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Celiac Disease Prevalence Is Increased in Primary Sjögren’s Syndrome and Diffuse Systemic Sclerosis: Lessons from a Large Multi-Center Study

Authors :
Elena Bartoloni
Onelia Bistoni
Alessia Alunno
Lorenzo Cavagna
Linda Nalotto
Chiara Baldini
Roberta Priori
Colomba Fischetti
Micaela Fredi
Luca Quartuccio
Francesco Carubbi
Carlomaurizio Montecucco
Andrea Doria
Marta Mosca
Guido Valesini
Franco Franceschini
Salvatore De Vita
Roberto Giacomelli
Giulia Mirabelli
Vittorio Bini
Armando Gabrielli
Carlo Catassi
Roberto Gerli
Source :
Journal of Clinical Medicine, Vol 8, Iss 4, p 540 (2019)
Publication Year :
2019
Publisher :
MDPI AG, 2019.

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.

Details

Language :
English
ISSN :
20770383
Volume :
8
Issue :
4
Database :
Directory of Open Access Journals
Journal :
Journal of Clinical Medicine
Publication Type :
Academic Journal
Accession number :
edsdoj.0c78ff5f3ea5445db9e84f3b79493950
Document Type :
article
Full Text :
https://doi.org/10.3390/jcm8040540