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Laamanen A, Salmi T, Huhtala H, Reunala T, Hervonen K, Kaukinen K, Pasternack C. Gastrointestinal symptoms at diagnosis and during long-term gluten-free diet treatment in dermatitis herpetiformis patients. J Eur Acad Dermatol Venereol 2024; 38:e91-e93. [PMID: 37595955 DOI: 10.1111/jdv.19443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 08/11/2023] [Indexed: 08/20/2023]
Affiliation(s)
- A Laamanen
- Celiac Disease Research Center, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - T Salmi
- Celiac Disease Research Center, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Dermatology, Tampere University Hospital, Tampere, Finland
| | - H Huhtala
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - T Reunala
- Celiac Disease Research Center, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - K Hervonen
- Celiac Disease Research Center, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Dermatology, Tampere University Hospital, Tampere, Finland
| | - K Kaukinen
- Celiac Disease Research Center, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - C Pasternack
- Celiac Disease Research Center, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Dermatology, Tampere University Hospital, Tampere, Finland
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Nilsson N, Leivo J, Collin P, Koskinen I, Kaukinen K, Huhtala H, Palmio J, Reunala T, Hervonen K, Salmi T, Pasternack C. Risk of vascular diseases in patients with dermatitis herpetiformis and coeliac disease: a long-term cohort study. Ann Med 2023; 55:2227423. [PMID: 37378421 DOI: 10.1080/07853890.2023.2227423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 06/13/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023] Open
Abstract
INTRODUCTION Dermatitis herpetiformis (DH) is a cutaneous manifestation of coeliac disease. Increased cardiovascular morbidity has been reported in coeliac disease, but in DH only little is known about this. In this cohort study with a long-term follow-up, the risk for vascular diseases in patients with dermatitis herpetiformis (DH) and coeliac disease was assessed. METHODS The study consisted of 368 DH and 1072 coeliac disease patients with biopsy-proven diagnosis performed between 1966 and 2000. For each DH and coeliac disease patient three matched reference individuals were obtained from the population register. Data regarding all outpatient and inpatient treatment periods between 1970 and 2015 were reviewed for diagnostic codes of vascular diseases from the Care Register for Health Care. Cox proportional hazard model was used to assess the risks for the diseases studied and the HRs were adjusted for diabetes mellitus (aHR). RESULTS The median follow-up time of DH and coeliac disease patients was 46 years. The risk for cardiovascular diseases did not differ between DH patients and their references (aHR 1.16, 95% CI 0.91-1.47), but among coeliac disease patients, the risk was increased (aHR 1.36, 95% CI 1.16-1.59). The risk for cerebrovascular diseases was found to be decreased in DH patients when compared with references (aHR 0.68, 95% CI 0.47-0.99) and increased in coeliac disease patients (aHR 1.33, 95% CI 1.07-1.66). The risk for venous thrombosis was increased in coeliac disease patients (aHR 1.62, 95% CI 1.22-2.16) but not in DH. CONCLUSIONS The risk for vascular complications appears to differ between DH and coeliac disease. In DH the risk for cerebrovascular diseases seems to be decreased, while in coeliac disease an elevated risk for cerebrovascular and cardiovascular diseases was observed. These differing vascular risk profiles between the two manifestations of the same disease merit further investigation.
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Affiliation(s)
- Noora Nilsson
- Celiac Disease Research Center, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Dermatology, Tampere University Hospital, Tampere, Finland
| | - Joonas Leivo
- Heart Hospital, Tampere University Hospital, Tampere, Finland
| | - Pekka Collin
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland
| | - Inka Koskinen
- Celiac Disease Research Center, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Gastroenterology, Hospital Nova of Central Finland, Jyväskylä, Finland
| | - Katri Kaukinen
- Celiac Disease Research Center, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Heini Huhtala
- Faculty of Health Sciences, Tampere University, Tampere, Finland
| | - Johanna Palmio
- Department of Neurology, Tampere University and Tampere University Hospital, Tampere, Finland
| | - Timo Reunala
- Celiac Disease Research Center, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Kaisa Hervonen
- Celiac Disease Research Center, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Dermatology, Tampere University Hospital, Tampere, Finland
| | - Teea Salmi
- Celiac Disease Research Center, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Dermatology, Tampere University Hospital, Tampere, Finland
| | - Camilla Pasternack
- Celiac Disease Research Center, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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Koskinen I, Hervonen K, Huhtala H, Pasternack C, Salmi T, Reunala T, Collin P, Kaukinen K. Mortality and causes of death in different celiac disease phenotypes during long-term follow-up. Dig Liver Dis 2022; 54:1502-1507. [PMID: 35589505 DOI: 10.1016/j.dld.2022.04.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 04/24/2022] [Accepted: 04/27/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Celiac disease has been associated with increased mortality, but data on long-term mortality are scarce. AIMS To determine long-term mortality in celiac disease. METHODS The study cohort consisted of all celiac disease patients (n=1,392) diagnosed in Tampere University Hospital catchment area 1960 - 2000. Patients were categorized into subgroups based on demographic (age, gender, decade of diagnosis) and celiac disease characteristics (e.g., phenotype, severity of villous atrophy) collected from medical records. Overall and cause-specific mortality was compared to those of age-, sex-, and place of residence matched reference individuals (n=4,177) over time. RESULTS During the 41 years of follow-up (median 26.5 years), 376 celiac disease patients and 1,155 reference individuals died. All-cause mortality was not increased (hazard ratio (HR) 0.96, 95% confidence intervals (CI) 0.85-1.08). Mortality from lymphoproliferative diseases and diseases of the central nervous system was increased (HR 2.42, 95% CI 1.38-4.24 and HR 2.14, 95% CI 1.05-4.36 respectively) while the risk from alcohol related diseases was decreased (HR 0.31, 95% CI 0.09-1.00). Examination of various celiac disease phenotypes revealed no significant differences in mortality CONCLUSIONS: Overall mortality was not increased in any celiac disease phenotype during a very long-term follow-up.
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Affiliation(s)
- Inka Koskinen
- Celiac Disease Research Center, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Department of Internal Medicine, Central Finland Central Hospital, Jyväskylä, Finland.
| | - Kaisa Hervonen
- Celiac Disease Research Center, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Department of Dermatology, Tampere University Hospital, Tampere, Finland
| | - Heini Huhtala
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Camilla Pasternack
- Celiac Disease Research Center, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Teea Salmi
- Celiac Disease Research Center, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Department of Dermatology, Tampere University Hospital, Tampere, Finland
| | - Timo Reunala
- Celiac Disease Research Center, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Department of Dermatology, Tampere University Hospital, Tampere, Finland
| | - Pekka Collin
- Celiac Disease Research Center, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland
| | - Katri Kaukinen
- Celiac Disease Research Center, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
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Nurmi R, Pasternack C, Salmi T, Hervonen K, Koskinen I, Järvelin J, Huhtala H, Collin P, Mustonen J, Kaukinen K, Mäkelä S. Authors' reply: The risk of renal comorbidities in celiac disease patients depends on the phenotype of celiac disease. J Intern Med 2022; 292:842-843. [PMID: 36065566 DOI: 10.1111/joim.13562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Rakel Nurmi
- Celiac Disease Research Center, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Camilla Pasternack
- Celiac Disease Research Center, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Teea Salmi
- Celiac Disease Research Center, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Dermatology, Tampere University Hospital, Tampere, Finland
| | - Kaisa Hervonen
- Celiac Disease Research Center, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Dermatology, Tampere University Hospital, Tampere, Finland
| | - Inka Koskinen
- Celiac Disease Research Center, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Internal Medicine, Central Finland Health Care District, Jyväskylä, Finland
| | - Jutta Järvelin
- Department of Knowledge Brokers, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Heini Huhtala
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Pekka Collin
- Celiac Disease Research Center, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland
| | - Jukka Mustonen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Katri Kaukinen
- Celiac Disease Research Center, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Satu Mäkelä
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
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Nurmi R, Pasternack C, Salmi T, Hervonen K, Koskinen I, Järvelin J, Huhtala H, Collin P, Mustonen J, Kaukinen K, Mäkelä S. The risk of renal comorbidities in celiac disease patients depends on the phenotype of celiac disease. J Intern Med 2022; 292:779-787. [PMID: 35713926 PMCID: PMC9796855 DOI: 10.1111/joim.13532] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND An increased risk of kidney disease in patients with celiac disease has been reported, but the association has remained obscure. Only few studies have investigated the association between renal comorbidities and dermatitis herpetiformis, a cutaneous manifestation of celiac disease. OBJECTIVES We investigated whether patients with different phenotypes of celiac disease are at higher risk of kidney diseases than age- and sex-matched references. METHODS The diagnoses of glomerulonephritis, diabetic nephropathy, interstitial nephritis, and end-stage renal disease obtained from the National Hospital Discharge Register between 1970 and 2015 were identified in celiac disease (Marsh III, n = 1072) and dermatitis herpetiformis (n = 368) patients diagnosed at Tampere University Hospital catchment region and in 4296 reference subjects. Using the Cox proportional hazards model, we compared the risk of kidney diseases between patients and references. The study protocol was approved by the Regional Ethics Committee of Tampere University Hospital (R16090). As the study was register based, no consent from patients was required. RESULTS Even after adjusting for type 1 diabetes, celiac disease was associated with an elevated risk of kidney disease (hazard ratio [HR] 1.85, 95% confidence interval [CI] 1.12-3.03), glomerulonephritis (HR 3.37, 95% CI 1.64-6.95), and IgA nephropathy (IgAN) (HR 18.98, 95% CI 2.29-157.63). No similarly elevated risk was found among dermatitis herpetiformis patients (HR 1.50, 95% CI 0.63-3.55; HR 2.21, 95% CI 0.77-6.38; and HR 5.87, 95% CI 0.53-64.79, respectively). CONCLUSION Celiac disease patients were at increased risk of kidney diseases, notably IgAN. The risk was dependent on the celiac disease phenotype and was not seen in patients with dermatitis herpetiformis. Awareness of possible renal manifestations is recommended when treating celiac disease patients.
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Affiliation(s)
- Rakel Nurmi
- Celiac Disease Research Center, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Camilla Pasternack
- Celiac Disease Research Center, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Teea Salmi
- Celiac Disease Research Center, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Dermatology, Tampere University Hospital, Tampere, Finland
| | - Kaisa Hervonen
- Celiac Disease Research Center, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Dermatology, Tampere University Hospital, Tampere, Finland
| | - Inka Koskinen
- Celiac Disease Research Center, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Internal Medicine, Central Finland Health Care District, Jyväskylä, Finland
| | - Jutta Järvelin
- Department of Knowledge Brokers, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Heini Huhtala
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Pekka Collin
- Celiac Disease Research Center, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland
| | - Jukka Mustonen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Katri Kaukinen
- Celiac Disease Research Center, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Satu Mäkelä
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
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Pasternack C, Hervonen K, Mansikka E, Reunala T, Kaukinen K, Salmi T. Sex-differences in Gluten-free Dietary Adherence and Clinical Symptoms in Patients with Long-term Treated Dermatitis Herpetiformis. Acta Derm Venereol 2022; 102:adv00713. [PMID: 35393627 PMCID: PMC9558333 DOI: 10.2340/actadv.v102.1072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Dermatitis herpetiformis is a blistering autoimmune skin disease, and a cutaneous manifestation of coeliac disease. The burden of coeliac disease is increased especially in females, but studies concerning sex differences in patients with long-term treated dermatitis herpetiformis are scarce. This questionnaire study compared adherence to a gluten-free diet, clinical symptoms and well-being between females and males in a cohort of 237 long-term treated (median 24 years) patients with dermatitis herpetiformis. Females had better adherence to a gluten-free diet (p = 0.022) and they used dapsone significantly less often at the time of the study than did males (4% vs 13%, p = 0.017). The occurrence of skin symptoms was equal in both sexes, but dermatological quality of life was lower in females (p = 0.024), and gastrointestinal symptoms were more severe among females with dermatitis herpetiformis than among males (p = 0.027). In conclusion, long-term treated female patients with dermatitis herpetiformis have better adherence to a gluten-free diet, but they also experience more severe clinical symptoms compared with males.
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Affiliation(s)
- Camilla Pasternack
- Celiac Disease Research Center, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
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Nurmi R, Pasternack C, Salmi T, Hervonen K, Koskinen I, Järvelin J, Huhtala H, Collin P, Mustonen J, Kaukinen K, Mäkelä S. MO418: The Risk of Renal Co-Morbidities in Celiac Disease Patients Depends on the Phenotype of Celiac Disease. Nephrol Dial Transplant 2022. [DOI: 10.1093/ndt/gfac070.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND AND AIMS
Albeit the association between renal disorders and celiac disease is still somewhat contradictory, an elevated risk of kidney diseases in patients with celiac disease has been shown [1, 2, 3]. Only case reports have described the link between glomerulonephritis and dermatitis herpetiformis, a cutaneous manifestation of celiac disease [4]. This study aimed to evaluate whether patients with various phenotypes of celiac disease have an increased risk of renal co-morbidities compared with matched references.
METHODS: The diagnoses of glomerulonephritis, diabetic nephropathy, interstitial nephritis and end-stage renal disease were collected from the Finnish National Hospital Discharge Register from 1970 to 2015 among 1440 celiac disease patients and 4296 age- and sex-matched references. Further, patients were divided into two cohorts, dermatitis herpetiformis and any other phenotype of celiac disease. We used Cox proportional-hazards model to compare the risk of renal co-morbidities between patients and reference individuals.
RESULTS
Celiac disease was positively associated with renal disorders even after adjusting for type 1 diabetes [hazard ratio (HR) 1.81, 95% confidence interval (CI) 1.18–2.76]. A 3-fold and 12-fold risk increase were seen for glomerulonephritis and IgA nephropathy, respectively. A similar risk increase for renal co-morbidities in dermatitis herpetiformis was not shown.
CONCLUSIONS: Celiac disease was associated with an increased risk of renal co-morbidities, especially glomerulonephritis. The risk depends on the phenotype of celiac disease. The possible association between renal disorders and celiac disease should be investigated more in the future and kept in mind also in clinical practice.
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Affiliation(s)
- Rakel Nurmi
- Tampere University, Celiac Disease Research Center, Faculty of Medicine and Health Technology, Tampere, Finland
| | - Camilla Pasternack
- Tampere University, Celiac Disease Research Center, Faculty of Medicine and Health Technology, Tampere, Finland
| | - Teea Salmi
- Tampere University, Celiac Disease Research Center, Faculty of Medicine and Health Technology, Tampere, Finland
- Tampere University Hospital, Department of Dermatology, Tampere, Finland
| | - Kaisa Hervonen
- Tampere University, Celiac Disease Research Center, Faculty of Medicine and Health Technology, Tampere, Finland
- Tampere University Hospital, Department of Dermatology, Tampere, Finland
| | - Inka Koskinen
- Tampere University, Celiac Disease Research Center, Faculty of Medicine and Health Technology, Tampere, Finland
- Central Finland Health Care District, Department of Internal Medicine, Jyväskylä, Finland
| | - Jutta Järvelin
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Heini Huhtala
- Tampere University, Faculty of Social Sciences, Tampere, Finland
| | - Pekka Collin
- Tampere University, Celiac Disease Research Center, Faculty of Medicine and Health Technology, Tampere, Finland
- Tampere University Hospital, Department of Gastroenterology and Alimentary Tract Surgery, Tampere, Finland
| | - Jukka Mustonen
- Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland
- Tampere University Hospital, Department of Internal Medicine, Tampere, Finland
| | - Katri Kaukinen
- Tampere University, Celiac Disease Research Center, Faculty of Medicine and Health Technology, Tampere, Finland
- Tampere University Hospital, Department of Internal Medicine, Tampere, Finland
| | - Satu Mäkelä
- Tampere University Hospital, Department of Internal Medicine, Tampere, Finland
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Pasternack C, Hervonen K, Mansikka E, Reunala T, Collin P, Kaukinen K, Salmi T. Persistent Skin Symptoms after Diagnosis and on a Long-term Gluten-free Diet in Dermatitis Herpetiformis. Acta Derm Venereol 2021; 101:adv00555. [PMID: 34490466 PMCID: PMC9425629 DOI: 10.2340/00015555-3914] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Dermatitis herpetiformis is a cutaneous manifestation of coeliac disease treated with a gluten-free diet. However, the itching and blistering rash alleviates slowly after gluten withdrawal and occasionally persists despite a long-term gluten-free diet. This study investigated the prevalence and factors associated with prolonged (i.e. > 2 years) and ongoing skin symptoms in 237 patients with dermatitis herpetiformis. Data were gathered from medical records and via questionnaires. Among patients with dermatitis herpetiformis, 38% had prolonged symptoms after diagnosis, and 14% had ongoing skin symptoms at follow-up (median duration of gluten-free diet 24 years). A severe rash at diagnosis was associated with both prolonged and ongoing cutaneous symptoms. In addition, patients with dermatitis herpetiformis with ongoing skin symptoms at follow-up had been on the dietary treatment for a shorter time (median duration 16 vs 25 years) and were less often on a strict diet (53% vs 78%) compared with patients with dermatitis herpetiformis without ongoing skin symptoms.
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Affiliation(s)
- Camilla Pasternack
- Celiac Disease Research Center, Faculty of Medicine and Health Technology, Tampere University, FIN-33014 Tampere, Finland. E-maill:
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Alakoski A, Pasternack C, Reunala T, Kaukinen K, Huhtala H, Mansikka E, Jernman J, Hervonen K, Salmi T. Anaemia in Dermatitis Herpetiformis: Prevalence and Associated Factors at Diagnosis and One-year Follow-up. Acta Derm Venereol 2021; 101:adv00443. [PMID: 33846758 PMCID: PMC9364257 DOI: 10.2340/00015555-3795] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Dermatitis herpetiformis is a cutaneous manifestation of coeliac disease. Anaemia is a common finding in patients with untreated coeliac disease, but little is known about the occurrence of anaemia in those with dermatitis herpetiformis. This study investigated the prevalence of anaemia and factors associated with anaemia in 250 patients with dermatitis herpetiformis, at diagnosis and one year after diagnosis. As controls, 139 patients with coeliac disease were included. Patient records were reviewed to gather baseline clinical, histological, and laboratory data. Follow-up data for patients with dermatitis herpetiformis were collected from patient records and via questionnaires or at follow-up visits. The prevalence of anaemia was 12% in patients with dermatitis herpetiformis and 17% in patients with coeliac disease at diagnosis (p = 0.257). Anaemia in patients with dermatitis herpetiformis was not associated with the severity of skin symptoms or small bowel damage. The prevalence of anaemia at a 1-year follow-up had increased to 19%, but it was associated mainly with dapsone treatment.
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Affiliation(s)
- Anna Alakoski
- Department of Dermatology, Tampere University Hospital, FIN-33521 Tampere, Finland
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Pasternack C, Koskinen I, Hervonen K, Kaukinen K, Järvelin J, Reunala T, Collin P, Huhtala H, Mattila VM, Salmi T. Risk of fractures in dermatitis herpetiformis and coeliac disease: a register-based study. Scand J Gastroenterol 2019; 54:843-848. [PMID: 31280614 DOI: 10.1080/00365521.2019.1636132] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Objectives: Dermatitis herpetiformis (DH) is a cutaneous manifestation of coeliac disease. Bone fracture risk is increased in coeliac disease, but little knowledge exists about bone complications in DH. This study aimed to evaluate the risk of hip and other hospital-treated fractures in DH and coeliac disease in a high prevalence area with good adherence to a gluten-free diet. Materials and methods: Hip, proximal humerus, wrist and ankle fractures in 368 treated DH and 1076 coeliac disease patients between 1970 and 2015 were reviewed from the National Hospital Discharge Register. Hip fracture incidence rates for DH and coeliac disease patients were compared to those for the general population. The overall fracture risk for DH was compared to coeliac disease. Results: The hip fracture incidence rates for DH and coeliac disease patients did not differ from the general population. In females aged 80-89, the hip fracture incidence was higher in DH than in coeliac disease, but the risk for any hospital-treated fracture was lower in DH compared to coeliac disease (adjusted HR 0.620, 95% CI 0.429-0.949). The DH and coeliac disease patients with hospital-treated fractures were diagnosed at an older age, but the degree of small bowel mucosal damage did not significantly differ between patients with and without fractures. Conclusion: The incidence of hip fracture is not increased in treated DH or coeliac disease in an area with high awareness and dietary compliance rates. However, patients with DH seem to have a lower risk for fractures overall compared to coeliac disease.
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Affiliation(s)
- Camilla Pasternack
- Celiac Disease Research Center, Faculty of Medicine and Health Technology, Tampere University , Tampere , Finland
| | - Inka Koskinen
- Department of Internal Medicine, Central Finland Central Hospital , Jyväskylä , Finland
| | - Kaisa Hervonen
- Celiac Disease Research Center, Faculty of Medicine and Health Technology, Tampere University , Tampere , Finland.,Department of Dermatology, Tampere University Hospital , Tampere , Finland
| | - Katri Kaukinen
- Celiac Disease Research Center, Faculty of Medicine and Health Technology, Tampere University , Tampere , Finland.,Department of Internal Medicine, Tampere University Hospital , Tampere , Finland
| | - Jutta Järvelin
- National Institute for Health and Welfare , Helsinki , Finland
| | - Timo Reunala
- Celiac Disease Research Center, Faculty of Medicine and Health Technology, Tampere University , Tampere , Finland.,Department of Dermatology, Tampere University Hospital , Tampere , Finland
| | - Pekka Collin
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital , Tampere , Finland
| | - Heini Huhtala
- Faculty of Social Sciences, Tampere University , Tampere , Finland
| | - Ville M Mattila
- Division of Orthopaedics and Traumatology, Department of Trauma, Musculoskeletal Surgery and Rehabilitation, Tampere University Hospital , Tampere , Finland
| | - Teea Salmi
- Celiac Disease Research Center, Faculty of Medicine and Health Technology, Tampere University , Tampere , Finland.,Department of Dermatology, Tampere University Hospital , Tampere , Finland
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Pasternack C, Kaukinen K, Kurppa K, Mäki M, Collin P, Hervonen K, Reunala T, Huhtala H, Kekkonen L, Salmi T. Gastrointestinal Symptoms Increase the Burden of Illness in Dermatitis Herpetiformis: A Prospective Study. Acta Derm Venereol 2017; 97:58-62. [PMID: 27241271 DOI: 10.2340/00015555-2471] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Dermatitis herpetiformis (DH) is an extraintestinal manifestation of coeliac disease. The burden of illness in untreated coeliac disease is known to be considerable, but corresponding evidence for DH is lacking. In this study the burden of DH was evaluated prospectively in 52 patients newly diagnosed with DH using a study questionnaire and a validated Psychological General Well-Being (PGWB) questionnaire. The PGWB scores were compared with those of 110 healthy controls. Quality of life was significantly (p < 0.001) lower among patients with DH at the time of diagnosis, but after 1 year on a gluten-free diet their quality of life was at same level as that of the controls. The presence of gastrointestinal symptoms was shown to significantly increase the burden of untreated DH. We conclude that there is a significant burden related to untreated, but not to treated, DH, and the burden is even greater among DH patients with gastrointestinal symptoms.
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Pasternack C, Kaukinen K, Kurppa K, Mäki M, Collin P, Reunala T, Huhtala H, Salmi T. Quality of Life and Gastrointestinal Symptoms in Long-Term Treated Dermatitis Herpetiformis Patients: A Cross-Sectional Study in Finland. Am J Clin Dermatol 2015; 16:545-52. [PMID: 26267424 DOI: 10.1007/s40257-015-0149-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Dermatitis herpetiformis (DH) is a cutaneous manifestation of celiac disease. Both conditions are treated with a restrictive life-long gluten-free diet (GFD). Treated celiac disease patients have been shown to have more severe gastrointestinal symptoms and inferior quality of life compared with healthy controls, but evidence regarding quality of life in DH is lacking. OBJECTIVE The aim was to evaluate whether long-term GFD-treated DH patients suffer from persistent gastrointestinal symptoms and if they experience a drawdown in quality of life. METHODS Gastrointestinal symptoms and quality of life were assessed in 78 long-term GFD-treated DH patients using the validated Gastrointestinal Symptom Rating Scale, Psychological General Well-Being and Short Form 36 Health Survey questionnaires. The findings were compared with 110 healthy controls, population-based reference values and 371 treated celiac disease controls. RESULTS The median age of the DH patients at the time of the study was 57 years, and 51 % were male. Significant differences in gastrointestinal symptoms or quality of life were not detected when treated DH patients were compared with healthy controls, but treated DH patients had less severe gastrointestinal symptoms and increased quality of life compared with celiac disease controls. Female DH patients had more severe gastrointestinal symptoms and reduced vitality compared with male DH patients. The presence of skin symptoms and the adherence to or duration of GFD did not have any influence on gastrointestinal symptoms or quality of life. CONCLUSION We conclude that long-term GFD-treated DH patients do not suffer from the burden of dietary treatment and have a quality of life comparable to that of controls.
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Affiliation(s)
| | - Katri Kaukinen
- School of Medicine, University of Tampere, Tampere, Finland
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
- Department of Internal Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Kalle Kurppa
- Tampere Center for Child Health Research, University of Tampere and Tampere University Hospital, Tampere, Finland
| | - Markku Mäki
- Tampere Center for Child Health Research, University of Tampere and Tampere University Hospital, Tampere, Finland
| | - Pekka Collin
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland
| | - Timo Reunala
- School of Medicine, University of Tampere, Tampere, Finland
- Department of Dermatology, Tampere University Hospital, PO.Box 2000, 33521, Tampere, Finland
| | - Heini Huhtala
- Tampere School of Health Sciences, University of Tampere, Tampere, Finland
| | - Teea Salmi
- School of Medicine, University of Tampere, Tampere, Finland.
- Department of Dermatology, Tampere University Hospital, PO.Box 2000, 33521, Tampere, Finland.
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