Celiac disease and antibodies associated with celiac disease in patients with inflammatory myopathy

Abstract

Celiac disease is usually associated with autoimmune disorders and has occasionally been reported in patients with inflammatory myopathies. Our aim was to determine the presence of celiac disease and antibodies associated with celiac disease in patients with inflammatory myopathies and to investigate their relationship. Serum antigliadin, anti–tissue transglutaminase, and antiendomysial antibodies were determined in 51 patients with inflammatory myopathies. HLA‐DQ2 and ‐DQ8 alleles were studied to assess their complementary diagnostic value. Jejunal biopsy was performed in patients with moderate to high levels of antigliadin antibodies. Patients with jejunal histology consistent with celiac disease initiated a gluten‐free diet. Seventeen patients (31%) were positive for antigliadin antibodies, which were significantly more frequent in patients with inclusion‐body myositis than dermatomyositis (P < 0.001). Positive status to HLA‐DQ2 and/or ‐DQ8 did not differ between antigliadin‐positive (75% and 12.5%) or ‐negative (60% and 15%) patients. Three of five jejunal biopsies were diagnostic for celiac disease with histological normalization after a gluten‐free diet. Thus, celiac disease is more prevalent in patients with inflammatory myopathies than in the general population. Positive status to HLA‐DQ2 allele, which is known to be more frequent in patients with inflammatory myopathies, could explain the high prevalence of antigliadin antibodies in this population. The diagnostic value of HLA‐DQ2 or ‐DQ8 haplotypes to detect celiac disease in patients with inflammatory myopathy is limited. Muscle Nerve, 2006

Increased prevalence of celiac disease in idiopathic inflammatory myopathies

“…Interestingly, three of 18 (17%) patients with IBM in our cohort had CD. Recent studies have also indicated a high prevalence of CD in IBM patients (Badrising et al., 2004; Selva‐O'Callaghan et al., 2007), and both diseases share an association with HLA B8‐DR3 (Badrising et al., 2004). A study specifically addressing systematic screening for CD in IBM may therefore be warranted.…”

“…In contrast to this, Selva‐O'Callaghan et al. (2007) reported biopsy‐confirmed CD in 3 of 17 IIM patients with IgA‐AGA, but none of these patients had raised titers of IgA‐EMA or IgA‐tTG. As possible explanations, the authors suggested that immunosuppressive treatment or the presence of a systemic inflammatory disease may suppress autoantibodies used for screening in this patient group.…”

“…The same group later reported five cases of CD in a cohort of 119 patients with IIM, and the need for serological CD screening in this patient group was discussed (Henriksson, Hallert, Norrby, & Walan, 1982). An association of CD with IIM has, however, only found some support in one systematic study (Selva‐O'Callaghan et al., 2007). …”

Celiac disease manifested by polyneuropathy and swollen ankles

“…The relationship between CD and different kinds of myopathies such as dermatomyositis, polymyositis and sporadic inclusion-body myositis, has also been reported [9][10][11] . The real cause of polyneuropathy as one of the extraintestinal CD signs is not known.…”

The Clinical and Pathological Spectrum of Idiopathic Inflammatory Myopathies : Implications for pathogenesis, classification and diagnosis

“…An increased prevalence of celiac disease in IIM has however only found support in one study, where screening for autoantibodies was followed by intestinal biopsy [144]. Three patients were diagnosed with celiac disease from a population of 51 IIM patients, and the authors concluded that celiac disease probably is more prevalent in IIM patients than in the general population [144].…”