The Value of Screening for Celiac Disease in Systemic Lupus Erythematosus: A Single Experience of a Tertiary Medical Center

Abstract

Introduction: Systemic lupus erythematosus (SLE) is a multi-organ inflammatory disease associated with autoimmune diseases. The aim of the study is to assessed the frequency of celiac disease (CD) in adults and children with SLE (aSLE and cSLE, respectively) and compare them with rheumatoid arthritis (RA) and juvenile idiopathic arthritis (JIA) patients; the study also explored the clinical impact of CD serologic markers on SLE disease activity and severity. Methods: This was a cross-sectional study. Patients with SLE who had regular follow-up in rheumatology clinics were evaluated for laboratory and clinical variables using serology and the SLE Disease Activity Index (SLEDAI). To assess the occurrence of CD serology in cSLE and aSLE and the clinical impact of CD serologic markers on SLE, patients were tested for antigliadin (AGA), anti-endomysium (EmA) and anti-tissue transglutaminase (tTG) antibodies. RA and JIA patients were included for comparison. Duodenal biopsy was conducted in patients who exhibited CD markers. Results: The CD marker was found in 29 (11.6%) of the 250 patients. AGA was present in seven aSLE patients and tTG in two (11.1%). Among cSLE patients, the autoantibody was present in 17.6% (AGA in four, tTG in two, and EmA in three). For RA patients, five had AGA and tTG and one had EmA, with an overall positivity of 9.7%. Five JIA patients had AGA (four with EmA and five with tTG) with overall positivity of 10.9%; the serum IgA level was normal in all patients except one. Duodenal endoscopic biopsy was performed in patients with positive CD markers (two declined). Histologic confirmation of CD was reported in one RA and one JIA patient but in none of the SLE patients. There was no correlation between the presence of CD markers and autoantibodies in SLE. Conclusion: CD antibodies did not influence SLE activity. Thus, SLE patients may not need to be screened for CD antibodies.

Celiac Disease in Juvenile Idiopathic Arthritis and Other Pediatric Rheumatic Disorders

“…Unfortunately, these three pediatric studies included small cohorts of patients, and the screening approach was quite variable. Overall, none showed a potential increase in CD prevalence in pSLE patients [26,55,56].…”

“…In order to investigate the epidemiological burden of CD in JIA patients, the literature search was performed using PubMed with the keywords (["children"] AND "Celiac Disease" AND "arthritis" OR "Juvenile Idiopathic Arthritis") restricted between 2000 and 2021 (31 December). Only the clinical studies describing cohorts (not case reports or series) of JIA patients screened for CD were included for data extraction, as summarized in Table 1 [15][16][17][18][19][20][21][22][23][24][25][26][27][28].…”

“…A third study (by Stoll et al) included a control group, but patients' number (JIA: n = 32; controls: n = 10) was among the smallest ones; here, no CD diagnoses were made in either group [18]. Among the remaining studies included in our selection, no one included a control group, and CD cases were identified in six studies, showing a CD prevalence ranging between 1.3% and 2.8% [19,23,[25][26][27]. All the other studies did not identify any CD patient; however, these were basically the least numerous studies [17,18,20,21], except the one published by Sahin et al (n = 96) [24].…”

“…In this review, we focused on the pediatric population and, thus, pSLE. Based upon literature research in PubMed database ("children" AND "Celiac Disease" OR "[Juvenile] systemic lupus erythematosus") starting from 2000 until 2021 (31 December), we could retrieve only a few clinical studies (excluding case reports) assessing the presence of CD in pSLE patients, as summarized in Table 2 [26,55,56].…”

Connection between Celiac Disease and Systemic Lupus Erythematosus in Children—A Development Model of Autoimmune Diseases Starting from What We Inherit to What We Eat

“…The present study still found that 9.6% of the subjects tested positive for anti-gliadin antibodies (either AGAG or AGAA), 3.5% for TGA and 2.6% for EMA. The negative impact of the lack of screening resides in the possibility of incorrect diagnosis and management, which can lead to unnecessary exposure to immunosuppressive drugs associated with side effects [11].…”