PRACA ORYGINALNA
Celiac disease in patients with systemic lupus erythematosus
1
Rheumatology Research Center, Tehran University of Medical Sciences, Iran
2
Department of Gastroenterology and Liver Diseases, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Iran
Data nadesłania: 29-10-2020
Data ostatniej rewizji: 04-02-2021
Data akceptacji: 25-03-2021
Data publikacji online: 27-04-2021
Data publikacji: 28-04-2021
Reumatologia 2021;59(2):85-89
SŁOWA KLUCZOWE
DZIEDZINY
SLE, zespół Sjögrena i zespół antyfosfolipidowy - etiologia, patogeneza, obraz kliniczny i leczenieEpidemiologia
STRESZCZENIE
Introduction:
Celiac disease (CD) is one of the most common chronic diseases. Celiac disease has been associated with several autoimmune disorders, but the association with systemic lupus erythematosus (SLE) as a systemic autoimmune disease is still controversial. In this study, we aimed to determine the prevalence of biopsy-proven CD in patients with SLE, and to determine the clinical symptoms and laboratory data in these patients.
Material and methods:
In a cross-sectional study, SLE patients at a referral clinic were evaluated for gastrointestinal symptoms between March and December 2016. Patients were evaluated by a gastroenterologist, and upper gastrointestinal endoscopy with intestinal biopsy was performed if deemed necessary. The clinical symptoms, laboratory data, and endoscopy results were recorded and compared between groups.
Results:
In total, 130 patients were evaluated in this study. Gastrointestinal symptoms were present in 40% of the patients. Endoscopy was performed in all SLE patients with gastrointestinal symptoms. Four patients (3%) were diagnosed as having CD based on biopsy results and response to a gluten-free diet. Anti-endomysium antibody (AEA) was found to be 100% sensitive and 99.2% specific for the diagnosis of CD in SLE patients, and anti-gliadin antibody (AGA) had a 50% sensitivity and 98% specificity. Patients with comorbid CD and SLE were significantly more likely to have diarrhea, abdominal pain, nausea/vomiting, recurrent oral aphthosis, and anemia.
Conclusions:
The results of this study suggest that a significant association is present between CD and SLE. We found a prevalence of 3% for biopsy-proven CD in patients with SLE, which is five times the prevalence of CD in the general population.
Celiac disease (CD) is one of the most common chronic diseases. Celiac disease has been associated with several autoimmune disorders, but the association with systemic lupus erythematosus (SLE) as a systemic autoimmune disease is still controversial. In this study, we aimed to determine the prevalence of biopsy-proven CD in patients with SLE, and to determine the clinical symptoms and laboratory data in these patients.
Material and methods:
In a cross-sectional study, SLE patients at a referral clinic were evaluated for gastrointestinal symptoms between March and December 2016. Patients were evaluated by a gastroenterologist, and upper gastrointestinal endoscopy with intestinal biopsy was performed if deemed necessary. The clinical symptoms, laboratory data, and endoscopy results were recorded and compared between groups.
Results:
In total, 130 patients were evaluated in this study. Gastrointestinal symptoms were present in 40% of the patients. Endoscopy was performed in all SLE patients with gastrointestinal symptoms. Four patients (3%) were diagnosed as having CD based on biopsy results and response to a gluten-free diet. Anti-endomysium antibody (AEA) was found to be 100% sensitive and 99.2% specific for the diagnosis of CD in SLE patients, and anti-gliadin antibody (AGA) had a 50% sensitivity and 98% specificity. Patients with comorbid CD and SLE were significantly more likely to have diarrhea, abdominal pain, nausea/vomiting, recurrent oral aphthosis, and anemia.
Conclusions:
The results of this study suggest that a significant association is present between CD and SLE. We found a prevalence of 3% for biopsy-proven CD in patients with SLE, which is five times the prevalence of CD in the general population.
REFERENCJE (29)
1.
Alves SC, Fasano S, Isenberg DA. Autoimmune gastrointestinal complications in patients with systemic lupus erythematosus: case series and literature review. Lupus 2016; 25: 1509–1519, DOI: 10.1177/0961203316655210.
2.
Fava A, Petri M. Systemic lupus erythematosus: diagnosis and clinical management. J Autoimmun 2019; 96: 1–13, DOI: 10.1016/j.jaut.2018.11.001.
3.
Fawzy M, Edrees A, Okasha H, et al. Gastrointestinal manifestations in systemic lupus erythematosus. Lupus 2016; 25: 1456–1462, DOI: 10.1177/0961203316642308.
4.
Brewer BN, Kamen DL. Gastrointestinal and hepatic disease in systemic lupus erythematosus. Rheum Dis Clin North Am 2018; 44: 165–175, DOI: 10.1016/j.rdc.2017.09.011.
5.
Ebert EC, Hagspiel KD. Gastrointestinal and hepatic manifestations of systemic lupus erythematosus. J Clin Gastroenterol 2011; 45: 436–441, DOI: 10.1097/MCG.0b013e31820f81b8.
6.
Kröner PT, Tolaymat OA, Bowman AW, et al. Gastrointestinal manifestations of rheumatological diseases. Am J Gastroenterol 2019; 114: 1441–1454, DOI: 10.14309/ajg.0000000000000260.
7.
Li Z, Xu D, Wang Z, et al. Gastrointestinal system involvement in systemic lupus erythematosus. Lupus 2017; 26: 1127–1138, DOI: 10.1177/0961203317707825.
8.
Metry AM, Al Salmi I, Al Balushi F, et al. Systemic lupus erythematosus: symptoms and signs at initial presentations. Antiinflamm Antiallergy Agents Med Chem 2019; 18: 142–150, DOI: 10.2174/1871523018666181128161828.
9.
Denham JM, Hill ID. Celiac disease and autoimmunity: review and controversies. Curr Allergy Asthma Rep 2013; 13: 347–353, DOI: 10.1007/s11882-013-0352-1.
10.
Shahbazkhani B, Faezi T, Akbari M, et al. Coeliac disease in Iranian type I diabetic patients. Dig Liver Dis 2004; 36: 191–194, DOI: 10.1016/j.dld.2003.10.015.
11.
Elfström P, Montgomery SM, Kämpe O, et al. Risk of primary adrenal insufficiency in patients with celiac disease. J Clin Endocrinol Metab 2007; 92: 3595–3598, DOI: 10.1210/jc.2007-0960.
12.
Luft LM, Barr SG, Martin LO, et al. Autoantibodies to tissue transglutaminase in Sjögren’s syndrome and related rheumatic diseases. J Rheumatol 2003; 30: 2613–2619.
13.
Komatireddy GR, Marshall JB, Aqel R, et al. Association of systemic lupus erythematosus and gluten enteropathy. South Med J 1995; 88: 673–676, DOI: 10.1097/00007611-199506000-00018.
14.
Mukamel M, Rosenbach Y, Zahavi I, et al. Celiac disease associated with systemic lupus erythematosus. Isr J Med Sci 1994; 30: 656–658.
15.
Peńa AS. Systemic lupus erythematosus, Sjögren’s syndrome, and purpura in a patient with coeliac disease. Neth J Med 1987; 31: 305.
16.
Rustgi AK, Peppercorn MA. Gluten-sensitive enteropathy and systemic lupus erythematosus. Arch Intern Med 1988; 148: 1583–1584.
17.
Rensch MJ, Szyjkowski R, Shaffer RT, et al. The prevalence of celiac disease autoantibodies in patients with systemic lupus erythematosus. Am J Gastroenterol 2001; 96: 1113–1115, DOI: 10.1111/j.1572-0241.2001.03753.x.
18.
Yu C, Gershwin ME, Chang C. Diagnostic criteria for systemic lupus erythematosus: a critical review. J Autoimmun 2014; 48: 10–13, DOI: 10.1016/j.jaut.2014.01.004.
19.
Marsh MN. Gluten, major histocompatibility complex, and the small intestine: a molecular and immunobiologic approach to the spectrum of gluten sensitivity (“celiac sprue”). Gastroenterology 1992; 102: 330–354.
20.
Gladman DD, Ibańez D, Urowitz MB. Systemic Lupus Erythematosus Disease Activity Index 2000. J Rheumatol 2002; 29: 288–291.
21.
Shahbazkhani B, Malekzadeh R, Sotoudeh M, et al. High prevalence of coeliac disease in apparently healthy Iranian blood donors. Eur J Gastroenterol Hepatol 2003; 15: 475–478, DOI: 10.1097/01.meg.0000059118.41030.96.
22.
Marai I, Shoenfeld Y, Bizzaro N, et al. IgA and IgG tissue transglutaminase antibodies in systemic lupus erythematosus. Lupus 2004; 13: 241–244, DOI: 10.1191/0961203304lu1004oa.
23.
Dahan S, Shor DB, Comaneshter D, et al. All disease begins in the gut: celiac disease co-existence with SLE. Autoimmun Rev 2016; 15: 848–853, DOI: 10.1016/j.autrev.2016.06.003.
24.
Freeman HJ. Adult celiac disease followed by onset of systemic lupus erythematosus. J Clin Gastroenterol 2008; 42: 252–255, DOI: 10.1097/MCG.0b013e31802e70a1.
25.
Ludvigsson JF, Rubio-Tapia A, Chowdhary V, et al. Increased risk of systemic lupus erythematosus in 29,000 patients with biopsy-verified celiac disease. J Rheumatol 2012; 39: 1964–1970, DOI: 10.3899/jrheum.120493.
26.
Alarcón-Segovia D. Shared autoimmunity: the time has come. Curr Rheumatol Rep 2004; 6: 171–174, DOI: 10.1007/s11926-004-0063-7.
27.
Aune TM, Maas K, Parker J, et al. Profiles of gene expression in human autoimmune disease. Cell Biochem Biophys 2004; 40: 81–96, DOI: 10.1385/CBB:40:2:081.
28.
Diez-Sampedro A, Olenick M, Maltseva T, Flowers M. A gluten- free diet, not an appropriate choice without a medical diagnosis. J Nutr Metab 2019; 2019: 2438934, DOI: 10.1155/2019/2438934.
29.
Saturni L, Ferretti G, Bacchetti T. The gluten-free diet: safety and nutritional quality. Nutrients 2010; 2: 16–34, DOI: 10.3390/nu20100016.
Copyright: © Narodowy Instytut Geriatrii, Reumatologii i Rehabilitacji w Warszawie. This is an Open Access journal, all articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0) License (https://creativecommons.org/licenses/by-nc-sa/4.0/), allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited and states its license.
Udostępnij
ARTYKUŁ POWIĄZANY
| eISSN: | 2084-9834 |
| ISSN: | 0034-6233 |
Przetwarzamy dane osobowe zbierane podczas odwiedzania serwisu. Realizacja funkcji pozyskiwania informacji o użytkownikach i ich zachowaniu odbywa się poprzez dobrowolnie wprowadzone w formularzach informacje oraz zapisywanie w urządzeniach końcowych plików cookies (tzw. ciasteczka). Dane, w tym pliki cookies, wykorzystywane są w celu realizacji usług, zapewnienia wygodnego korzystania ze strony oraz w celu monitorowania ruchu zgodnie z Polityką prywatności. Dane są także zbierane i przetwarzane przez narzędzie Google Analytics (więcej).
Możesz zmienić ustawienia cookies w swojej przeglądarce. Ograniczenie stosowania plików cookies w konfiguracji przeglądarki może wpłynąć na niektóre funkcjonalności dostępne na stronie.
Możesz zmienić ustawienia cookies w swojej przeglądarce. Ograniczenie stosowania plików cookies w konfiguracji przeglądarki może wpłynąć na niektóre funkcjonalności dostępne na stronie.
