Adult celiac disease followed by onset of systemic lupus erythematosus.
BACKGROUND
Celiac disease has been associated with autoimmune disease (eg, autoimmune thyroiditis) and the appearance of different autoantibodies (eg, antidouble-stranded DNA). Conversely, tissue transglutaminase antibodies have been detected in autoimmune disorders, including systemic lupus erythematosus (SLE), but cases of celiac disease with SLE have been only rarely recorded.


METHODS
In this study, 246 patients with biopsy-defined celiac disease were evaluated for a prior diagnosis of SLE on the basis of American Rheumatological Association-defined clinical and serologic parameters.


RESULTS
There were 6 patients with celiac disease and SLE, or 2.4%, including 4 females and 2 males. Their mean age at diagnosis of celiac disease was 44.7 years and SLE 50 years. In all patients, the diagnosis of SLE was established from 2 years to more than 10 years after the diagnosis of celiac disease, with a mean of 5.3 years. The celiac disease in all 6 patients responded to a gluten-free diet with histologic normalization of the small intestinal biopsies. Despite this small bowel biopsy response, SLE appeared later in the clinical course of the celiac disease.


CONCLUSIONS
This study suggests that SLE occurs far more frequently in biopsy-defined celiac disease than is currently appreciated, and detection may be more likely if the period of clinical follow-up of the celiac disease is prolonged.
Freeman
Hugh J
HJ
Department of Medicine (Gastroenterology), University of British Columbia, Vancouver, BC. hugfree@shaw.ca
D000328:Adult; D017677:Age Distribution; D000368:Aged; D000974:Antibodies, Antinuclear / Q000032:analysis; D001706:Biopsy; D001955:British Columbia / Q000453:epidemiology; D002446:Celiac Disease / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology; D018753:Diet, Protein-Restricted; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007421:Intestine, Small / Q000473:pathology; D008180:Lupus Erythematosus, Systemic / Q000150:complications* / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D017678:Sex Distribution
D000974:Antibodies, Antinuclear