[Inflammatory rheumatism and celiac disease in adults. Coincidence or pathogenic relationship?].
Five adults had inflammatory rheumatic disorders 6 to 20 years before the diagnosis of coeliac disease. It is known that joint inflammation occurs in certain patients with adult coeliac sprue who develop either a specific inflammatory rheumatic disease or an atypical progressive polyarthropathy, sometimes as the first manifestation of the intestinal disorder. The diagnosis of adult coeliac sprue should be entertained in these cases even in absence of major digestive disorders or malabsorption. IgA anti-reticulin antibodies and atrophy of the duodenojejunal villosities are the best indicators for diagnosis. There are two important reasons for making the diagnosis of "asymptomatic adult coeliac sprue". First a gluten-free diet can improve or even cure the inflammatory joint disease, a rare situation which emphasizes the causal relationship between these two diseases. Second, the risk of developing lymphoma (especially in the small bowel) is apparently lower in patients on gluten-free diet. Pathogenesis is unclear. Frequently the two autoimmune disorders simply appear to coincide in the same patient; more rarely, arthritis is a symptom of coeliac disease. The immunological mechanisms probably begin when antigens cross an excessively permeable intestinal mucosa.
Carli
P
P
Service de Médecine interne, HIA Sainte Anne, Toulon.
Chagnon
A
A
Harlé
J R
JR
Paris
J F
JF
Marlier
S
S
Galzin
M
M
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002446:Celiac Disease / Q000150:complications* / Q000178:diet therapy; D005258:Felty Syndrome / Q000188:drug therapy / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012216:Rheumatic Diseases / Q000188:drug therapy / Q000209:etiology*; D012859:Sjogren's Syndrome / Q000188:drug therapy / Q000209:etiology*; D014580:Ursodeoxycholic Acid / Q000627:therapeutic use
D000305:Adrenal Cortex Hormones; D014580:Ursodeoxycholic Acid
Rhumatisme inflammatoire et maladie coeliaque de l'adulte. Coïncidence ou lien pathogénique?