Chronic autoimmune disorders are increased in coeliac disease

Abstract

Coeliac disease (CD) is an autoimmune disorder of the small bowel associated with increased risk of additional autoimmune diseases (ADs).To investigate the prevalence of ADs in a population of adult coeliac patients.This was a retrospective case–control study. Data from coeliac patients and controls referred to a tertiary center between 2013 and 2016 were collected. The frequency of ADs and the unadjusted and adjusted odds ratios (ORs) for age, gender, disease duration, and body mass index with their 95% confidence intervals (CIs) were evaluated.Two hundred fifty-five patients with CD (median age 37.1 years; 206 women) were matched with 250 controls. ADs were more frequent (35.3%) in coeliac patients than in controls (15.2%). Adjusted ORs for the presence of only 1, at least 1, and more than 1 AD were 3.13 (95% CI 1.81–5.42, P < .0001), 3.31 (95% CI 2.00–5.46, P < .0001), and 3.93 (95% CI 1.49–10.36, P = .006), respectively. Hashimoto thyroiditis was the most prevalent AD (24.3% vs. 10%) OR = 2.55 (95% CI 1.39–4.70, P < .0001), followed by psoriasis (4.3% vs. 1.6%), type 1 diabetes (2.7% vs. 0.4%), and Sjögren syndrome (2.4% vs. 0.4%).These findings suggest a need for a careful surveillance of autoimmune status, especially for Hashimoto thyroiditis in patients with celiac disease.

Identifying True Celiac Disease and Wheat Allergy in the Era of Fashion Driven Gluten-Free Diets

“…Despite the lack of a statistically significant association, this result supports the well-known association of CD with autoimmune thyroiditis [16, 17, 20]. …”

“…Using data of patients assessed for tTGIgA or WIgE likely allows to identify most patients who present with symptoms or morbidities (i.e., anemia, osteoporosis) possibly associated with gluten ingestion. Moreover, because CD has been associated with several autoimmune conditions, in particular type 1 diabetes [11], thyroiditis [16, 17], hepatitis [11, 18], primary biliary cholangitis [11, 19], gastritis [11], Sjögren’s syndrome [20], and also IgA deficiency [17, 21], assessing the presence of other auto-antibodies and IgA levels is sometimes performed during work-up of suspected CD, despite the lack of specific recommendations [22]. Eventually, in the presence of IgA ­deficiency, the assessment of anti-deamidated Gliadin Peptide IgG (DGPIgG) antibodies has been recently reported to be helpful [23].…”

Rheumatologic manifestations in celiac disease: what should we remember?

“…The relative risk of associating one or more autoimmune pathologies is approximately three times higher in CD patients when compared to general population [14] and 30% of the CD patients have also another immune pathology [15]. Together with the musculoskeletal involvement, the female gender, DGP positivity, vitamin D deficiency and antinuclear antibody positivity were associated with polyautoimmunity in CD patients [15].…”

“…The following mechanisms might explain the increased autoimmunity expression in CD: similar genetic features, common triggers, or the disturbed intestinal permeability [16]. In this regard, the association of type I diabetes, autoimmune thyroiditis, and Sjögren's syndrome was established [1,14]. There are also other autoimmune diseases like primary biliary cirrhosis, Addison's disease, juvenile idiopathic arthritis [1], or psoriasis [14] for which there are some arguments for an association with CD.…”

When type 1 diabetes meets celiac disease

“…In contrast to T1D, dietary restriction prevents disease manifestation. Additional autoimmune disease occurs in 35% of patients with CD, one of them is T1D . Key genetic risk factors in CD are DQ2 ( DQA1*05:01‐DQB1 * 02:01 ) and DQ8 ( DQA1*03:01‐DQB1 * 03:02 ) due to their physiochemical properties and binding of gliadin‐derived peptides deamidated by tissue transglutaminase 2 (tTG2).…”