title: High prevalence of gluten sensitivity in a cohort of patients with undifferentiated connective tissue disease.
abstract: OBJECTIVE
  The aim of this study was to investigate if co-morbid conditions as hepatitis C virus infection and celiac disease may be associated to undifferentiated connective tissue disease.
  
  
  METHODS
  We studied retrospectively and prospectively 52 patients with diagnosis of undifferentiated connective tissue disease, subdivided, according to Vaz criteria, in systemic lupus erythematosus, systemic sclerosis and Sjögren's syndrome-like subgroups. Serological markers of celiac disease as anti-gliadin, anti-endomysium and anti-tissue transglutaminase antibodies were investigated. An esophagogastroduodenoscopy with duodenal biopsy and histological examination was proposed to patients with positive celiac disease serology. In addition antibodies directed to hepatitis C virus and total IgA-antibodies were investigated.
  
  
  RESULTS
  Six patients (11,5%) were positive for celiac disease serological tests although two of them were asymptomatic. Four patients underwent an esophagogastroduodenoscopy, showing total or subtotal villous atrophy at duodenal biopsies. Hepatitis C virus serology was negative in all patients and none had IgA deficiency. 83% of celiac patients showed a scleroderma-like phenotype. We observed a statistically higher incidence of autoimmune symptoms in patients with gluten sensitivity. Fatigue and myalgia regressed early after the beginning of gluten-free diet.
  
  
  CONCLUSIONS
  In our cohort of patients the prevalence of celiac disease was higher than that reported in the general population. We believe that all patients with diagnosis of undifferentiated connective tissue disease, especially those with a systemic sclerosis-like presentation, should be investigated for celiac disease, even in absence of gastrointestinal symptoms. Gluten-free diet should be early recommended to all patients having undifferentiated connective tissue disease and gluten sensitivity.
authors.affiliation: Department of Clinical Immunology, Sapienza University of Rome, Rome, Italy.
authors.forename: V
authors.initials: V
authors.lastname: Conti
authors.affiliation: Department of Clinical Immunology, Sapienza University of Rome, Rome, Italy.
authors.forename: M C
authors.initials: MC
authors.lastname: Leone
authors.affiliation: Department of Clinical Immunology, Sapienza University of Rome, Rome, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Casato
authors.affiliation: Department of Clinical Immunology, Sapienza University of Rome, Rome, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Nicoli
authors.affiliation: Department of Clinical Immunology, Sapienza University of Rome, Rome, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Granata
authors.affiliation: Department of Internal Medicine and Clinical Immunology, Sapienza University of Rome, Viale dell'Università 37, 00185 Rome, Italy, Phone: +39 06 499 72 090 Fax: +39 06 444 08 06 E-mail: maurizio.carlesimo@uniroma1.it.
authors.forename: M
authors.initials: M
authors.lastname: Carlesimo
mesh_terms: D000328:Adult; D000368:Aged; D001323:Autoantibodies / Q000097:blood; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D002446:Celiac Disease / Q000097:blood / Q000175:diagnosis / Q000178:diet therapy / Q000453:epidemiology* / Q000276:immunology; D015897:Comorbidity; D003240:Connective Tissue Diseases / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology* / Q000276:immunology; D055050:Diet, Gluten-Free; D004386:Duodenum / Q000473:pathology; D016099:Endoscopy, Gastrointestinal; D005260:Female; D006526:Hepatitis C / Q000453:epidemiology; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015995:Prevalence; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D012384:Rome / Q000453:epidemiology; D012595:Scleroderma, Systemic / Q000453:epidemiology; D012698:Serologic Tests; D012859:Sjogren's Syndrome / Q000453:epidemiology; D055815:Young Adult
chemical_list: D001323:Autoantibodies; D015415:Biomarkers
keywords: Undifferentiated connective tissue disease (UCTD); anti-nuclear antibody (ANA); celiac disease (CD); gluten sensitivity; hepatitis C virus (HCV) infection