita S, Giacomelli R, Mirabelli G, Bini V, Gabrielli A, Catassi C, Gerli R. Celiac Disease Prevalence is Increased in Primary Sjögren's Syndrome and Diffuse Systemic Sclerosis: Lessons from a Large Multi-Center Study. J Clin Med 2019; 8:jcm8040540. [PMID: 31010199 PMCID: PMC6517955 DOI: 10.3390/jcm8040540] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 04/09/2019] [Accepted: 04/16/2019] [Indexed: 02/06/2023] Open
Abstract
Association of celiac disease (CD) with systemic autoimmune diseases (ADs) remains controversial. Awareness of CD in these patients is important to prevent complications, including lymphoproliferative disorders. We evaluated previously diagnosed CD prevalence in systemic lupus erythematosus (SLE), primary Sjögren’s syndrome (pSS) and systemic sclerosis (SSc) patients in comparison to 14,298 matched controls. All patients were screened for subclinical CD. Data from 1458 unselected consecutive SLE (580), pSS (354) and SSc (524) patients were collected. Previously biopsy-proven CD diagnosis and both CD- and AD-specific features were registered. All patients without previous CD were tested for IgA transglutaminase (TG). Anti-endomysium were tested in positive/borderline IgA TG. Duodenal biopsy was performed in IgA TG/endomysium+ to confirm CD. CD prevalence in AD was compared to that observed in 14,298 unselected sex- and age-matched adults who acted as controls. CD was more prevalent in pSS vs controls (6.78% vs 0.64%, p < 0.0001). A trend towards higher prevalence was observed in SLE (1.38%, p = 0.058) and SSc (1.34%, p = 0.096). Higher CD prevalence was observed in diffuse cutaneous SSc (4.5%, p ≤ 0.002 vs controls). Subclinical CD was found in two SLE patients and one pSS patient. CD diagnosis usually preceded that of AD. Primary SS and SSc–CD patients were younger at AD diagnosis in comparison to non-celiac patients. Autoimmune thyroiditis was associated with pSS and CD. CD prevalence is clearly increased in pSS and diffuse SSc in comparison to the general population. The association of CD with diffuse but not limited SSc may suggest different immunopathogenic mechanisms characterizing the two subsets. CD screening may be considered in pSS and diffuse SSc in young patients, particularly at the time of diagnosis.
Collapse
Affiliation(s)
- Elena Bartoloni
- Rheumatology Unit, Department of Medicine, University of Perugia, 06128 Perugia, Italy .
| | - Onelia Bistoni
- Rheumatology Unit, Department of Medicine, University of Perugia, 06128 Perugia, Italy .
| | - Alessia Alunno
- Rheumatology Unit, Department of Medicine, University of Perugia, 06128 Perugia, Italy .
| | - Lorenzo Cavagna
- Department of Rheumatology, University and IRCCS Foundation Policlinico S. Matteo, 27100 Pavia, Italy.
| | - Linda Nalotto
- Division of Rheumatology, Department of Medicine, University of Padua, 35128 Padova, Italy.
| | - Chiara Baldini
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy.
| | - Roberta Priori
- Department of Internal Medicine and Medical Specialties, Rheumatology, Sapienza University of Rome, 00185 Rome, Italy.
| | - Colomba Fischetti
- Clinical Medicine, Department of Internal Medicine, Ospedali Riuniti University Hospital, 60030 Ancona, Italy.
| | - Micaela Fredi
- Department of Rheumatology and Clinical Immunology, ASST Spedali Civili, 25133 Brescia, Italy.
| | - Luca Quartuccio
- Department of Medical and Biological Sciences, Rheumatology Clinic, Santa Maria della Misericordia University Hospital, 33100 Udine, Italy.
| | - Francesco Carubbi
- Rheumatology Unit, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, 67100 L'Aquila, Italy.
| | - Carlomaurizio Montecucco
- Department of Rheumatology, University and IRCCS Foundation Policlinico S. Matteo, 27100 Pavia, Italy.
| | - Andrea Doria
- Division of Rheumatology, Department of Medicine, University of Padua, 35128 Padova, Italy.
| | - Marta Mosca
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy.
| | - Guido Valesini
- Department of Internal Medicine and Medical Specialties, Rheumatology, Sapienza University of Rome, 00185 Rome, Italy.
| | - Franco Franceschini
- Department of Rheumatology and Clinical Immunology, ASST Spedali Civili, 25133 Brescia, Italy.
| | - Salvatore De Vita
- Department of Medical and Biological Sciences, Rheumatology Clinic, Santa Maria della Misericordia University Hospital, 33100 Udine, Italy.
| | - Roberto Giacomelli
- Rheumatology Unit, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, 67100 L'Aquila, Italy.
| | - Giulia Mirabelli
- Rheumatology Unit, Department of Medicine, University of Perugia, 06128 Perugia, Italy .
| | - Vittorio Bini
- Internal Medicine, Endocrine and Metabolic Science Section, University of Perugia, 06128 Perugia, Italy.
| | - Armando Gabrielli
- Clinical Medicine, Department of Internal Medicine, Ospedali Riuniti University Hospital, 60030 Ancona, Italy.
| | - Carlo Catassi
- Department of Pediatrics, Marche Polytechnic University, 60121 Ancona, Italy.
| | - Roberto Gerli
- Rheumatology Unit, Department of Medicine, University of Perugia, 06128 Perugia, Italy .
| |
Collapse
|
13
|
Zylberberg HM, Lebwohl B, Green PHR. Celiac Disease-Musculoskeletal Manifestations and Mechanisms in Children to Adults. Curr Osteoporos Rep 2018; 16:754-762. [PMID: 30350261 DOI: 10.1007/s11914-018-0488-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW We aim to review the current literature on the association of musculoskeletal disorders and celiac disease that is a common disorder, affecting about 1% of the population. Extra-intestinal symptoms and presentations predominate. RECENT FINDINGS While the literature supports an association with reduced bone mineral density and increased fracture risk and celiac disease, there is little evidence supporting associations with other rheumatological conditions. Patients frequently report musculoskeletal symptoms; however, studies of specific disease entities suffer from a lack of standardization of testing for celiac disease and a lack of control groups. Well-controlled, preferably population-based studies are required to further explore a relationship between celiac disease and musculoskeletal disorders.
Collapse
Affiliation(s)
- Haley M Zylberberg
- Celiac Disease Center, Columbia University Medical Center, 180 Fort Washington Ave, New York, NY, 10032, USA
| | - Benjamin Lebwohl
- Celiac Disease Center, Columbia University Medical Center, 180 Fort Washington Ave, New York, NY, 10032, USA
| | - Peter H R Green
- Celiac Disease Center, Columbia University Medical Center, 180 Fort Washington Ave, New York, NY, 10032, USA.
| |
Collapse
|
14
|
Demirezer Bolat A, Akın FE, Tahtacı M, Tayfur Yürekli Ö, Köseoğlu H, Erten Ş, Başaran M, Selvi E, Büyükaşık Ş, Ersoy O. Risk Factors for Polyautoimmunity among Patients with Celiac Disease: A Cross-Sectional Survey. Digestion 2016; 92:185-91. [PMID: 26376434 DOI: 10.1159/000439586] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 08/21/2015] [Indexed: 02/04/2023]
Abstract
AIM To define the prevalence of polyautoimmunity (PAI) among celiac disease (CD) patients and to compare clinical and laboratory features of CD patients with or without PAI in order to determine the risk factors for PAI in CD. MATERIAL AND METHOD Patients diagnosed with CD in our clinic between 2007 and 2014 with at least 1 year of follow-up were retrospectively evaluated. Totally 145 patients were included in the study. Information on patient demographics and laboratory data were obtained from patient records. The study participants were divided into 2 groups. Group 1 was the CD-alone group consisting of patients without any other autoimmune diseases (AIDs), while group 2 was the PAI group consisting of patients with accompanying one or more AIDs. RESULTS The mean age of 145 CD patients (106 female and 39 male) included in the study was 37.2 ± 12.3 years. Of the 145 patients included, 48 (33.1%) were in the PAI group. When two groups were compared with each other in terms of the demographic features and laboratory data, the following were identified as risk factors for PAI: female gender, family history for AIDs, antigliadin IgG positivity, vitamin D deficiency, antinuclear antibody positivity ≥1/80 titer and having any musculoskeletal disease. CONCLUSION To the best of our knowledge, this is one of the largest studies in the literature on CD patients for the PAI prevalence and related risk factors. Identification of the risk factors in early stages is important to explore PAI among CD patients. Larger, prospective studies are warranted about the risk factors and autoimmune characteristics of CD.
Collapse
|
15
|
Lerner A, Matthias T. Rheumatoid arthritis-celiac disease relationship: joints get that gut feeling. Autoimmun Rev 2015; 14:1038-47. [PMID: 26190704 DOI: 10.1016/j.autrev.2015.07.007] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 07/09/2015] [Indexed: 12/11/2022]
Abstract
Rheumatoid arthritis (RA) and celiac disease (CD) belong to the autoimmune disease family. Despite being separate entities they share multiple aspects. Epidemiologically they share comparable incidence environmental influences, associated antibodies and a recent incidental surge. They differ in their HLA pre-dispositions and specific predictive and diagnostic biomarkers. At the clinical level, celiac disease exhibits extra-intestinal rheumatic manifestations and RA gastrointestinal ones. Small bowel pathology exists in rheumatic patients. A trend towards responsiveness to a gluten free diet has been observed, ameliorating celiac rheumatic manifestations, whereas dietary interventions for rheumatoid arthritis remain controversial. Pathophysiologically, both diseases are mediated by endogenous enzymes in the target organs. The infectious, dysbiotic and increased intestinal permeability theories, as drivers of the autoimmune cascade, apply to both diseases. Contrary to their specific HLA pre-disposition, the diseases share multiple non-HLA loci. Those genes are crucial for activation and regulation of adaptive and innate immunity. Recently, light was shed on the interaction between host genetics and microbiota composition in relation to CD and RA susceptibility, connecting bugs and us and autoimmunity. A better understanding of the above mentioned similarities in the gut-joint inter-relationship, may elucidate additional facets in the mosaic of autoimmunity, relating CD to RA.
Collapse
Affiliation(s)
- Aaron Lerner
- Pediatric Gastroenterology and Nutrition Unit, Carmel Medical Center, B. Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
| | | |
Collapse
|
16
|
Horwitz A, Skaaby T, Kårhus LL, Schwarz P, Jørgensen T, Rumessen JJ, Linneberg A. Screening for celiac disease in Danish adults. Scand J Gastroenterol 2015; 50:824-31. [PMID: 25687734 PMCID: PMC4487537 DOI: 10.3109/00365521.2015.1010571] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The prevalence of celiac disease (CD) as recorded in the Danish National Patient Registry is ∼50/100,000 persons. This is much lower than the reported prevalence of CD in other Nordic countries and underdiagnosis is suspected. Our aim was to estimate the prevalence of CD in a population-based study of Danish adults. METHODS A total of 2297 adults aged 24-76 years living in the southwestern part of Copenhagen were screened for CD by immunoglobulin (Ig)A and IgG antibodies to transglutaminases and deamidated gliadin. IgA/IgG-positive participants were invited to a clinical evaluation, including biopsies, by a gastroenterologist. RESULTS Of the invited 56 participants, 40 underwent a full clinical evaluation and 8 persons were diagnosed with CD; 2 of the 16 persons, who did not complete the clinical evaluation, were considered by experts to have probable CD. None of the above 56 participants had a known history of CD or a recorded diagnosis of CD in National Patient Registry. By combining cases of biopsy-proven CD (n = 8), probable CD (n = 2), and registry-recorded CD (n = 1), the prevalence of CD was estimated to be 479/100,000 (11/2297) persons (95% CI: 197-761). CONCLUSION In this general adult population, the prevalence of CD as estimated by screening and clinical evaluation was 10 times higher than the registry-based prevalence of CD. Of 11 participants diagnosed with CD in our screening study, 10 were unaware of the diagnosis prior to the study. Thus, our study suggests that CD is markedly underdiagnosed in Danish adults.
Collapse
Affiliation(s)
- Anna Horwitz
- Research Centre for Prevention and Health, The Capital Region, University of Copenhagen , Copenhagen , Denmark
| | | | | | | | | | | | | |
Collapse
|
17
|
Parra-Medina R, Molano-Gonzalez N, Rojas-Villarraga A, Agmon-Levin N, Arango MT, Shoenfeld Y, Anaya JM. Prevalence of celiac disease in latin america: a systematic review and meta-regression. PLoS One 2015; 10:e0124040. [PMID: 25942408 PMCID: PMC4420463 DOI: 10.1371/journal.pone.0124040] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Accepted: 03/10/2015] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Celiac disease (CD) is an immune-mediated enteropathy triggered by the ingestion of gluten in susceptible individuals, and its prevalence varies depending on the studied population. Given that information on CD in Latin America is scarce, we aimed to investigate the prevalence of CD in this region of the world through a systematic review and meta-analysis. METHODS AND FINDINGS This was a two-phase study. First, a cross-sectional analysis from 981 individuals of the Colombian population was made. Second, a systematic review and meta-regression analysis were performed following the Preferred Reporting Items for Systematic Meta- Analyses (PRISMA) guidelines. Our results disclosed a lack of celiac autoimmunity in the studied Colombian population (i.e., anti-tissue transglutaminase (tTG) and IgA anti-endomysium (EMA)). In the systematic review, 72 studies were considered. The estimated prevalence of CD in Latin Americans ranged between 0.46% and 0.64%. The prevalence of CD in first-degree relatives of CD probands was 5.5%. The coexistence of CD and type 1 diabetes mellitus varied from 4.6% to 8.7%, depending on the diagnosis methods (i.e., autoantibodies and/or biopsies). CONCLUSIONS Although CD seems to be a rare condition in Colombians; the general prevalence of the disease in Latin Americans seemingly corresponds to a similar scenario observed in Europeans.
Collapse
Affiliation(s)
- Rafael Parra-Medina
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Carrera 24 #63-C-69, Bogotá, Colombia
| | - Nicolás Molano-Gonzalez
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Carrera 24 #63-C-69, Bogotá, Colombia
| | - Adriana Rojas-Villarraga
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Carrera 24 #63-C-69, Bogotá, Colombia
| | - Nancy Agmon-Levin
- The Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel
- Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
| | - Maria-Teresa Arango
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Carrera 24 #63-C-69, Bogotá, Colombia
- The Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel
- Doctoral Program in Biomedical Sciences Universidad del Rosario, Bogotá, Colombia
| | - Yehuda Shoenfeld
- The Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel
- Incumbent of the Laura Schwarz-Kip Chair for Research of Autoimmune Diseases, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Juan-Manuel Anaya
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Carrera 24 #63-C-69, Bogotá, Colombia
- * E-mail:
| |
Collapse
|
18
|
Zayeni H, Shafaghi A, Gharib Pour A, Naghi Pour MR, Jafari Nezhad A, Hassankhani A, Amir Maafi A, Geranmayeh S. Celiac disease in rheumatoid arthritis: A cross-sectional study in Iran. INDIAN JOURNAL OF RHEUMATOLOGY 2014. [DOI: 10.1016/j.injr.2014.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
19
|
Picceli VF, Skare TL, Nisihara R, Kotze L, Messias-Reason I, Utiyama SRR. Spectrum of autoantibodies for gastrointestinal autoimmune diseases in systemic lupus erythematosus patients. Lupus 2013; 22:1150-5. [DOI: 10.1177/0961203313503911] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background Organ-specific autoimmune diseases may appear in patients with systemic lupus erythematosus (SLE). Gastrointestinal symptoms are well documented in SLE and may be similar to those related to autoimmune gastrointestinal diseases. Objective Our aim was to search for gastrointestinal organ-specific autoantibodies in 194 patients with systemic lupus and 103 healthy controls from Southern Brazil. Methods Anti-endomysium antibodies (IgA-EmA), anti-gastric parietal cells (GPC) antibodies, anti-smooth muscle antibodies (ASMA), anti-mitochondrial antibodies (AMA) and anti-LKM-1 (liver-kidney microsomal) were searched for using indirect immunofluorescence in the sera of patients and controls. Results The total positivity of antibodies in SLE patients was 14.4% (28/194) and differed significantly from healthy individuals (0.97%; p < 0.001). IgA-EmA was more common in lupus patients than in controls (11/194; p = 0.009), and one of these patients had dermatitis herpetiformis. Clinical association revealed that IgA-EmA was more common in SLE patients with discoid lesions. The frequency of anti-GPC ( p = 0.10), ASMA ( p = 0.16) and AMA ( p = 0.55) did not differ significantly between groups. No patient presented LKM-1 autoantibodies. One patient presenting anti-GPC was diagnosed with atrophic gastritis and pernicious anemia. Conclusion Only IgA-EmA was significantly associated with lupus and with the presence of discoid lesions. Until now, no obvious association with celiac disease has been found.
Collapse
Affiliation(s)
- VF Picceli
- Immunopathology Laboratory, Clinical Hospital, Federal University of Paraná, Brazil
| | - TL Skare
- Rheumatology Unit, Hospital Universitário Evangélico de Curitiba, Brazil
| | | | - L Kotze
- Gastroenterology Service, Pontifical Catholic University of Paraná, Curitiba, Paraná, Brazil
| | - I Messias-Reason
- Immunopathology Laboratory, Clinical Hospital, Federal University of Paraná, Brazil
| | - SRR Utiyama
- Immunopathology Laboratory, Clinical Hospital, Federal University of Paraná, Brazil
| |
Collapse
|
20
|
Skare T, Nisihara RM, Utiyama SRR. Is it worth investigating coeliac disease in patients with rheumatic disorders? Rheumatology (Oxford) 2012; 52:217-8. [PMID: 22956552 DOI: 10.1093/rheumatology/kes229] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
21
|
Abstract
A gluten-free diet (GFD) is commonly recognized as the treatment for celiac disease. It also has been investigated as a treatment option for other medical conditions, including dermatitis herpetiformis, irritable bowel syndrome, neurologic disorders, rheumatoid arthritis, diabetes mellitus, and HIV-associated enteropathy. The strength of the evidence for the use of a GFD in these nonceliac diseases varies, and future research may better define the benefits of a GFD for those conditions with weak existing evidence.
Collapse
|