The prevalence of celiac disease appears to strongly increase in patients with primary Sjögren’s syndrome (pSS), as well as in patients with systemic sclerosis (SSc). Although no association between celiac disease and systemic autoimmune diseases has been documented, rheumatologists know very little about the immunopathogenic basis of that relationship. In the case of pSS, researchers have proposed that environmental factors promote abnormal immune responses, mononuclear cell infiltration and organ damage in the target tissues of the exocrine gland and the small bowel.
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Recent research reinforces the increase incidence of celiac disease in patients with pSS and diffuse SSc, suggesting celiac disease screening should be performed in patients with these autoimmune diseases. The findings by Elena Bartoloni, MD, associate professor of rheumatology at the University of Perugia, Italy, and colleagues indicates that such screening may be especially beneficial to young patients at the time of diagnosis of rheumatological diseases. The investigators published their research online April 19 in the Journal of Clinical Medicine.1
The study included a population of patients with systemic lupus erythematosus (SLE, n=580), pSS (n=354) and SSc (n=524), as well as healthy controls (n=14,298). In addition to looking for previous diagnoses of celiac disease, the investigators performed systematic screenings for undiagnosed celiac disease, identifying individuals who had high concentrations of IgA and anti-tTG (tissue transglutaminase).
The investigators found an overall celiac disease prevalence of 2.9% in the total systemic autoimmune disease patient group compared with 0.64% in the controls. The prevalence of celiac disease was 1.72% in SLE patients, 7.06% in pSS patients and 1.34% in SSc patients. Patients with diffuse cutaneous SSc had a prevalence of 4.5%, which led the researchers to conclude that the association of celiac disease with diffuse as opposed to limited SSc may indicate that the two subsets of SSc have different immunopathogenic mechanisms.
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