title: Celiac disease arthropathy and autoimmunity study.
abstract: OBJECTIVE
  To evaluate presence of sero-negative spondyloarthritis (SpA) in celiac disease (CD) patients, and whether compliance with a gluten free diet (GFD) improved arthritis manifestations in these patients.
  
  
  METHODS
  We undertook a prospective, questionnaire based, cross-sectional cohort study to evaluate the presence or absence of SpA simultaneously in both CD and non-CD cohorts.
  
  
  RESULTS
  356/590 (60.3%) patients with CD participated in this study. 99% had diagnosis confirmed by a diagnostic test (79% small bowel biopsy, 19.8% blood test, 3.9% stool test). Approximately 131 (37%) cases of arthritis were reported in CD patients. Of the 6/356 CD patients with seronegative spondyloarthritides, four had sacroiliitis, two ankylosing spondylitis, and one psoriatic arthritis, compared to one ankylosing spondylitis and five psoriatic arthritis in non-CD. Osteoarthritis (89 vs 59, P = 0.93) was the most common diagnosis reported by respondents. More CD patients with diarrhea (94%) and anemia (81%) improved on GFD, compared to arthritis symptoms (30%). Autoimmune thyroiditis (10.6% vs 0.4%), insulin dependent diabetes mellitus (IDDM) (2.2% vs 1.7%), systemic Lupus erythematosus (SLE) (1.1% vs 0), and psoriasis (12.9% vs 5.5%) occurred more frequently in CD patients. The prevalence of Crohn's disease, ulcerative colitis, Sjogren's syndrome, primary biliary cirrhosis, and primary sclerosing cholangitis was around 1% each. Univariate Logistic regression analysis showed ≤ high school education (odds ratio [OR] 2.01, P < 0.003), age ≥ 60 years (OR 4.13, P < 0.001), and osteoporosis (OR 2.78, P < 0.001) to be significantly associated with report of arthritis in CD patients.
  
  
  CONCLUSIONS
  We did not find a high rate of SpA in CD patients. In contrast, increased rates of autoimmune thyroiditis, SLE, IDDM, and psoriasis were seen in CD.
authors.affiliation: Department of Medicine, Division of Rheumatology, The Ottawa Hospital, Sudbury, Canada. iqbal.tariq@gmail.com
authors.forename: Tariq
authors.initials: T
authors.lastname: Iqbal
authors.forename: Mukarram A
authors.initials: MA
authors.lastname: Zaidi
authors.forename: George A
authors.initials: GA
authors.lastname: Wells
authors.forename: Jacob
authors.initials: J
authors.lastname: Karsh
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000150:complications / Q000178:diet therapy; D002170:Canada / Q000453:epidemiology; D002446:Celiac Disease / Q000150:complications / Q000178:diet therapy* / Q000453:epidemiology*; D002648:Child; D003093:Colitis, Ulcerative / Q000453:epidemiology; D003424:Crohn Disease / Q000453:epidemiology; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000453:epidemiology; D003967:Diarrhea / Q000150:complications / Q000178:diet therapy; D055050:Diet, Gluten-Free; D004522:Educational Status; D005260:Female; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000453:epidemiology; D010349:Patient Compliance; D015995:Prevalence; D011446:Prospective Studies; D012720:Severity of Illness Index; D012859:Sjogren's Syndrome / Q000453:epidemiology; D025241:Spondylarthritis / Q000178:diet therapy / Q000453:epidemiology* / Q000276:immunology; D011795:Surveys and Questionnaires; D013967:Thyroiditis, Autoimmune / Q000453:epidemiology; D055815:Young Adult