All disease begins in the gut: Celiac disease co-existence with SLE.
BACKGROUND
Case reports and case series have indicated a possible association between celiac disease (CD) and systemic lupus erythematosus (SLE), but additional population-based studies are required. The true prevalence of CD in SLE patients is still unknown, but is indeed an important factor when considering the clinical implications, notably the necessity of screening strategies in SLE patients. Our objective was to investigate the association between CD and SLE using a community-based approach in a real-life population database.


METHODS
Patients with SLE were compared with age- and sex-matched controls regarding the prevalence of CD in a case-control study. Chi-square and t-tests were used for univariate analysis and a logistic regression model was used for multivariate analysis. The study was performed utilizing the medical database of Clalit Health Services.


RESULTS
The study included 5018 patients with SLE and 25,090 age- and sex-matched controls. The prevalence of CD was significantly higher in patients with SLE than in controls in univariate analysis (0.8% and 0.2%, respectively, p<0.001). Also, SLE was associated with CD (OR 3.92, 95% CI 2.55-6.03, p<0.001) in a multivariate logistic regression model.


CONCLUSIONS
Patients with SLE had a greater prevalence of CD than matched controls in a large case-control study. A complex combination of genetic, immunological and novel environmental factors may explain this positive association. Physicians should keep in mind that CD can be a tricky diagnosis in SLE patients, yet a treatable condition, probably more common in this population than we used to think.
Department of Medicine 'B', Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Israel.
Shani
S
Dahan
Department of Medicine 'B', Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Israel; Department of Gastroenterology, Sheba Medical Center affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Israel.
Dana Ben-Ami
DB
Shor
Chief Physician's Office, Clalit Health Services, Tel Aviv, Israel.
Doron
D
Comaneshter
Chaim Sheba General Hospital, Sheba Medical Center, Tel-Hashomer, Israel.
Dorit
D
Tekes-Manova
Department of Medicine 'B', Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Israel.
Ora
O
Shovman
Department of Medicine 'B', Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Israel. Electronic address: howard.amital@sheba.health.gov.il.
Howard
H
Amital
Chief Physician's Office, Clalit Health Services, Tel Aviv, Israel; Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel.
Arnon D
AD
Cohen
D000328:Adult; D016022:Case-Control Studies; D002446:Celiac Disease / Q000453:epidemiology* / Q000209:etiology* / Q000235:genetics / Q000276:immunology; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007557:Israel / Q000453:epidemiology; D008180:Lupus Erythematosus, Systemic / Q000150:complications* / Q000453:epidemiology* / Q000235:genetics / Q000276:immunology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015995:Prevalence; D014808:Vitamin D Deficiency / Q000453:epidemiology; D055815:Young Adult
Autoantibodies; Autoimmunity; Celiac disease (CD); Comorbidity; Systemic lupus erythematosus (SLE)