Koehne Victor de Barros, Bahia Magda, Lanna Cristina Costa Duarte, Pinto Maria Raquel da Costa, Bambirra Eduardo Alves, Cunha Aloísio Sales da
Department of Internal Medicine, Medical School of the Federal University of Minas Gerais, Belo Horizonte, MG, Brazil.
Arq Gastroenterol. 2010 Jul-Sep;47(3):250-6. doi: 10.1590/s0004-28032010000300008.
Patients with autoimmune rheumatologic conditions and celiac disease tend to have a variety of autoantibodies, many of which have no clear pathogenic role. The literature contains frequent reports of celiac disease being more prevalent in patients with rheumatologic diseases, although this remains controversial.
To investigate the prevalence of positive serum tests for celiac disease, particularly IgA and IgG antigliadin (AGA) antibodies and IgA antiendomysium antibodies (EmA) in patients with autoimmune rheumatologic diseases. A second aim was to correlate positive serum tests with prednisone and immunosuppressant medication.
A total of 190 adults and pediatric patients with a variety of autoimmune rheumatologic diseases (systemic lupus erythematosus, rheumatoid arthritis, juvenile rheumatoid arthritis and spondyloarthrophathies) were evaluated and tested for IgA and IgG antigliadin-antibodies and IgA antiendomysium antibodies. Patients with positive serum tests underwent endoscopic duodenal biopsies for pathology studies.
There were four positive sera (2.1%) for AGA IgA, all of which tested negative for AGA IgG and EmA. Three sera (1.6%) tested positive for AGA IgG; all were negative for AGA IgA and EmA. The EmA test at a 1:2.5 serum dilution tested positive in 94 patients (49.5%); at a 1:5 serum dilution it was positive in 41 patients (21.6%). Eleven subjects tested positive for EmA at 1:40 dilution; and all of these tested negative for IgA tissue antitransglutaminase (tTG) antibodies. Nine of the 11 EmA-positive patients and all 7 patients with positive antigliadin antibodies tests underwent duodenal endoscopic biopsies, and no significant changes were demonstrated in their duodenal mucosa. A positive EmA was associated with elevated optical density AGA IgA readings; however, there was no relationship between positive EmA and AGA IgG optical density readings. Prednisone and immunosuppressant use were unrelated to AGA IgA optical density readings or AGA IgG readings. These drugs were associated with fewer positive EmA tests.
Positive AGAA, AGAG or EmA results are probably nonspecific for the presence of celiac disease among autoimmune rheumatologic disease patients. The intake of prednisone and immunosuprressant drugs seems to reduce the prevalence of IgA EmA, but it does not interfere with antigliadin antibodies tests.Further studies are required to estimate more accurately the prevalence of this disease in rheumatologic patients.
自身免疫性风湿性疾病和乳糜泻患者往往有多种自身抗体，其中许多抗体并无明确的致病作用。文献中经常报道乳糜泻在风湿性疾病患者中更为常见，尽管这一点仍存在争议。
调查自身免疫性风湿性疾病患者中乳糜泻血清学检测阳性的患病率，特别是IgA和IgG抗麦胶蛋白（AGA）抗体以及IgA抗肌内膜抗体（EmA）。第二个目的是将血清学检测阳性结果与泼尼松和免疫抑制剂的使用情况相关联。
对190例患有各种自身免疫性风湿性疾病（系统性红斑狼疮、类风湿关节炎、幼年类风湿关节炎和脊柱关节病）的成人及儿童患者进行评估，并检测其IgA和IgG抗麦胶蛋白抗体以及IgA抗肌内膜抗体。血清学检测阳性的患者接受十二指肠内镜活检以进行病理研究。
AGA IgA有4份血清阳性（2.1%），所有这些血清的AGA IgG和EmA检测均为阴性。AGA IgG有3份血清阳性（1.6%）；所有这些血清的AGA IgA和EmA检测均为阴性。在血清稀释度为1:2.5时，EmA检测有94例患者阳性（49.5%）；在血清稀释度为1:5时，有41例患者阳性（21.6%）。在1:40稀释度下，有11名受试者EmA检测阳性；所有这些受试者的IgA组织型转谷氨酰胺酶（tTG）抗体检测均为阴性。11例EmA阳性患者中的9例以及所有7例抗麦胶蛋白抗体检测阳性的患者接受了十二指肠内镜活检，其十二指肠黏膜未显示出明显变化。EmA阳性与AGA IgA光密度读数升高相关；然而，EmA阳性与AGA IgG光密度读数之间无关联。泼尼松和免疫抑制剂的使用与AGA IgA光密度读数或AGA IgG读数无关。这些药物与EmA检测阳性较少相关。
在自身免疫性风湿性疾病患者中，AGA IgA、AGA IgG或EmA检测结果阳性可能并非乳糜泻存在的特异性表现。泼尼松和免疫抑制剂的摄入似乎降低了IgA EmA的患病率，但不影响抗麦胶蛋白抗体检测。需要进一步研究以更准确地估计风湿性疾病患者中这种疾病的患病率。
