title: HLA DQ2 HAPLOTYPE, EARLY ONSET OF GRAVES DISEASE, AND POSITIVE FAMILY HISTORY OF AUTOIMMUNE DISORDERS ARE RISK FACTORS FOR DEVELOPING CELIAC DISEASE IN PATIENTS WITH GRAVES DISEASE.
abstract: OBJECTIVE
  The diagnosis of celiac disease (CD) in patients with different autoimmune diseases including Graves disease (GD) remains a challenge. The aims of our study were to: (1) assess the prevalence of CD in Polish patients with GD and (2) evaluate the prevalence of CD in the subgroups of patients with GD divided on the basis of clinical and human leukocyte antigen (HLA) typing criteria.
  
  
  METHODS
  The prospective study was conducted at an academic referral center. The study groups consisted of consecutive, euthyroid patients with GD (n = 232) and healthy volunteers without autoimmune thyroid diseases (n = 122). The diagnosis of CD was based on elevated immunoglobulin A autoantibodies to the enzyme tissue transglutaminase (IgA-TTG) and small intestine biopsy findings.
  
  
  RESULTS
  CD was diagnosed in 8 patients with GD (3.4%) and 1 healthy volunteer (0.8%). The development of CD in patients with GD was strongly associated with HLA-DQ2 haplotype (as predicted from linkage disequilibria, 14.6% vs. 1.5%, P = .009; odds ratio [OR] = 11.3; 95% confidence interval [CI] 1.3-252.7): 6 patients with CD carried HLA-DRB1(*)03, 1 carried an HLA-DRB1(*)04 allele, and 1 had an HLA-DRB1(*)07/(*)11 genotype. Multivariate analysis showed independent associations between CD and early GD onset (P = .014, OR = 9.6), autoimmunity in family (P = .029, OR = 6.3) and gastroenterologic symptoms (P = .031, OR = 8.1).
  
  
  CONCLUSIONS
  The results of our study suggest that serologic screening for CD may be considered in GD patients (1) with the HLA alleles typical for CD, (2) with an early onset of GD, or (3) a family history of autoimmunity. Moreover, the diagnosis of CD should be explored in euthyroid GD patients with nonspecific gastrointestinal symptoms.
authors.forename: Piotr
authors.initials: P
authors.lastname: Miskiewicz
authors.forename: Agata
authors.initials: A
authors.lastname: Gos-Zajac
authors.forename: Alina
authors.initials: A
authors.lastname: Kurylowicz
authors.forename: Teresa Maria
authors.initials: TM
authors.lastname: Plazinska
authors.forename: Maria
authors.initials: M
authors.lastname: Franaszczyk
authors.forename: Zbigniew
authors.initials: Z
authors.lastname: Bartoszewicz
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Kondracka
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Pirko-Kotela
authors.forename: Maciej
authors.initials: M
authors.lastname: Rupinski
authors.forename: Dorota
authors.initials: D
authors.lastname: Jarosz
authors.forename: Jaroslaw
authors.initials: J
authors.lastname: Regula
authors.forename: Rafal
authors.initials: R
authors.lastname: Ploski
authors.forename: Tomasz
authors.initials: T
authors.lastname: Bednarczuk
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001327:Autoimmune Diseases / Q000235:genetics*; D002446:Celiac Disease / Q000150:complications / Q000235:genetics*; D005260:Female; D020022:Genetic Predisposition to Disease; D006111:Graves Disease / Q000150:complications / Q000235:genetics*; D006683:HLA-DQ Antigens / Q000235:genetics*; D059811:HLA-DRB1 Chains; D006239:Haplotypes; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies
chemical_list: D006683:HLA-DQ Antigens; C053186:HLA-DQ2 antigen; D059811:HLA-DRB1 Chains