Bartoloni Elena, Bistoni Onelia, Alunno Alessia, Cavagna Lorenzo, Nalotto Linda, Baldini Chiara, Priori Roberta, Fischetti Colomba, Fredi Micaela, Quartuccio Luca, Carubbi Francesco, Montecucco Carlomaurizio, Doria Andrea, Mosca Marta, Valesini Guido, Franceschini Franco, De Vita Salvatore, Giacomelli Roberto, Mirabelli Giulia, Bini Vittorio, Gabrielli Armando, Catassi Carlo, Gerli Roberto
Rheumatology Unit, Department of Medicine, University of Perugia, 06128 Perugia, Italy .
Department of Rheumatology, University and IRCCS Foundation Policlinico S. Matteo, 27100 Pavia, Italy.
J Clin Med. 2019 Apr 19;8(4):540. doi: 10.3390/jcm8040540.
Association of celiac disease (CD) with systemic autoimmune diseases (ADs) remains controversial. Awareness of CD in these patients is important to prevent complications, including lymphoproliferative disorders. We evaluated previously diagnosed CD prevalence in systemic lupus erythematosus (SLE), primary Sjögren's syndrome (pSS) and systemic sclerosis (SSc) patients in comparison to 14,298 matched controls. All patients were screened for subclinical CD. Data from 1458 unselected consecutive SLE (580), pSS (354) and SSc (524) patients were collected. Previously biopsy-proven CD diagnosis and both CD- and AD-specific features were registered. All patients without previous CD were tested for IgA transglutaminase (TG). Anti-endomysium were tested in positive/borderline IgA TG. Duodenal biopsy was performed in IgA TG/endomysium+ to confirm CD. CD prevalence in AD was compared to that observed in 14,298 unselected sex- and age-matched adults who acted as controls. CD was more prevalent in pSS vs controls (6.78% vs 0.64%, < 0.0001). A trend towards higher prevalence was observed in SLE (1.38%, = 0.058) and SSc (1.34%, = 0.096). Higher CD prevalence was observed in diffuse cutaneous SSc (4.5%, ≤ 0.002 vs controls). Subclinical CD was found in two SLE patients and one pSS patient. CD diagnosis usually preceded that of AD. Primary SS and SSc-CD patients were younger at AD diagnosis in comparison to non-celiac patients. Autoimmune thyroiditis was associated with pSS and CD. CD prevalence is clearly increased in pSS and diffuse SSc in comparison to the general population. The association of CD with diffuse but not limited SSc may suggest different immunopathogenic mechanisms characterizing the two subsets. CD screening may be considered in pSS and diffuse SSc in young patients, particularly at the time of diagnosis.
乳糜泻（CD）与系统性自身免疫性疾病（ADs）之间的关联仍存在争议。了解这些患者中的CD对于预防并发症（包括淋巴增殖性疾病）很重要。我们评估了系统性红斑狼疮（SLE）、原发性干燥综合征（pSS）和系统性硬化症（SSc）患者中先前诊断出的CD患病率，并与14298名匹配的对照进行比较。所有患者均接受亚临床CD筛查。收集了1458例未经选择的连续SLE（580例）、pSS（354例）和SSc（524例）患者的数据。记录先前经活检证实的CD诊断以及CD和AD的特异性特征。所有既往无CD的患者均检测了IgA转谷氨酰胺酶（TG）。对IgA TG呈阳性/临界值的患者检测抗肌内膜抗体。对IgA TG/抗肌内膜抗体阳性的患者进行十二指肠活检以确诊CD。将AD患者中的CD患病率与14298名未经选择的年龄和性别匹配的成年人（作为对照）中观察到的患病率进行比较。与对照组相比，pSS患者中CD更为常见（6.78%对0.64%，<0.0001）。在SLE（1.38%，P = 0.058）和SSc（1.34%，P = 0.096）中观察到患病率有升高趋势。在弥漫性皮肤型SSc中观察到更高的CD患病率（4.5%，与对照组相比P≤0.002）。在两名SLE患者和一名pSS患者中发现了亚临床CD。CD诊断通常先于AD诊断。与非乳糜泻患者相比，原发性SS和SSc-CD患者在AD诊断时年龄更小。自身免疫性甲状腺炎与pSS和CD相关。与普通人群相比，pSS和弥漫性SSc中CD患病率明显升高。CD与弥漫性而非局限性SSc的关联可能提示这两个亚组具有不同的免疫致病机制。对于年轻患者的pSS和弥漫性SSc，尤其是在诊断时，可考虑进行CD筛查。
